Posts Tagged ‘bone cancer’

Chondrosarcoma Patient Story: “I can now walk unaided and enjoy time with my family.”

skiiing patient storyI noticed something was “not right” with my right leg when I couldn’t sit crisscross-applesauce-style on the floor during my daughter’s music class. The tendon near my groin area was very tight and sore. Pilates exercises were difficult to complete and my left leg responded better than my right during daily activities. At the time, I thought maybe the pain was a sign of aging and simply that I needed more exercise and stretching. I continued to go about my daily life, living with pain that was sporadic and more of an ache at that point.

In March 2009, I was on a spring break skiing trip with my family when I noticed my leg felt “wobbly” during the downhill runs. I couldn’t control my right leg well and immediately knew something was wrong, so I stopped skiing. The next day, we went horseback riding and as I swung my leg up and around to get on the horse, there was a sharp stabbing pain at the top of my thigh. That was my big “ah-ha” moment. I knew that once I returned home I needed to seek medical attention, especially since the bursts of pain continued on and off throughout the rest of my trip. When I got home, I visited my primary care doctor who ordered X-rays, MRI and bone scan. After reviewing my results, my primary care doctor referred me to Dr. David Monson, an orthopaedic oncology surgeon at the Emory Orthopaedics & Spine Center in Atlanta, GA. Dr. Monson met with me and explained I had Chondrosarcoma of the hip, which is a rare type of cancerous bone tumor.

Getting the news that it was cancer was startling and left me feeling quite shocked, especially after thinking the pain was just something having to do with the typical aging process. I was expecting them to find arthritis, not cancer. What made me most nervous was the type of cancer I had and its location in my hip. During the first visit with Dr. Monson that day, he walked me and my family through the different treatment options and then recommended I take some time to compare options. Like most people would, I went straight to the internet and began researching my cancer and different options. What I found scared me – up until five years ago, most tumors of the pelvis were surgically treated through amputation. This made me extremely anxious. I didn’t want to lose my leg.

During this tough decision-making process, Dr. Monson made me feel comfortable and at peace. He was extremely knowledgeable, very caring and direct. After reviewing my options with Dr. Monson, I felt sure he was the guy to do my surgery, so I made my decision and moved forward. Andre Roy, Dr. Monson’s Nurse Practitioner, was available any time I called and provided answers to my multitude of questions. I felt very cared for and looked after at Emory, and I was impressed with the office staff every time I came in for an appointment.

In the end, we decided that during the surgery to remove my tumor, we would reconstruct my hip using a saddle prosthesis. I was pleased that Dr. Monson knew how to perform this procedure comforted that is one of the few doctors that knows how to place such a prosthetic.

Following my surgery in November of 2009, I went through extensive physical therapy. Today I am walking really well and keeping up with my active teenage daughter. My range of motion is limited so minor adjustments have been made in my daily life to stay safe and comfortable. I’m thankful to be able to do all the things that I can do now, and continue enjoying life!

A note from Dr. David Monson

Bone tumors of the pelvis are uncommon and their surgical management depends on multiple factors, including tumor size, location and whether the tumor is benign (noncancerous) or malignant (cancerous). These factors determine whether a limb-saving surgery is possible or not and if the losses associated with surgery may result in a non-functioning extremity.

Three main factors to consider with pelvis surgery relate to stability of the hip after surgery, and function of the sciatic and femoral nerves. A minimum of two out of three must remain intact for the lower limb to be worth saving. Fortunately for Mrs. Powers, both her sciatic and femoral nerves were able to be preserved and we were able to restore stability of her right hip with a saddle prosthesis.

Options for reconstruction of the hip joint after removal of pelvic bone tumors may include prosthesis such as a saddle, a cadaveric bone transplant (allograft) or sometimes no reconstruction at all. Each has its own set of advantages and disadvantages which makes selecting the right treatment for each individual patient unique based upon the factors above.

At Emory Orthopaedics & Spine Center, our goal is to always offer patients with what we expect to be the most functional, yet durable surgical reconstruction possible without compromising the long term likelihood of cure. These surgeries are often quite complex and can take as long as 6-8 hours or longer. Complications can occur and the recovery time after surgery takes anywhere from six months to a year. We want patients to be fully educated before heading into a surgery this complex.

Mrs. Powers has worked extremely hard with her physiotherapy and has achieved an excellent functional outcome. We are incredibly proud of her and most grateful that there has been no recurrence of her tumor!


What is an Osteosarcoma and What is the Best Way to Treat it?

Bone and soft tissue sarcomas are rare conditions that affect approximately 13,000 people each year. In the US, 10,000 are diagnosed with soft tissue sarcomas and approximately 3,000 are diagnosed with bone sarcomas, of which 1,000 are osteosarcomas.

The most common type of sarcoma that develops in the bone is called an osteosarcoma while sarcomas that develop in the connective tissue are called soft tissue sarcomas. Soft tissue sarcomas can develop in soft tissues like fat, muscle, nerves, fibrous tissues, blood vessels, or deep skin tissues. The rarity of sarcomas means most doctors seldom see one, which explains why patients are often referred to specialty hospitals where experienced surgeons utilize limb-sparing (no amputation) surgery whenever possible.

Understanding Osteosarcomas

Osteosarcomas are aggressive malignant bone tumors and are the most common type of bone cancer in young people. They usually occur between the ages of 10 and 25, but can occur at any age and are more common in males than females. They encompass about 20% of all primary bone cancers and it is estimated that the incidence rate in U.S. patients under 20 years of age is 5 per million. Osteosarcomas most commonly start in the ends of long bones of the arms or legs where new bone tissue rapidly forms.

Symptoms of Osteosarcoma

  • Pain near the affected bone is the most common osteosarcoma symptom
  • Swelling of the bones and joints. Noticeable swelling or protrusion near the location of the tumor
  • Brittleness/weakness of the bone which can lead to fractures
  • Difficulty moving during physical activity
  • Noticeable limp when the osteosarcoma is in the leg

Treatment for Osteosarcoma

Typically chemotherapy is given to shrink the tumor before surgery. Most often, chemotherapy results in a necrosis (or death) of the tumor and allows the physician to treat possible cells in the blood stream. In most cases, surgery is required to remove the section of cancerous bone. Limb sparing surgery (LSS) is a special operative procedure performed by oncology orthopedic surgeons and has become the accepted standard of care for patients with sarcomas of the extremities. Limb sparing surgery can be accomplished in approximately 90% of the cases. During limb sparing surgery, the cancer in the bone is removed surgically and the portion of the bone that was removed is either replaced with special metal prostheses or a bone allograft. An allograft is a bone transplant obtained sterilely from a person that has died and agreed to be an organ donor. Emory Orthopaedic surgeons have mastered the limb-sparing surgery in order to save as much bone as possible without compromising the ability to cure the patient.

Emory offers a unique multi – disciplinary treatment approach to bone sarcoma care. Emory Orthopaedic oncology surgeons collaborate with medical oncologists, radiation oncologists, pathologist, radiologists, thoracic surgeons, plastic surgeons and vascular surgeons to develop a treatment plan catered to each individual patient.

Dr. David MonsonAbout Dr. Monson
David K. Monson, MD, assistant professor of Orthopaedic Surgery and Chief of Orthopaedic Surgery at Emory University Hospital Midtown, started practicing at Emory in 1988. Dr. Monson is an expert in the treatment of rare tumors (sarcomas of the bone and soft tissue). Dr. Monson’s specialties are Orthopaedic Surgery (Board certified since 1990) and Orthopaedic Oncology. His areas of clinical interest are orthopaedic tumors, sarcoma, and limb reconstruction.


Dr. Shervin OskoueiAbout Dr. Oskouei
Shervin V. Oskouei, MD, assistant professor of Orthopaedic Surgery at Emory University, is an expert in the treatment of musculoskeletal (extremity) tumors, total hip and total knee replacements and revisions. Dr. Oskouei started practicing at Emory in 2004. Dr. Oskouei is board-certified and fellowship trained in orthopaedic surgery. Combining his experience and interests with the state-of-the-art facilities of Emory University and the Winship Cancer Institute of Emory University allows Dr. Oskouei to treat patients with the latest modalities using a multi-disciplinary approach.

About Emory Orthopaedic Oncology
Dr. Monson and Dr. Oskouei lead the Emory Musculoskeletal Oncology and Limb Reconstruction program at Emory. The world – class program treats a variety of conditions, including benign and malignant tumors of the extremities and spine, as well as metastatic disease. Together, they offer a combined 34 years of clinical practice experience. They care for both pediatric and adult aged patients.

Both of these physicians belong to the Musculoskeletal Tumor Society which requires fellowship training in orthopaedic oncology. Physicians belonging to this group must also have a primary clinical focus in orthopaedic oncology. This is important for patients because it means the specialist you are seeing has had extra training in this area and is viewed by peers as an expert in the care of orthopaedic oncology. Patients should take the time to research physicians in their area to determine if they are seeing an orthopaedic oncology specialist that belongs to this organization.

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