Orthopaedic Oncology: Demanding, Challenging and Rewarding
Abstract: Complicated, cancerous orthopaedic tumors pose challenges that demand expertly delivered biopsies, extensive pre-operative planning and a host of multidisciplinary support. Sarcomas are treated on a daily basis at Wake Forest University Baptist Medical Center, which now has two full-time orthopaedic oncologists.
From Clinical Update, Spring 2007
In a community hospital, sarcoma cases are rarely encountered. At Wake Forest University Baptist Medical Center, western North Carolina’s only academic medical center, these highly variable and generally uncommon tumors are treated on a daily basis. The case load build-up has been so extensive that a second full-time orthopaedic oncologist, Scott Wilson, M.D., joined the faculty within the past year to complement the services of William G. Ward, M.D., professor of orthopaedics and director of orthopaedic oncology and adult reconstruction. Ward began the orthopaedic oncology service at Wake Forest Baptist more than 16 years ago and last year served as president of the North American Musculoskeletal Tumor Society.
These unusual and complicated tumors demand specialized surgical resections to achieve optimal outcomes and often require reconstructive procedures rarely performed outside of major tertiary care referral centers.
Surgeries may include the use of novel massive endoprostheses (artificial bone replacements), massive allografts (cadaveric bone transplants), muscle and vascularized free tissue transfers and a wealth of other surgical options provided by the close interdisciplinary collaborations between the orthopaedic oncologists, general surgical oncologists, plastic surgeons, and their colleagues in hematology/oncology and radiation oncology.
Close working relationships and collaborations with the pathologists and the radiologists allow for optimization of preoperative imaging, biopsy techniques and postoperative surveillance.
Many patients can be accurately diagnosed and under treatment within days of the first visit through the use of percutaneous needle biopsies, obviating the need for more extensive surgical biopsies that may spread the tumor cells prior to their definitive resections.
These procedures, including even so-called “simple biopsies” are best done by or under the supervision of the experienced operating surgeon who will be performing the definitive resection, as incorrect placement of a biopsy incision, or inadvertent tumor contamination by an ill-planned surgical biopsy, can convert the patient from a life-saving or a limb-salvage patient into an amputation, leaving the patient with a poorer prognosis.
Recent research performed by Ward and his staff confirms that a tumor is three times more likely to recur after definitive resection here, if it has had any sort of surgical procedure performed prior to referral to Wake Forest Baptist. Proper preoperative planning by experienced surgeons is key to optimal resection of sarcomas.
The team also treats people with incurable cancers, in whom their cancer has spread to their bones, causing them to have pain, fractures and inability to walk. Over 90 percent of such patients can have their bones reconstructed in such a way as to relieve pain, restore function and allow them to resume meaningful lives with whatever time they have left.
“Orthopaedic oncology is a very trying and challenging field, but it is unbelievably rewarding. Most people dream of having one opportunity to save a person’s life or their limb. I am blessed with the opportunity to do both of these on a frequent basis,” said Ward. “I can think of no greater rewards in life than those that I get from these opportunities.”