A National Cancer Institute-designated Comprehensive Cancer Center

Make an appointment: 800-826-HOPE

Musculoskeletal Tumors

Musculoskeletal Tumors
City of Hope has one of the largest musculoskeletal cancer programs in California. As one of a handful of institutes to attain the elite designation of Comprehensive Cancer Center by the National Cancer Institute, City of Hope is acknowledged as a leader in cancer research and treatment.  Patients at City of Hope have access to innovative clinical trials, and researchers and physicians who are nationally recognized experts in developing novel methods for preventing, detecting and treating soft tissue sarcoma and bone cancers, and a multidisciplinary team of specialists in medical oncology, surgery and rehabilitation.
 
  • City of Hope serves as a regional referral center for both pediatric and adult patients with soft tissue sarcoma and bone cancer and is a national leader in the use of expandable implants. City of Hope’s Musculoskeletal Cancers and Sarcoma Program is led by Judith K. Sato, M.D. 
  • The program approach integrates powerful new anti-cancer drugs with alternative therapies with a goal of sparing limbs.  In 85 percent of our of cases, we have saved the patient’s limb. We are actively developing tomorrow’s treatments today, and our musculoskeletal investigators are collaborating with scientists in other disciplines to develop promising new treatments.
 
Expedited Treatment by a Multidisciplinary Team
 
  • Patients with musculoskeletal cancers find more than hope here. They also find expedited diagnosis and rapid treatment that begins in a matter of hours or days, not weeks. Because musculoskeletal cancers can be especially aggressive and fast-growing, we have assembled a team comprised of all the necessary specialists and clinicians who are on-site and collaborating together on the best course of treatment for each individual patient.
  • In evaluating each individual’s needs—from children to adults to elderly patients—during the initial assessment in our sarcoma clinic, we use our advanced knowledge and experience to carefully make the correct diagnosis and deliver the best possible care, eliminating delays in treatment that help to achieve the optimal outcome. Total comprehensive care is provided, including cancer education, surgical options, rehabilitation and survivorship. Other important services include psychology, psychiatry and social work for the patient and his or her family, all crucial to achieving the best outcome.
  • Children who are treated at City of Hope and experience a relapse in adulthood will typically find the same team that treated them upon their initial diagnosis. This provides greater continuity of care and avoids having the patient seek a new team if the cancer returns.
 
We treat all types of musculoskeletal tumors, including:
 
Bone Tumors
 
Malignant Borderline Benign Non-neoplastic
Osteosarcoma Giant cell tumor Osteoid osteoma Fibrous dysplasia
Chondrosarcoma Epitheloid hemangioendothelioma Osteoblostoma Non-ossifying fibroma
Ewing's sarcoma   Enchondroma Aneurysmal bone cyst
Malignant fibrous histiocytoma   Condroblostoma [soft tissue tumor]
Adamantinoma   Chonddromyxoid fibroma [soft tissue tumor]
    Hemangioma [soft tissue tumor]
      Osteofibrous dysplasia
      Myositis ossificans
      Florid reactive periostitis
      Avulsion/stress fracture
      Pubic osteolysis
 
Soft Tissue Tumors
 
Benign Intermediate Malignant
Nodular Fascitis
Fibromas
Fibromatoses
Superficial fibromatoses
Deep fibromatoses
Fibrosarcoma
Inflammatory fibrosarcoma
Fibrous histiocytoma Dermatofibrosarcoma
protuberans
Angiomatoid fibrous
histiocvtoma
Malig. fibrous histocytoma
Undifferentiated pleomorphic sarcoma
Lipoma
Spindle cell lipoma
  Liposarcoma
Leiomyoma
Epitheliold leiomyoma
  Leiomyosarcoma
Epithelioid leiomyosarcoma
Rhabdomyoma   Rhabdomyosarcoma
Ectomesenchymoma
Hemangioma
Lymphangioma
Hemangioendothelioma Angiosarcoma
Lymphangiosarcoma
Kaposi' s sarcoma
Hemangiopericytoma   Malig. Glomus tumor ...
Malig. Hemangiopericvtoma
Tenosynovial GCT   Synovial sarcoma
Malig. GCT of tendon sheath
Solitary mesothelioma   Malig. solitary fibrous tumor
Diffuse mesothelioma
Traumatic neuroma
Schwannoma
Neurofibroma
Ganglioneuroma
  Malig. peripheral nerve sheath tumor
Triton tumor
Clear cell sarcoma
Primitive neuroectodermal tumor
Paraganglioma   Malig. Paraganglioma
Myositis ossificans
Extraskel. chondroma
Extraskel.  osteochondroma
  Extraskel. chondroma
Extroskel. osteochondroma
Mesenchymoma   Malig. mesenchymoma
Cong granular cell tumor
Myxoma
  Alveolar soft port sarcoma
Epithelioid sarcoma
Angiomyxoma   Malig. extrarenal rhabdoid tumor
Desmoplastic small cell tumor
 
About Musculoskeletal Tumors
 
Bone tumors may be benign (noncancerous) or malignant (cancerous). Benign bone tumors are more common than malignant ones. Both types may grow and compress healthy bone tissue and absorb or replace it with abnormal tissue. However, benign tumors do not spread and are rarely life-threatening.
 
Cancer that arises in the bone (primary bone cancer) is not the same disease as cancer that spreads to the bone from another part of the body (secondary bone cancer). Primary bone cancer is rare, with approximately 2,500 new cases diagnosed each year in the United States. More commonly, bones are the site of tumors that result from the spread (metastasis) of cancer from another organ, such as the breasts, lungs, and prostate.
 
The most common type of bone cancer is osteosarcoma, which develops in new tissue in growing bones. Another type of cancer, chondrosarcoma, arises in cartilage. Evidence suggests that Ewing’s sarcoma, another form of bone cancer, begins in immature nerve tissue in bone marrow. Osteosarcoma and Ewing’s sarcoma tend to occur more frequently in children and adolescents, while chondrosarcoma occurs more often in adults

Musculoskeletal Tumors Symptoms

A doctor should be consulted if any of the following problems occur:
 
  • Bone pain (may be worse at night or when the bone is used, as in walking)
  • Bone break (fracture), even from slight injury
  • A mass and swelling at the tumor site

Soft tissue tumors may not cause any symptoms in their early stages, because the tissue tends to be very elastic. These tumors can become quite large before they can be felt. Typically, the first symptom is a painless lump. As the growing tumor begins to press against nerves and muscles, it may cause pain and soreness.
 

Diagnosing Musculoskeletal Tumors

We gather dedicated oncologists, radiologists, pathologists, physical rehabilitation experts and others in one place to focus on musculoskeletal tumors.

Tests and procedures used to detect and diagnose musculoskeletal tumors include:
 

  • Physical exam and history
  • Blood test
    The doctor may suggest a blood test to determine the level of an enzyme called alkaline phosphatase. A large amount of alkaline phosphatase can be found in the blood when the cells that form bone tissue are very active — when children are growing, when a broken bone is mending, or when disease or a tumor causes production of abnormal bone tissue. Because high levels of this enzyme can normally be found in growing children and adolescents, this test is not a completely reliable indicator of bone cancer.
  • X-ray
    An X-ray can show the location, size and shape of a bone tumor. If X-rays suggest that a tumor may be cancer, the doctor may recommend special imaging tests such as a bone scan, a CT (or CAT) scan, an MRI, or an angiogram.
  • CT or CAT (computerized axial tomography) scan
    A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed prior to the scan to help the organs or tissues show up more clearly. This procedure is also called computed tomography or computerized tomography. A spiral or helical CT scan makes a series of very detailed pictures of areas inside the body using an X-ray machine that scans the body in a spiral path.
  • MRI (Magnetic Resonance Imaging)
    MRI uses a magnet, radio waves and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging.
  • Biopsy
  • The removal of cells or tissues so they can be viewed under a microscope to check for signs of cancer. A physician may perform a needle biopsy or a small incisional biopsy to check for bone cancer. During a needle biopsy, a small hole is made in the bone and a sample of tissue is removed from the tumor with a needle-like instrument. In an incisional biopsy, a physician cuts into the tumor and removes a small sample of tissue.
  • Bone scan
    This procedure allows us to see if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones and is detected by a scanner.
 

Research and Clinical Trials

We are a fully independent, biomedical research institution with the vision, drive and infrastructure to accelerate new treatment ideas from the laboratory to patients through clinical trials. Our onsite biologic manufacturing labs accelerate this process, as do our collaborative research efforts.
 
City of Hope’s Musculoskeletal Tumor Program pursues joint initiatives with colleagues on campus as well as with researchers nationwide. Complementing these efforts, we have the longest-standing cancer survivorship program in the country.
 
In a concerted effort to develop viable treatments that significantly improve cancer survival, musculoskeletal investigators collaborate across disciplines to develop the most promising therapies.
 
Some of our current research initiatives include:
 
  • City of Hope’s Western Sarcoma Team has developed a unique web-based database to study the characteristics, treatment and outcome of many types of sarcomas and musculoskeletal tumors.
  • A Phase II Study of Pazpanib in Treatment of Surgically Unresectable or Metastatic Chondrosarcoma
  • Childhood Cancer Survivor Study
  • A COG Soft Tissue Sarcoma Biology and Banking Protocol
  • City of Hope researchers are developing novel therapies that block musculoskeletal cancer's ability to proliferate and spread throughout the body; a Phase I and II study of Dasatinib, an investigational drug that acts to inhibit cancer growth and invasion, has just been completed.
 
To learn more about our clinical trials program, specifically those for musculoskeletal and pediatric cancers, click here.
 
 
 
 
 
 
 
 
 
 
 

 

Resources

All of our patients have access to the Sheri & Les Biller Patient and Family Resource Center, which offers a wide array of support and educational services. Patients and loved ones may work with a coordinated group of social workers, psychiatrists, psychologists, patient navigators, pain management specialists and spiritual care providers at the center, as well as participate in programs such as music therapy, meditation and many others.

Additional Resources
 
800-ACS-2345 (800-227-2345)
Central Los Angeles: 213-386-6102
San Fernando Valley: 818-905-7766

Camp Ronald McDonald for Good Times
800-625-7295
Dedicated to providing children with cancer a place to experience camping, have fun and develop self confidence.

Candlelights Childhood Cancer Foundation
800-366-2223
National organization for self-help groups for parents of children with cancer.

CureSearch
800-458-6223 (U.S. and Canada)
CureSearch represents the combined efforts of the Children's Oncology Group and the National Childhood Cancer Foundation.

Desi Geestman Foundation
888-29-4DESI (3374)
Provides financial and emotional support to City of Hope pediatric patients and their families.

National Cancer Institute (NCI)
800-4-CANCER (800-422-6237)
TTY: 800-332-8615

Wellness Community
888-793-WELL (9355)
Nonprofit organization dedicated to providing free emotional support, education and hope for people with cancer and their loved ones.
 

Treatments

Physicians from across Southern California send their musculoskeletal cancer patients to City of Hope because our musculoskeletal tumor specialists routinely treat children and adults with rare tumors.  Our treatment approach for these cancers combines chemotherapy and other drugs with surgery and radiation. Surgical oncologists, medical oncologists and radiation oncologists work together with pathologists, radiologists, rehabilitation experts and others to achieve the best possible outcomes for patients. In 85 percent of bone cancer cases, we are able to save the patient’s limb.
 
Diagnosis

Because these types of tumors can grow rapidly, patients with a suspected musculoskeletal tumor should go directly to a sarcoma center of excellence.  At City of Hope, an initial assessment is made involving the expertise of dedicated radiologists, pathologists, interventional radiologists, surgeons and oncologists to obtain a precise diagnosis. 

ORTHOPEDIC SURGERY/GENERAL ONCOLOGIC SURGERY

In these types of cancers, surgery is typically required to remove the tumor and surrounding tissue, often including lymph nodes. Each case must be evaluated carefully to ensure that the most effective surgery is chosen for the individual. Musculoskeletal tumors usually affect the limbs. In the past, amputation was often required to prevent the disease from spreading to healthy tissue. Today, advanced surgical techniques combined with radiation therapy make it increasingly possible to preserve the limb. Limb-stabilizing devices may also be used to reduce the number of surgical procedures needed and accelerate the patient’s recovery.
 
 
Expandable Prosthetic Implants
City of Hope is a national center for the use of expandable prosthetic implants for limb-sparing reconstruction in children and adolescents.  These expandable prostheses are able to “grow” through noninvasive or minimally invasive techniques.  This allows us to accommodate for a child’s continued growth in future years without multiple significant surgeries. Using these devices, we are able to reduce the number of surgeries and improve the recovery time for children, while removing their bone cancer and reconstructing their limbs. 

RADIATION THERAPY

Radiation therapy uses energy beams to destroy cancer cells. Radiation is used as an added measure after surgery to destroy any remaining cancer cells. However, radiation can be used before surgery, or it may be the main treatment in some cases. Radiation therapy can also be used to relieve symptoms when a cancer has spread. Types of radiation therapy used to treat musculoskeletal tumors include:

Helical TomoTherapy

TomoTherapy is an advanced radiation therapy system that merges intensity modulated radiation therapy with precision spiral computed tomography scanning. This allows doctors to deliver the highest dose of radiation in a way that matches the exact shape of the tumor, providing effective treatment while reducing exposure of healthy tissues.
 
Brachytherapy

In this procedure, tiny pellets of radioactive material smaller than a grain of rice are inserted directly into the cancerous tissue. The radiation attacks the tumor from the inside out. By directly targeting cancer, brachytherapy minimizes radiation to healthy tissue.

CHEMOTHERAPY
 

Chemotherapy, anticancer medicines given intravenously or by mouth, includes a wide range of drugs and treatment strategies to treat musculoskeletal tumors/sarcoma. Depending on the type and stage of disease, chemotherapy is given as the main treatment followed by surgery and/or radiation.
 

DEVELOPMENTAL CANCER THERAPEUTICS
 

The Developmental Cancer Therapeutics Program focuses on the molecular basis of cancer to develop novel agents that fight cancer more effectively and with fewer side effects. Over the long term, scientists in the program aim to match individual patients with the highly customized therapies for the best clinical outcomes.
 
PSYCHOSOCIAL SUPPORT

Psychosocial support is an important component of treatment for musculoskeletal tumors/sarcoma. At City of Hope, the treatment team includes psychologists, psychiatrists, social workers and childlife specialists to help patients and their families learn about their disease and treatment, cope with having a life-threatening illness, and support each other through the illness. 
 
REHABILITATION SERVICES

Our team includes professionals in occupational therapy, physical therapy, recreational therapy, and speech and language pathology. Orthotics and prosthetic services are also are provided.

Occupational therapy
Occupational therapy focuses on restoring skills, teaching adaptive techniques and recommending adaptive equipment necessary in self-care, daily living, homemaking and work-related activities.

Physical therapy
Physical therapy facilitates patient recovery with a focus on mobility, exercise training, reconditioning and other specific therapies. Patients who experience the loss or function of a limb may require braces and prostheses. The City of Hope team includes orthotists and prosthetists who can design appliances that offer maximum function and comfort, and provide training in their use.

Recreation therapy
Recreation therapy promotes wellness and improves the quality of life through leisure activities. Our recreation therapists work to minimize the impact of disease and treatment in the lives of their patients.
 
 
 

Musculoskeletal Tumor Team

Support This Program

It takes the help of a lot of caring people to make hope a reality for our patients. City of Hope was founded by individuals' philanthropic efforts 100 years ago. Their efforts − and those of our supporters today − have built the foundation for the care we provide and the research we conduct. It enables us to strive for new breakthroughs and better therapies − helping more people enjoy longer, better lives.

For more information on supporting this specific program, please contact us below.

Kimberly Wah
Director
Phone: 213-241-7275
Email: kwah@coh.org

 
 
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Refer a Patient
Physicians can choose a number of options to refer a patient:

  • Call 800-826-HOPE (4673) to speak with a patient referral specialist.
  • Fax the patient face sheet to 626-301-8432
  • Complete an online callback request form
 
Your insurance company/medical group will tell you if you need any authorizations. You can also find out what, if any, co-payments and deductibles will be your responsibility.
Clinical Trials
Our aggressive pursuit to discover better ways to help patients now – not years from now – places us among the leaders worldwide in the administration of clinical trials.
 
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