Do I need a referral?
It is always best to check with your insurance provider. If you are on an HMO plan you must have a referral from your primary care physician (PCP). If you are on workman's comp or autoclaim, please call your case adjuster or claim adjuster. Referral must be in place prior to your appointment.
Which insurances do we accept?
We accept most major insurance plans, please contact our offices to verify your eligibility.
What about benign tumors?
There are numerous types of benign bone and soft tissue tumors. These non-cancerous tumors affect children and adults, and can be found primarily in the arms and legs.
The presentation of theses tumors is similar to that of malignant tumors. Typically, a person is injured in a fall or playing sports, and obtains an x-ray of the cyst in the bone. Soft tissue tumors typically appear as a bump, that is usually not painful and may grow slowly, even over many months or years.
The diagnosis of benign tumors is similar to that of malignant tumors. An experienced orthopedic oncologist may be able to diagnose a benign tumor based on examination of the patient and plain x-rays only. However, if there is any question , MRI, CAT scan, or bone scan may be ordered. A biopsy, where a small piece of the tumor is taken and sent to a pathologist to review under the microscope, may be necessary to confirm the diagnosis.
The treatment of these lesions depends on their size, location, and tumor type. Some tumors are simply observed and may require no treatment at all. Others may require surgical removal (resection), and some of the very aggressive, benign tumors may even require low dose chemotherapy or radiation treatment to control their growth.
What about malignant tumors ?
Malignant tumors of bone and tissue, known as sarcomas, can spread to other body parts and can be life threatening. These sarcomas affect both children and adults, and are usually found in the arms and legs.
There are numerous types of sarcomas whose names describe either the tissue type they arise from (i.e. liposarcoma: arising from fat), or the characteristics of the cell type (i.e. Ewing's sarcoma). The two most common types of bone sarcomas are osteosarcomas and Ewing's sarcoma. Ewing's and osteosarcomas usually affect patients between the ages of 10-25 years old, however patients can be found on both ends of the age spectrum.
With extremity tumors, most patients first notice pain or a lump. Many tumors are found incidentally, when a patient is injured playing sports or during a fall , and the tumor is discovered when an x-ray is done for the injury. Many times the pain will respond to drugs such as Motrin or Naprosyn, which leads to a false reassurance that the pain "is nothing." Most lumps will grow in size and may or may not be painful.
Determining a diagnosis involves getting as much information as possible. This will include evaluating the patient in the office, and may include x-rays, MRI (magnetic resonance imaging), CAT scans (computerized tomography) , and bone scans. If indicated the physician will perform a biopsy to make the diagnosis. This involves taking a small piece of tissue from the tumor and sending it to a pathologist who examines it under a microscope. Usually, the pathologist can confirm the diagnosis. Sometimes, however, an exact diagnosis is difficult. In this instance, either the slides are sent to other national experts for consultation, or the pathologist may request more tissue from the tumor.
These biopsies are performed either in the office under local anesthesia, or may require a trip to the operating room with general anesthesia. This decision is made by the surgeon, and is affected by location, size, and accessibility of the tumor. How the biopsy is performed can affect treatment. Overall, it is best to have the surgeon who will be performing the resection of the tumor perform the biopsy. When this is not feasible, the referring physician can consult with the orthopedic oncologist for recommendations regarding the biopsy technique.
For some cancers, Intra-arterial (IA) chemotherapy is administered through a catheter that has been placed directly into the tumor bed, and delivers these drugs at a concentration 5-9 times greater than the same drug administered by intravenous (I.V.). The patient receives both I.V. and intra-arterial chemotherapy prior to surgery. Once completed, the patient must undergo surgical removal (resection) of the tumor*. If a large amount of bone must be removed, this can be replace with either a metal prosthesis, an allograph (cadaver bone), or a composite of both. If the surgeon cannot adequately resect the entire tumor in one piece, or if the this surgery renders the limb useless, an amputation may be preferable.
Dye shows malignant tumor before intra-arterial chemotherapy.
After chemotherapy the cancer is 100% dead.
After adequate recovery from surgery (usually 3-4 weeks) has occurred, intravenous chemotherapy will resume, typically for 3-12 months.
* Previously, most patients had amputations for these tumors. Now, ninety percent of patients limbs can be preserved.