Musculoskeletal Oncology Overview


Hi, my name is Douglas McDonald. I'm one of the Orthopedic Surgeons at Washington University Barnes Hospital. I treat patients with musculoskeletal oncology problems. I see patients at Barnes Hospital as well as St. Louis Children's Hospital and I also see patients at Shriner's Hospital for Children. We see patients that have both benign and malignant tumors of bone and soft tissue. The malignant tumors are cancerous and they can occur in adults and children. The soft tissue tumors are also seen in both adults and children and can be cancerous tumors as well as benign tumors.

Musculoskeletal oncology is a unique subspecialty within orthopedics for a number of reasons. One, it's fairly rare so there are not many centers around the country that have enough patient volume that can actually have a practice in this specialty. Malignant bone tumors for example are less than 1% of all the malignancies in the body so they're much less common than most of the things that you hear about in terms of orthopedic surgery and orthopedic problems. It's also somewhat unique that we deal with these problems all throughout the body. Many of the subspecialties within orthopedics focus on a certain anatomical area or a certain problem but we have to deal with problems throughout the body and all the extremities as well as the spine. We also deal with patients as adults and children, so there's a broad age spectrum within these patients.

We're a part of the Siteman Cancer Center as tumor surgeons. The Siteman Cancer Center has multi-specialty involvement from numerous specialties to develop the institution, and our involvement is that in taking care of the patients with musculoskeletal oncology problems so in a sense, we are a part of Siteman even though I'm specifically a part of the department of orthopedic surgery.

We have a number of techniques that are available to us to not only remove the tumor but to helpfully preserve patients' limbs and maximize their functional result. For example, one of the techniques that we have in removing a large segment of bone that might be involved with cancer is to replace that segment and the joint with an artificial prosthesis. These are metallic prosthesis. They, depending on the joint, have a section that is used to restore the length of the bone but also parts that are used to restore the joint itself.

Other techniques that we have available are to use bone grafts. These can be large fragments of bone that are allografts and these are bones that are harvested from cadavers just like hearts and kidneys and lungs are harvested. The lung bones can be harvested too and we can utilize these in restoring skeletal defects.

Another technique that we have available to us is to occasionally use the patient's own bone. For example, in conjunction with our hand surgery section and our microvascular surgery section, we can harvest segments of the fibula. That's a smaller bone in the lower leg and transport that to the various different parts of the body along with the blood supply so we're transferring a vascularized piece of bone. This is particularly effective in the upper extremity and we've used it effectively in some of the children to actually restore not only a segment of bone but also a growth plate. We have a tremendous advantage and opportunity to take care of patients that have these life-threatening and limb-threatening problems and it's very rewarding to see someone be cured of their cancer and have their functionality restored where they can go on to a normal healthy life.

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