Ortho Cancer‘ the dreaded word can affect any part of the body. When it affects the limbs it is much more evident as it causes gross cosmetic disfigurement as well as a significant functional disability. A variety of tumors, some benign and most of the malignant ones can cause functional loss to the body. The malignant tumors which primarily involve the other parts of the body can also metastases to the limbs thus involving the bones or the muscles or both, causing severe pain and functional disability. Treatment of these require various modalities like chemotherapy, radiotherapy or surgery all either in various combinations or alone. However, surgery is the only hope of cure for most of the tumors. Tumors of bones, joints and the skeletal muscles are important because of various reasons. These tumor even if benign have the tendency to progress in size, severity and intensity thus causing cosmetic disfigurement with or without pain, with or without functional disability. More over these benign tumors carry the risk of conversion to the more dreaded malignant forms.
Tumors whether benign or malignant cause the ailment due to certain reasons like
- Pathological Fracture.
- Nerve pressure or nerve entrapment
- Vascular compromise
- Metastasis to vital organs thus hampering their function and hence decreasing the life expectancy.
The surgical option of treatment is usually the only treatment required for most of the benign tumors, but for the malignant forms, surgical excision is to be combined with either radotherapy (RT) or chemotherapy
(CCT) or both.
Surgery is the most definitive hope of cure as well as rapid relief from pain in addition to early return to normal or near normal function.
Since the past the surgery offered has been mutilating which included crude removal of a part of or the entire limb from the body in the hope to eliminate the disease from the body. This type of treatment had mixed result which were dependent on the histopathology and aggressiveness of the tumor.
With the improvement in the adjuvant medicines like RT and CCT the post surgical life of the patients srarted improving. With this promising improvement the need to a better functional outcome led to research and technical application and improvement in the surgical procedures. These newer techniques involved appropriately required excision of the tumor without removal of the limb and also preserving the function of the limb as well as its cosmetic appearance. These are the LIMB SPARING SURGERIES (LSS). LSS are technically demanding and require a pre prepared prosthesis for fixation to replace the resected part. LSS require a good anatomical and a good histopathological knowledge of the disease and the affected area and also the timely application of the same. Working experience the only answer to it. LSS give a good functional limb and along with adjuvant therapy increase the survival of the patient by decreasing or eliminating the chance of micrometastasis. These LSS, sometimes, instead of replacing the excised diseased part, reconstruct the same using certain sacrifice able bony or bone + joint part of the body, the ultimate aim being to give a tumor free functional limb.
For the tumors that have crossed a stage where cure from the tumor cannot be expected, there are procedures which make the patient free from pain and also help the bed ridden patients to be independent and be on their own. These are mostly the tumors which have metastised to the bones. There treatment involves two basic principles 1) to give a pain free and if possible a functional limb. 2) To decrease the tumor load from the body, helping the adjuvant therapy to fight the tumor better. These both contribute to the aim of giving a good quality life to the patients.
These surgeries are termed palliative surgeries and mostly involve the following
Fixation of the pathological fractures..
Replacement of the juxtaarticular area (i.e. area near the joint) with a specially designed prosthesis or implant.
Decompression of the neurovascular bundle.
Here one more area of the skeletal system needs to be mentioned and that is the pelvis. The tumors in and around the pelvicgirdle, whether benign or malignant, usually present late due to the availability of ample of space for the growth to grow and then cause the symptoms. The symptoms are usually pain due to compression of nerves or due to the destruction of the bony tissue. These tumors are also important because these present not only late but also the involved parts are usually vital and hence not easily sacrificed, there is very less space left for the surgeon to carry out surgery, important neurovascular structures like the static nerve with plexus and lilac vessels lie near by and the sacrificed bony tissue is extremely difficult to reconstruct.