What to Bring:
On your fist visit to the University of Iowa, there are a few things that you can bring to make your visit as efficient as possible.
- Imaging: It is important to bring a comprehensive CD of the most recent imaging studies. Occasionally, your local doctor will have this sent prior but it is often most effective to hand carry these disks. If there is any question about what studies are necessary to bring, please call our office in advance of your appointment.
- Paper Reports: If you have any imaging studies, previous surgeries, or tissue biopsies, it is helpful to have your local doctor send these reports or to bring them with you.
- Past Medical History: Knowing your past medical history and list of current medications is helpful in providing our physicians you’re your most accurate health status.
- Friend or Family member: It is often helpful to bring someone with you on your visit to help absorb the information and ask any potential questions.
What to Expect:
At your first meeting, the orthopaedic oncologist will discuss a list of potential diagnoses and begin to formulate treatment options. On the same day as your visit, it may be necessary to complete further imaging studies, undergo an image guided biopsy, or determine a date to come back for follow up imaging studies, surgery, or subsequent office visits. Surgery will not be done on the same day as your visit. It is possible that surgery may be scheduled within days of your visit depending on the character of the tumor.
How Diagnoses are made:
Because of the rarity and variety of presentations of musculoskeletal tumors, obtaining definitive diagnosis can be a time consuming process requiring multiple steps. This can be done in a number of ways:
- Imaging: Sometimes, additional radiologic studies are needed to further determine the character and extent of the lesion. Types of imaging that may be completed are as follows:
- CT (computed tomography): this scan is a rapid test that uses x-rays to create cross-sectional pictures of the body. CT scans are also used to look for disease elsewhere in the body such as in the chest, abdomen, and pelvis and contrast dye will be administered by drinking a liquid and by an IV in your arm. It can also be used to guide a radiologist or surgeon to the right area during a biopsy.
- MRI (magnetic resonance imaging): this scan uses magnets and radio waves to produce images instead of using ionizing radiation like a CT. Contrast dye is given before the test through a vein in your forearm to help see soft tissues more clearly. The test may take an hour or longer and you will be asked to remove all metal from your body. You may not be able to have an MRI if you have certain metallic objects in your body (like a pacemaker).
- Bone Scan: this test shows areas of increased bone turnover and is used to find skeletal abnormalities. It can show benign and malignant bone tumors, arthritis, fractures, infection, or other metabolic bone disorders. Radioactive material will be injected into a vein and images may be taken right away and again 3-4 hours later.
- PET (positron emission tomography): this scan produces 3D images and shows how organs and tissues are working and is used to look for disease elsewhere in the body. A radioactive
- Skeletal Survey: this consists of taking regular x-rays of every bone in the body. It is used to look for bone abnormalities elsewhere in the body. It may take up to an hour.
- Incisional or Needle Biopsy: A biopsy is a small piece of tissue taken from the bone or soft tissue in order to make a diagnosis. This is done to determine the best course of treatment. Sometimes surgery to resect the tumor is not initially indicated because chemotherapy or radiation is needed first. This procedure is done in the operating room or a radiology suite. Occasionally, sedation or general anesthesia is required. The pathologists at the University of Iowa will then look at the tumor under the microscope to determine a diagnosis; this process can take up to one week. Sometimes, a repeat biopsy is needed in order to acquire more tissue.
- Image Guided Biopsy: Depending on the location of the tumor, imaging is needed to guide the radiologist or surgeon to the site of the tumor during a biopsy. If the radiologists complete the biopsy, this procedure is done in a radiology suite and the patient is often awake or partially sedated.
- Excision or Resection: At times, a total resection of the tumor is indicated before a diagnosis is made. This procedure will take place in the operating room under general anesthesia or a regional nerve block. The definite diagnosis will be made after the radiologists have looked at the tumor cells under the microscope and occasionally further treatment is needed with chemotherapy, radiation, or another surgery.
Types of Diagnosis
- Bone Tumors
- Aneurysmal bone cyst: These tumors arise without any known cause. It is thought to be a reactive lesion that may be caused by a vascular malformation or injury. If surgery is indicated, it can be treated by scrapping out the lesion and replacing it with bone graft. Sometimes, fragile bone must be augmented with plates, screws or rods.
- Unicameral bone cyst: these lesions are most active during skeletal growth and often heal spontaneously at maturity. Many times they are without symptoms until the bone actually breaks through the cyst. If a fracture occurs, the cyst occasionally heals without surgical intervention. However, sometimes it is necessary to place bone graft in the cyst to aid in healing and prevent future breaks.
- Enchondroma – link: http://orthoinfo.aaos.org/topic.cfm?topic=A00085
- Chondroblastoma: this is a rare, benign tumor found in long bones usually in the lower extremity. The diagnosis can be made by x-ray; sometimes a CT or MRI is indicated. Treatment consists of scrapping out the bone and possible reconstruction.
- Chondromyxoid fibroma: this is a benign lesion of cartilage origin. It most often occurs in the lower leg and can often be diagnosed by x-ray. It can be treated with surgery.
- Giant cell tumor – link: http://orthoinfo.aaos.org/topic.cfm?topic=A00080
- Osteoblastoma: this is a benign bone lesion that may grow over time. It resembles a number of other benign lesions on x-ray and is usually addressed surgically.
- Osteoid Osteoma - link: http://orthoinfo.aaos.org/topic.cfm?topic=A00507
- Fibrous Dysplasia – link: http://orthoinfo.aaos.org/topic.cfm?topic=A00083
- Nonossifying fibroma: these are common developmental abnormalities that occur in 35% of children and are often found incidentally. They are diagnosed by x-ray and observed over time. No treatment is considered unless the lesion becomes symptomatic.
- Osteochondroma – link: http://orthoinfo.aaos.org/topic.cfm?topic=A00079
- Chondrosarcoma: these tumors can occur in any location; however they are most commonly located in the pelvis, femur, tibia, and humerus. These often can be diagnosed with an x-ray, but a CT or MRI may be helpful. These tumors are treated by surgical removal.
- Ewing sarcoma – link: http://orthoinfo.aaos.org/topic.cfm?topic=A00082
- Osteosarcoma – link: http://www.boneandcancerfoundation.org/pdfs/Osteosarcoma-2.pdf
- Multiple Myeloma – link: http://orthoinfo.aaos.org/topic.cfm?topic=A00086
- Current and Future Treatment: http://www.boneandcancerfoundation.org/pdfs/myeloma-booklet.pdf
- Metastatic Bone Disease – link: http://orthoinfo.aaos.org/topic.cfm?topic=A00093
- Soft Tissue Tumors
- Lipoma: these tumors are slow growing deposits of fat cells. It is common to have more than one and they occasionally run in families. If the tumors begin to grow abnormally fast or become large they may need to be removed. They can also be removed for cosmetic reasons.
- Pigmented Villonodular Synovitis – link: http://orthoinfo.aaos.org/topic.cfm?topic=A00506
- Desmoid Tumors – link: http://orthoinfo.aaos.org/topic.cfm?topic=A00505
- Soft Tissue Sarcomas: http://orthoinfo.aaos.org/topic.cfm?topic=A00508
- Malignant fibrous histiocytoma
- Synovial cell sarcoma
- Clear cell sarcoma
There are both surgical and non-surgical approaches to musculoskeletal oncological diagnoses. The orthopaedic surgeons at the University of Iowa combine years of experience with the most recent techniques for treatment for bone and soft issue tumors. Often, both non-surgical and surgical treatment is indicated.
- Surgery: Here at the University of Iowa, our orthopaedic oncologists use the most modern surgical techniques to allow for limb salvage. Implants, bone transplants, and bone graft substitutes are some ways that the surgeons in the Department of Orthopaedics restore the limb to adequate function after a tumor resection. There are some cases where amputation is necessary and can sometimes be an advantage over limb salvage. In either case, the patient will play a vital role in the decision making process about their surgical and treatment options.
- Chemotherapy: Adjuvant, or “assisted’ chemotherapy is used for some bone sarcomas. It can allow for limb salvage and a safer surgical removal of the tumor. Chemotherapy is the use of medications to kill cancer cells which can be administered by pills, injections, or through IVs. The drugs travel through the bloodstream to the entire body to deliver body-wide treatment. These medications can be used to get rid of cancer cells or keep cancer from spreading. It is most often given in cycles which can last days, a week, or more. There are rest periods in between which can last days, weeks, or months.
- Radiation Therapy: this treatment uses high powered x-rays and particles to kill cancer cells. This may be used to shrink a tumor before surgery or it may be given after surgery to prevent a cancer from recurring.
- Physical Therapy and Other Rehabilitation Therapies for Patients with Cancer and Bone Involvement – link: http://www.boneandcancerfoundation.org/pdfs/RehabPublicationFinal-2010.pdf
- Surgical Management of Cancer that Spreads to the Bone – link: http://www.boneandcancerfoundation.org/pdfs/surgical%20_management_of_cancer-2.pdf
Other Useful Links
- American Academy of Orthopaedic Surgeons – Your Orthopaedic Connection – www.orthoinfo.org
- Orthopaedic Research and Education Foundation – www.oref.org
- National Cancer Institute – www.nci.nih.gov
- American Cancer Society – http://www.cancer.org
- Association of Cancer Online Resources - http://www.acor.org/
- American Academy of Orthopaedic Surgeons - http://www.aaos.org/
- The Journal of Bone and Joint Surgery - http://www.jbjs.org/
- National Institutes of Health - http://www.nih.gov
- Connective Tissue Oncology Society - http://www.ctos.org/
- Hemi-Pelvectomy and Hip Disarticulation Support Page - http://www.hphdhelp.org/
Soft Tissue Sarcomas
- Desmoid Tumor Research Foundation – http://www.dtrf.org
- The Electronic Sarcoma Update Newsletter - http://sarcomahelp.org/esun.html
- GIST Cancer Awareness Foundation - http://www.gistawareness.org/
- The GIST Cancer Research Fund - http://www.gistinfo.org/
- GIST Support International - http://www.gistsupport.org/
- Leiomyosarcoma Direct Research Foundation - http://www.lmsdr.org/index.php
- Northwest Sarcoma Foundation - http://www.nwsarcoma.org/index.php
- Sarcoma Alliance - http://www.sarcomaalliance.org/main.shtml
- Sarcoma Foundation of America - http://www.curesarcoma.org/
- Rare Bone Disease Patient Network - http://www.usbjd.org/projects/RBDPN_op.cfm?CFID=3523937&CFTOKEN=79691222
- Bone and Cancer Foundation http://www.boneandcancerfoundation.org/