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Orthopaedics

Musculoskeletal tumour clinic

  • About the musculoskeletal tumour clinic

    Musculoskeletal tumour surgery has been performed by the Orthopaedic surgeons at the Royal Children's Hospital for over 30 years. The musculoskeletal tumour clinic looks after children with benign and malignant tumours of bone and soft tissue, affecting the limbs,  pelvis and spine.

    The clinic caters to  children 16 years and under. Our clinic works closely with other specialty units at the Royal Children's Hospital particularly oncology, radiology, and physiotherapy. The clinic is run by Mr Leo Donnan and Mr Mark O'Sullivan, consultant Orthopaedic Surgeons who has have over 20 years experience at the Royal Children's Hospital managing these tumours.

    What are musculoskeletal tumours?

    Musculoskeletal tumours are lumps or masses that develop in the arms, legs, pelvis or the spine. 90% of the tumours that we see are benign, but malignant tumours do occur in children and it is very important that we pick these tumours up early so that we can get the best possible outcome for your child. Malignant tumours of the musculoskeletal system are called sarcomas. They are differentiated from benign tumours by their ability to spread to distant sites and produce another tumour.

    Benign and malignant tumours can present with a lump or pain. Any unexplained severe pain or ache needs to be investigated to exclude a tumour.

    The work-up of musculoskeletal tumours

    New patient referrals

    Please fax to (03) 9345 5034 

    Most patients are initially seen in the private rooms, clinic or emergency department. Preliminary discussion and investigations are performed before referral to the musculoskeletal tumour clinic.

    Where is the musculoskeletal tumour clinic?

    Specialist Clinics A1 Ground Floor.

    Children with malignant tumours of the Musculoskeletal System are given first preference and are seen on an urgent basis.

    Investigations

    Imaging of bone and soft tissue tumours is always required before a decision is made regarding the need for biopsy and treatment.

    Plain Radiographs (XRays)

    • are used as a baseline investigation to assess the tumour

    Nuclear Medicine Bone Scans

    • are commonly used to assess bone tumours. There are several types of scanning, and these are used to obtain different information about the tumour and whether there are other tumours throughout the skeleton

    MRI (magnetic resonance imaging)

    • is a commonly used investigation when looking at bone or soft tissue tumours. MRI gives excellent detail of both the tumour and surrounding tissues. It is the only investigation that gives adequate information about soft tissue tumours.

    CT scanning

    • is occasionally used in the assessment of tumours and is particularly useful in obtaining information about benign bone tumours.

    Ultrasound

    • is occasionally used in the investigation of soft tissue tumours, particularly if the the tumour is thought to contain a large number of blood vessels

    Review

    After all the investigations have been performed, a further appointment is made to discuss the radiological findings and further investigations and treatment. In particular a decision is made whether biopsy is needed, or whether surgery is indicated for your child's tumour.

    Biopsy

    Biopsy is always indicated when there is a suspicion that the tumour is malignant. Some benign tumours have a malignant appearance and it is impossible to tell clinically or radiologically, so that the biopsy is vital as a guide to further treatment.

    This is performed under General Anaesthetic and usually by a Specialist Radiologist with CT or Ultrasound guidance. Some tumours will need open biopsy with a small operation.

    The biopsy results take between 2 and 10 days to come back to us. Tumours of bone usually take 7-10 days for a biopsy result, while soft tissue tumours are faster and we usually have a result in 2-3 days

    The treatment of musculoskeletal tumours 

    Benign tumours

    Benign tumours of bone and soft tissue are treated in many different ways, depending of their site, size and pathology. The treatment will be discussed with you after initial consultation, imaging and biopsy, if necessary.

    Malignant tumours

    Malignant tumours of Bone and Soft Tissue are treated with a Multidisciplenary approach, by a team including an Orthopaedic Surgeon and Oncologist. Treatment is discussed over several meetings between the patient and their family and the RCH team.

    In general, the initial treatment for malignant tumours is with chemotherapy. This treatment is used for several months in an attempt to shrink the tumour and kill any cells that are circulating in the rest of the body.

    The tumour is then restaged with Plain radiology, bone scanning and MRI. These investigations are used to determine whether the tumour has shrunk and whether the tumour can be removed safely. We also need to know whether there has been any spread of tumour throughout the body.

    Once the tumour has been restaged, a decision is made about how to remove the tumour. Before 1970, almost all tumours were treated by amputation. Most tumours in children now are treated by Limb Salvage surgery.