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Spotting tigers in the long grass public copy
3
Malignant tumours in children and young adults
Benign lesions
Evolution of modern treatment
Surgery for sarcoma
Reconstruction in children
Challenges
Education and awareness
Early diagnosis
Communication
How to spot a tiger
Think Tiger!
All patients with a palpable mass or a suspicious history should have an x-ray!
Questions to ask:
- Where is the lesion?
- What is the lesion doing to the bone?
- What is the bone doing in return?
- Is there matrix formation?
Take an x-ray
- Careful clinical examination for swellings and lymphadenopathy
- Is there a palpable mass around a joint?
- If there is a mass, is it deep to fascia, growing, >5cm or recurrent?
Examine the patient
- Pain, especially night pain
- Swelling, especially rapidly growing
- Systemic symptoms
- Fracture - history of trauma
- Family history
- Rarely symptoms related to lung metastases
Take a history
Access to new drugs
no new drugs in 20 years for osteosarcoma
Soft tissue tumours
Future directions
- Adequate margins not possible with limb salvage
- Major complications of radiotherapy would follow
- A below knee amputation may be more serviceable than a salvaged distal extremity
- Some cases of local recurrence may not be treatable by standard surgery and radiotherapy
Amputation
non-invasive growing
endoprostheses
Endoprostheses
Biological reconstruction
No reconstruction
- Growth
- Durability
- Adaptation
risks
amputation vs limb sparing surgery
Aims of surgery
- Remove tumour
- Preserve function
benefits
follow up
adjuvant chemotherapy
local therapy:
surgery
radiotherapy
neoadjuvant chemotherapy
on clinical trials
Survival
- MDT
- Careful workup
- Clinical Trials
- individualised decision making
2010
2000
1980
None of us is as smart as all of us
Japanese proverb
1960
1950
Teamwork is essential - it allows you to blame someone else
Anonymous
1900
social networking
patient experience
1931
Modern treatment
navigation
silver coated implants
1913
1930
toothpastefordinner.com
MRI scanning
new prosthetics
1935
surgeon's experience
1974
PET scanning
translational research
limb sparing surgery
can you see the tiger?
Fibromatosis
ganglion
Others
Fibrous dysplasia
Non-ossifying fibroma
Osteochondroma
Unicameral bone cyst
- Patient delay
- Health professional delay
Presentation often delayed
7% of childhood tumours
- 4% Rhabdomyosarcoma
- 3% Non-rhabdo eg synovial sarcoma, clear cell sarcoma
Soft tissue sarcoma
- 12% of childhood tumours
- Osteosarcoma (55%)
- Ewings sarcoma (35%)
Primary malignant bone tumours
- Leukaemias, lymphomas
- Brain tumours
- Others
1700 under 15s each year in the UK
Incidence
Craig Gerrand, Consultant Orthopaedic Surgeon, Newcastle Upon Tyne (and BCRT Trustee)
Spotting tigers in the long grass - orthopaedic oncology for everyone