Why is bone and soft tissue tumor a dangerous tumor?
People lack the understanding of bone and soft tissue tumor, early symptoms are not obvious, and often misdiagnosed as injury or arthritis, etc. 60% of patients with malignant bone and soft tissue tumor are already in the middle and late stage when they are diagnosed, 40% of them are delayed because they cannot get timely diagnosis and standardized treatment, and when the diagnosis is confirmed, the tumor is often very large, difficult to be removed surgically or metastasis has already occurred, and they face the double threat of forced amputation due to postoperative local recurrence or life-threatening distant metastasis. They face the double threat of life threatening amputation due to local recurrence or distant metastasis.
How to diagnose and treat bone and soft tissue tumors?
The diagnosis and treatment of bone tumors include clinical, imaging and pathological diagnosis, radiotherapy and chemotherapy, and comprehensive treatment based on limb preservation surgery. Benign tumors can be removed by surgery alone, while malignant tumors usually require adjuvant chemotherapy and radiotherapy before and after surgery to reduce the chance of recurrence and metastasis.
Puncture biopsy.
The classification and diagnosis of bone and soft tissue tumors are extremely complicated, and it is difficult to make a correct diagnosis by clinical examination and imaging alone. Biopsy is the necessary way to diagnose most patients. Biopsy is divided into puncture biopsy and excisional biopsy.
Puncture biopsy is a minimally invasive technique that uses a coarse trocar needle to penetrate the patient’s diseased bone tissue, which has the advantages of low cost, minimal trauma, and quick recovery, and chemotherapy drugs can be applied the day after puncture. Incisional biopsy is often performed after a failed puncture biopsy, and the incision is about 6-8 cm, which is very traumatic and slower to recover. After incisional biopsy is carried out in some hospitals, it makes it difficult to perform secondary extensive resection of tumor for limb preservation surgery, which makes patients lose the chance of limb preservation.
Combined with diagnosis.
Bone and soft tissue tumors are complex in origin and of various types, so it is difficult to make a clear diagnosis simply by clinical, imaging or pathology, and the misdiagnosis rate is high. Therefore, the combination of clinical, imaging and pathology is the best method of diagnosis recognized and proven at home and abroad. The Bone and Soft Tissue Tumor Center of Sun Yat-sen University regularly conducts triple-disciplinary discussion and diagnostic consultation every Thursday, in which clinicians, pathologists and imaging experts discuss the difficult cases admitted to our hospital and other hospitals in a week. The most optimal treatment plan is selected based on the results of the discussion between radiologists, chemotherapists and surgeons.
Diagnostic and treatment misconceptions.
If “minor surgery” or incisional biopsy is done in the case of unknown diagnosis, patients will lose the chance of limb preservation surgery and long-term survival. Irregular chemotherapy is more likely to induce chemoresistance, delay the best time for treatment and lead to treatment failure. Appropriate application of TCM after surgery can regulate blood and qi and enhance immunity; however, if patients hope to rely on local external and internal application of TCM as a “cure-all”, it will only promote tumor metastasis and delay the treatment time.
Early and reasonable diagnosis and treatment.
The earlier the bone and soft tissue tumors are detected, the higher the cure rate is, and standardized comprehensive treatment is the key to cure. Early diagnosis and treatment are directly related to whether the patient can retain the limb function, and the first surgery is very crucial; a comprehensive individualized treatment plan based on surgery and combined with radiotherapy is adopted to make the patient get radical treatment.
Neoadjuvant chemotherapy.
Chemotherapy is to kill tumor cells in the body through drugs, which is one of the important means of treatment for malignant bone and soft tissue tumors and greatly improves the prognosis of malignant tumor patients. The application of neoadjuvant chemotherapy has greatly increased the possibility and success rate of limb-preserving reconstructive surgery for malignant bone tumors, and it can be said that chemotherapy is the cornerstone of successful treatment for malignant bone tumors.
Surgical treatment.
Surgery is the most important treatment method in the comprehensive treatment of bone and soft tissue tumors. Surgery should strive to be thorough to avoid recurrence, and at the same time, limb function should be preserved as much as possible. For malignant tumors, life saving should be the main focus, and limb preservation should be considered only on the premise of not reducing survival rate. In 2002, the first domestic case of osteosarcoma with extensive resection and lengthenable prosthesis reconstruction was followed up for 5 years after surgery, and the prosthesis was lengthened 4 times with the height of the lower limb, and the functional assessment of the affected limb was excellent. The functional assessment of the affected limb was excellent.
Length of surgical hospitalization.
Due to the small number of beds and patients in our bone oncology department, without special circumstances, it is generally recommended that patients should be discharged 1-2 days after small and medium surgeries, 3-5 days after major surgeries, and 7-10 days after mega surgeries. If the patient wants to have long-term treatment after surgery, we can also refer to the relevant hospital for rehabilitation and treatment, etc.
Follow up.
Close follow-up of patients with bone and soft tissue tumors is an important part of the treatment process. Standardized follow-up is a necessary way to guide the patient’s functional exercise and rehabilitation, which can timely deal with surgical complications and detect possible recurrence and metastasis, so as to take proper treatment at the early stage of recurrence and avoid unnecessary amputation.
The first postoperative follow-up is often 2 weeks after surgery, while the stitches can be removed; the second postoperative follow-up in March to evaluate the efficacy, and the treating physician will discuss with the patient the plan for future follow-up. In general, benign recurrence-prone tumors should be followed up every 3 months for 2 years after surgery and gradually decrease after 2 years; malignant tumors generally require follow-up every 3 months for 3 years after surgery, every 6 months after 3 years, and every 12 months after 5 years.