Posts Tagged ‘osteosarcoma’

Emory Bone Cancer Patient Story: “I have full motion in my arm again!”

ms k11-27 2msk 11-27It happened so quickly. One day I was working out and noticed a bulge in my left shoulder but I didn’t think much of it, in fact, I thought maybe my muscles were growing! But my concern grew as the lump got larger. I made a random visit to the chiropractor and during the visit he moved my right arm across my body. When he went to move my left arm across my body, it was impossible; motion of my left arm was completely restricted. The chiropractor knew something was not right and referred me to a primary care physician for an X-ray. I was scared and didn’t want to face reality that this inability to move my arm could be something serious. I wasn’t in pain – the ball on my shoulder wasn’t bothering me or affecting my life – but it was critical that I figure out what it was.

On September 5, 2013, the news was broken to me that I had a tumor in my left shoulder. It was on that day that I was diagnosed with Osteosarcoma, the most common type of bone cancer. This cancer begins in the bone compared to other cancers that begin somewhere else in the body and spread to bone. Immediately my parents started making calls, knocking on neighbors’ doors and doing research in hopes of finding the best doctor and treatment in the area for my diagnosis. My parents were told that an oncology surgeon, Dr. David Monson at Emory Orthopedics & Spine Center in Atlanta, GA, was the best in the business. That’s when I knew I was going to be in good hands. Dr. Monson’s exceptional reputation was my definition of a rock star surgeon!

The first step in this treatment journey was to make an appointment for an MRI, CT scan and biopsy. Before the tests, my medical oncology team prepped me that chemotherapy and radiation would mostly likely be needed for the next 6 months of my life. Thankfully, the MRI and CT scan showed the cancer had not spread to anywhere else in my body. Then the biopsy results came in and revealed that the bulge was a low grade tumor, which meant no chemotherapy or radiation was needed, rather surgery and physical therapy.

I was informed that the surgery would be to remove six inches of bone from my arm and replace it with a cadaver. I was relieved and extremely grateful that this treatment option wouldn’t turn my whole life upside down, but there were still concerns. I didn’t know if I would ever get back full motion in my arm or be able to get my arm over my head again. I didn’t know if I would look the same after surgery with this “new” arm.

Less than twenty days from the date of my diagnosis, on September 23, 2013, I had surgery. I remained hospitalized for three days following the surgery and then began my healing journey. I couldn’t return to work for four weeks and went through six months of physical therapy. I am incredibly lucky to have a support group of family and friends that surrounded me and picked me up when I was down.  They took care of me and gave me the love and support I needed to get through what could have been a devastating time.  My parents stayed with me overnight while I was in the hospital, I even stayed with my sister and brother in law for a week after surgery and my sister filled the room I stayed in with all of the flowers I received.  I am extremely grateful to have every one of them in my life. The team at Emory made my journey to recovery seamless. I especially loved my physical therapist. Her excitement every session made me excited! She looked at my circumstances as a challenge, but together we pushed through. In fact, because my recovery went so well – something she had never seen with my type of surgery before – she ended up using it as a case study.

Today, my life is mostly back to normal. I have full motion in my left arm again, but my arm is still restricted when it comes to putting weight on it. It is going to take some time for the new bone to fully fuse with my natural bone, so right now I cannot hold more than five pounds with my left hand. I am aware and mindful of the activity and stress I place on my new arm, but I do not want to do anything that could potentially damage it, but thankfully I am able to work out regularly and both my work and social life are as normal as they can be!

A Note From Dr. Monson
Ms. Peterson was fortunate in that her osteosarcoma was low grade and required surgery alone for resection and reconstruction. There was no need for chemotherapy as there is in high grade osteosarcomas. There are only about 50 of these tumor types diagnosed a year in the entire United States. Our goal was to provide Ms. Peterson with as functional a reconstruction as possible and thus we chose to do so with a cadaver bone transplant of the proximal humerus where we could perform a direct rotator cuff repair. Repair of the shaft of the cadaver to the patient’s own remaining humerus bone distally was performed with plates and screws, much like that performed in fracture repair surgery. Reconstruction with an artificial prosthesis is actually an easier procedure technically; however the inability to reestablish reliable rotator cuff function often leads to lesser function of the shoulder. Although no reconstruction option can be declared a permanent solution, the use of the cadaver transplant burns no bridges and keeps options open for Ms. Peterson should she require more surgery in the future. She has excelled with her physical therapy and her full restoration of motion reflects strongly on her will and determination.

About Dr. Monson

monson-david-kDavid Monson, MD, and his partners at Emory Orthopaedics & Spine Center have the ONLY multidisciplinary musculoskeletal oncology service in Georgia that serves both children and adults. His focus is on rare tumors, sarcomas of the bone (2,500 cases a year in the U.S.) and soft tissue (10,000 cases a year in the U.S.) as well as other uncommon benign bone and soft tissue tumors. He also treats metastatic disease to the bone from other primary malignancies and often performs complex reconstructive procedures for these disorders not available in the community. The efforts of his practice also extend to complex skeletal reconstructions that may arise from failed orthopaedic procedures performed elsewhere.

He is only one of two fellowship-trained orthopaedic oncologists in the state of Georgia (the other is his partner, Dr. Shervin Oskouei) that concentrates his practice within his subspecialty. He also performs total hip and total knee replacements, specifically more difficult primary replacements or revisions that may require the skills developed within his practice of musculoskeletal oncology.

Understanding Rotationplasty – Alternative to Limb Sparing Surgery

Rotationplasty Child Limb Sparing Surgery AlternativeRotationplasty is a surgical option for young children who have been diagnosed with a variety of malignant or benign conditions. Rotationplasty is most commonly used as a treatment option for osteosarcoma or Ewing’s sarcoma in the distal femur or proximal tibia. This procedure can also be used in the proximal femur for rotationplasty in the hip, but this is much less common than the knee.

In rotationplasty, the bone cancer and surrounding tissues are removed and the remaining lower section of the leg is rotated before reattaching to the healthy upper section.  Rotationplasty is typically recommended when a portion of the limb is injured or diseased.

During the leg rotationplasty procedure, the ankle becomes the knee joint.  A prosthesis is built that allows the foot and ankle to function as the patient’s knee.  This prosthesis is different than a typical prosthetic device since it requires consideration of an anatomical ankle to act as the knee.  The ankle (new knee) requires structural support so that the patient does not overextend the ankle.  Prosthetic fit and function are very critical and should only be performed by a skilled prosthetist.

Patients who undergo rotationplasty as a surgical option for treatment require intensive physical therapy to gain motion and strength in the reconstructed limb. A physical therapist and prosthetist who are skilled in this specific design/procedure should work very closely with the patient’s orthopedic surgeon to guide the exercise program and prosthetic fitting.

Other surgical options for young patients with sarcomas such as osteosarcoma or Ewing’s sarcoma are:

When making the decision whether to receive rotationplasty versus the other treatment options, parents should take into consideration the age of the child, the location and size of the cancer, medical diagnosis and prognosis as well as the “functional outcomes” that the parents/child/physician agree on.

Rotationplasty is a good option for young patients who have not finished growing and have a malignant bone tumor around the knee joint.  Because their legs have not grown completely, the leg length difference will not be as great.  Also, the young patient will be able to run and jump and keep up with their friends and classmates.  The patient can participate in most sports even those with jumping and high impact.  Because the ankle joint is a natural joint functioning as the “new knee,” the patient has greater control of the “knee” with sensation of how it is moving as well as the position of the knee as the patient walks and runs.

At Emory Orthopaedics & Spine, we work closely with the resources at Children’s Healthcare of Atlanta’s Aflac Cancer and Blood Disorders Center, one of the largest childhood cancer programs in the country. Our continuum of care features pediatric experts in orthopedic surgery, radiation oncology, social work, case management, physical therapy and prosthetics.

Related Resources:

About the Experts

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.

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.

Related Resources: