Treatment of Bone and Extremity Tumours at John Hunter Children's Hospital

Tumours in the musculoskeletal system occur in:

• Bone
• Cartilage
• Muscle
• Fat
• Surrounding soft tissues

Children often present to the doctor with unexplained hard lumps in their arms and legs. The majority of these tumours are benign. Any unexplained lump should be considered as potentially troublesome and should be checked out by your child's general practitioner. Especially if this lump is painful. Lumps that don't go away are called tumours. A tumour may be benign or malignant.

Benign Tumour

A tumour that is not cancer. It cannot spread to other parts of the body. Most benign tumours can be removed and usually will not return. Some benign tumours can be aggressive and destroy nearby structures, such as bone and muscle, without spreading. These tumours are not usually a threat to life. Benign bone tumours occur most frequently in the first 30 years of life.

Example:

Exostosis - an extra piece of bone growing near the end of a long bone such as the femur (thigh bone) or tibia (shin bone).

Malignant Tumour

A tumour that is cancer. It can invade and damage tissues and cells by spreading throughout the body. Malignant tumours associated with the musculoskeletal system are called sarcomas.

Sarcomas

A sarcoma is a malignant tumour that begins in the musculoskeletal system. The part of the musculoskeletal system the cancer originates from provides the name of the cancer:

• Chondrosarcoma - cartilage
• Osteosarcoma - bone
• Liposarcoma - fat
• Rhabdomyosarcoma - muscle

Example:

Ewing's sarcoma - a malignant bone tumour that occurs more frequently in males. It occurs in the 10-20 year age group. It can be sometimes confused with a bone infection.

Osteosarcoma - a malignant bone tumour that occurs more frequently in male adolescents. 50% of the patients have the tumour in their knee area.

 

Staging System for Musculoskeletal Tumours

If your child has been diagnosed with a sarcoma, they will be referred to an Oncologist (cancer doctor) at John Hunter Children's Hospital. The Oncologist will decide on the best treatment for your child. The treatment is dependent on the stage of the cancer. This is decided by looking at the:

• The grade of the cancer
• The extent of the cancer at the site of origin
• If the cancer has spread to other body parts

If the sarcoma is complex, your child may need to go to see a tumour specialist in Sydney for removal of the tumour. The cancer treatment can still be completed in Newcastle.

Any child who has:

• An unexplained growth or mass
• A deep mass that feels quite firm and unmovable
• Has pain that continues at night and is not relieved by rest

Should have the tumour checked out by their family doctor.

Tests

Patients with musculoskeletal tumours often have several types of scans or tests to assist the doctors in diagnosis and treatment. These can include:

• Plain x-ray
• CT scan
• MRI scan
• Bone scan
• Angiography
• PET scan
• Blood tests
• Biopsy