Musculoskeletal Oncology Center Offers Multi-Disciplinary Approach

The Medical College of Wisconsin Musculoskeletal Oncology Center is dedicated to the surgical management of a wide range of bone and soft tissue disorders. The Center provides patients with evaluation, diagnosis, and treatment of benign, malignant and metastatic disease affecting the bones, muscles, tendons, and joints in both adults and children.

Patients benefit from a multi-disciplinary approach provided by surgeons as well as staff from Adult and Pediatric Oncology Services and Radiation Oncology Services. "Our focus is on saving limbs," said David M. King, MD, orthopaedic surgeon and Assistant Professor of Orthopaedic Surgery at the Medical College. "We have specialists here that you are not likely to find in another facility in this region. In fact, it's rare to find two physicians in one place that are dedicated to this specialty."

Orthopaedic surgeon Donald A. Hackbarth, Jr., MD, is Dr. King's colleague in treating musculoskeletal oncology patients in the Center. Dr. Hackbarth is an Associate Professor of Orthopaedic Surgery at the Medical College.

Other experts are also available to meet with patients who come to the Center. "We take an integrated approach to our patients' care. We will facilitate patients' needs to see other professionals if necessary," Dr. King said. For those undergoing amputation or limb salvage, emotional and psychological support is available from the clinical psychologists affiliated with the department, as well as from other patients who have had similar conditions. Individuals are also available to help facilitate school and work issues.

Unusual Tumors
Musculoskeletal tumors are relatively rare, according to Dr. King. The National Cancer Institute reported 8,300 annual cases of soft tissue sarcoma in the entire US in 2002. (Sarcomas are cancers arising from connective or supporting tissues, such as bone or muscle.)

Because they are so rare, musculoskeletal tumors are challenging to diagnose and treat. As a result, patients with such tumors are best evaluated at a place with an active orthopaedic oncology service, making the Musculoskeletal Oncology Center a highly desirable treatment site.

Diagnosis and Treatment
Waiting for a diagnosis can often be one of the most difficult things a patient can endure, so every effort is made to obtain a diagnosis as soon as possible. CT scanning, magnetic resonance imaging, and nuclear medicine facilities are excellent. A strong relationship with the radiology and nuclear medicine departments facilitates scheduling of studies, which often are coordinated so that they can all be accomplished in one day.

Biopsies are evaluated quickly and accurately by the pathology department, reducing unnecessary delays in treatment. "We have mastered some techniques that expedite diagnosis by biopsy so patients don't have to wait for prolonged periods of time. We may have a diagnosis by the following day," Dr. King says.

Malignant bone tumors are usually treated with a combination of pre-operative chemotherapy, surgery and postoperative chemotherapy. Malignant soft tissue tumors are typically treated with a combination of chemotherapy, radiation therapy, and surgery. Many variations of treatment exist and must be tailored for each patient, taking into consideration the location of the tumor and the desires of the individual.

"In the past, many of these patients would be facing the loss of a limb. Now, it is more possible than ever that we can reconstruct a limb. We are improving our techniques all the time," noted Dr. King. "Treatment may include the use of allografts - bone grafts from a donor - as well as custom prosthetic reconstruction. We use special oncologic prostheses to salvage and reconstruct bones that need to be removed because of tumors. We have recently started using expanding prostheses in children that keep up with their growth. For patients with amputations, some of the newest prostheses use computers to assist with their gait. Things are constantly evolving," he explained.

Treatment does not end after surgery, however. The Musculoskeletal Oncology Center also provides comprehensive follow-up care including rehabilitation, and detection and comprehensive treatment of tumor recurrence or metastatic disease.

Main Referral Site
Hundreds of patients come to the Center each year. "We see a number of patients from as far away as the Upper Peninsula of Michigan and the Chicago area," said Dr. King. "Patients are typically referred from their primary care physician or orthopaedic surgeon because they need specialized care for some kind of soft tissue mass or bone tumor," said Dr. King. He notes that while the vast majority of tumors are benign, probably half of the patients he sees have malignancies. "These are patients who have serious needs," he said. About one-third of the patients he sees are children.

The number of patients being treated at the Center has been increasing in recent years. "We try to see patients within one week whenever possible. We hope to add another physician to our ranks so we can begin doing more research and improve patient outcomes. That is our next goal," said Dr. King.

The team reviews each case at a weekly sarcoma conference at either Froedtert or Children's Hospital. They discuss preoperative and postoperative cases and evaluate the pathology, radiology and clinical course of patients, formulating a comprehensive treatment plan once the patient has been diagnosed and the stage of the tumor determined. "We want to ensure that they return to a healthy, functional life as soon as possible," Dr. King says.

JoAnn Petaschnick
HealthLink Contributing Writer

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.