These are the basic investigations needed with most suspected primary tumours.
In addition the tumor will have to be staged. These investigations can be done at the oncology center to which the patient is referred.
Once the local imaging is done a biopsy can be done and the histology of the tumour studied A Staging system such as that of Enneking is used to prognosticate and decide on management.
TreatmentMost malignant bone tumors require surgery and chemotherapy. Radiotherapy is reserved for irresectable or marginally excised tumours.
Chemotherapy is usually started about 6 weeks preoperatively once the diagnosis has been confirmed by histology.
SurgeryA wide surgical margin should be achieved.
To achieve this aim, either a en block excision with arthrodesis,
or custom mage prosthetic joint is required or an amputation
is needed. The patient needs postoperative chemotherapy too, in most
Block excision can also be usedfor the treatment of benign, but aggressive tumours e.g. giant cell tumour about the knee.
Chemotherapy is also given postoperatively. Excised lesion is examined histologically to determine if the margins ate tumour free. Another factor looked at is the amount of tumour necrosis caused by the chemotherapy. If there was a good response the same regimen is given postoperatively. If the response was poor the chemotherapy agents are changed, with the hope that alternative drugs will be nore effective.