Primary Tumours
Primary bone and soft tissue tumours originate in the bone and soft tissue. Symptoms include pain that persists and worsens over time and/or the appearance of a lump.
Secondary Tumours
Metastatic disease, or secondary cancer, develop elsewhere in the body (breasts, lungs, prostate), and spread to the bone and soft tissue. Metastatic disease is likely to be identified in early development as the patient undergoes periodic screening following primary cancer treatment.
The Bone Tumour Centre receives patient referrals from GP’s and external Hospitals. We also provide advice to Orthopaedic Surgeons across the country to guide biopsy of suspected tumours, especially those in hard-to-reach areas of the body. Working with Radiology and Pathology Departments we provide rapid and accurate diagnosis to inform treatment.
Diagnostic Tests
If you have a suspected tumour, you may undergo one or more of the following tests to assist diagnosis:
Radiological Examinations
- X-ray machines use a small amount of radiation to create an image of bones, fat and muscle. Iodine or barium may be introduced to the body intravenously to improve the clarity of the picture. Xrays can highlight bone fragility and tumours. X-rays are quick and painless.
- Ultrasound uses high-frequency waves to scan the soft tissue. The process is easy and painless.
- Computerized Tomography (CT) combines x-ray and computer technology to generate graphic images of the organs, bones and tissue. CT technology is used for tumour detection, precision biopsy, image-guided surgery and tumour ablation (destruction of benign tumours using cryotherapy). CT technology may also be employed by your oncologist for the administration of neoadjuvant and adjuvant treatments.
- Magnetic Resonance Imaging (MRI) uses a magnetic field, radio waves and computer technology to create detailed pictures of soft tissue that can highlight the smallest abnormality. Tests are safe and painless, however, they can take up to 50 minutes to complete and can be noisy. Contrast dye may be introduced to the bloodstream intravenously, to improve picture clarity.
Biopsy
As bone and soft tissue tumours are rare and can form in hard-to-reach places, they can prove difficult to biopsy and resect. Accurate diagnosis is critical to effective treatment and optimal outcomes.
If a tumour mass is identified, a biopsy is required. The location of the tumour will determine how the biopsy is taken. A needle is inserted into the site of the tumour and a sample of the tissue is extracted for laboratory analysis. If the tumour is difficult to access, image-guided technology may be employed to assist.
A biopsy will confirm if the tumour is benign or malignant, and confirm the type of cancer. Tumour histology and staging will determine the surgical approach and post-operative treatment.
The Bone Tumour Centre operates a virtual advisory service for consultants nationwide to guide the safe and effective biopsy of complex and obscure tumour masses. The stage and location of the tumour will determine the approach for the best outcome.
Tumour Histology/Grading
A cancer grading determines the nature of cancer and how likely it is to spread. A low-grade classification typically indicates slow-growing cancer that is contained. A higher grading can indicate aggressive cancer that may invade local cells and metastasize (infiltrate a secondary site) to other areas of the body.
Tumour Staging
Tumour staging determines how advanced a cancer is by examing tumour size and the extent of spread.
Surgery is a critical component of treatment, however, patients may require preoperative chemotherapy and radiotherapy (neo-adjuvant treatment) to reduce the tumour size before surgery can be undertaken. In addition, postoperative therapies (adjuvant treatment) may be recommended to lessen the possibility of recurrence.
Surgery
Tumour location, histology and staging determine the best approach to treatment. Historically, amputation was the preferred approach to the treatment, however today, we endeavour to preserve the limb and limb function where possible. Advanced technology helps us to visualise the full extent of disease and plan our surgical approach. If reconstructive surgery is required, we can anticipate prosthesis and bone allograft requirements in advance. Furthermore, we are able to prepare patients for surgery, rehabilitation, adjuvant treatment (chemotherapy and radiotherapy) and set their expectations for recovery.
When operating, surgeons endeavour to attain ‘clear margins’ (removal of the tumour and a margin of healthy cells surrounding the tumour), however, this is not always possible. Patients may benefit from chemotherapy and radiotherapy treatments post-surgery.
A sarcoma is a form of rare cancer that accounts for 1% of all cancers diagnosed. Typically affects the bones and connective tissues of the limbs, however, it can manifest in other areas of the body.
Sarcomas often resist conventional cancer treatments (chemotherapy and radiotherapy), and surgical resection is considered to be one of the most effective treatment options.
The National Sarcoma Service
Due to its rarity, all incidences of sarcoma are managed through a centralised centre – The National Sarcoma Service. A multidisciplinary team of Medical, Surgical and Radiation Oncologists, Consultant Orthopaedic Surgeons specialising in oncology, Pathologists and Radiologists combine their expertise to develop effective treatment pathways for sarcoma patients. The Bone Tumour Centre is the National Sarcoma Services dedicated elective centre for orthopaedic surgical oncology.
The National Sarcoma Service records patient data and collaborates with international rare disease centres. It is hoped that data accumulated will identify trends to inform the future treatment of Sarcoma patients.
Soft tissue sarcoma
Soft tissue sarcomas occur in the muscles, fat, blood vessels, tendons, and fibrous tissues. Treatment is determined by the size, location, stage and grade of the tumour.
Bone Sarcomas
There are 3 types of bone sarcoma.
- Chondrosarcoma accounts for almost 30% of skeletal system cancers. Although typically found in children and adolescents, we frequently treat adults presenting with this condition.
- Osteosarcoma (Osteogenic Sarcoma) is cancer that produces immature bone in teenagers and young adults and manifests in the knee, hip, and shoulder
- Ewings Sarcoma, a tumour of the bone or soft tissue, impacts young people between the age of five and 20 years. Tumour sites can be found in the upper and lower leg, pelvis, upper arm and ribs
Our Consultant Orthopaedic Surgeons combine extensive knowledge, honed skills and a passion for medicine to deliver exceptional treatment and outcomes.
Mr Gary O’Toole
Consultant Orthopaedic Surgeon
- Graduate BSc (Hons) UCD
- Basic Surgical Training St. Vincents Hospital
- Irish Specialist Training Programme in Orthopaedic Surgery
- Specialist Fellowship Programme in Hip and Knee reconstruction at Mater hospital Sydney
- Specialist Fellowship Programme in Orthopaedic Oncology at Sloan Kettering Cancer Centre, New York.
Mr Alan Molloy
Consultant Orthopaedic Surgeon
- Graduate Medicine Trinity College Dublin
- 2-year Fellowship in Orthopaedic Oncology at Stanmore Orthopaedic Hospital, United Kingdom
Ms Margaret Cavanagh
Clinical Nurse Specialist
- 30 years service at the National Orthopaedic Hospital Cappagh
- Exceptional support for patients and families
We recommend patients undergo repeat scans at regular intervals to monitor the tumour site. In addition, cancers can spread to other areas of the body such as the lungs, and additional tests may be recommended to screen vulnerable sites.
A cancerous diagnosis is traumatic for the patient. Our Social Work Services offer emotional support for those affected by cancer. They help patients to come to terms with their diagnosis, connect them with community supports, and provide information on benefits and entitlements available to them during and following treatment.
The team is acutely aware of the devastating impact a cancer diagnosis can have on patients and their family and they work collaboratively to provide practical and emotional support and extraordinary care for those affected.