Taking Aim at Bone Cancer

As your care team plans the most-effective osteosarcoma care for your child, we consider whether the cancer has spread elsewhere in the body and also its grade.

• Children with low-grade tumors may only need surgery.
• Children with high-grade osteosarcoma may need surgery and chemotherapy. We often start with chemotherapy before surgery to shrink the tumor and kill any cancer cells elsewhere in the body. This is followed by surgery to remove the tumor, sparing or restoring the affected limb as much as possible.

Saving Lives, Preserving Life

At MSK Kids, we take every step we can to make sure children with bone and muscle tumors have the best chance of taking every step they can — including limb-sparing operations whenever possible. We have one of the largest and most experienced pediatric orthopedic surgery programs in the world. Our surgeons combine the expertise of subspecialty training with compassion and understanding to provide your child with unparalleled care.

The World’s Pediatric Orthopedic Leaders Are at MSK Kids

Our multidisciplinary team of experts includes world leaders in pediatric orthopedic surgery. They have participated in and led Children’s Oncology Group clinical trials and committees to improve the futures of children with muscle and bone tumors. Our pediatric orthopedic surgeons have drafted the standards of care for pediatric bone tumors that are now followed by doctors all around the globe. They have also trained other pediatric orthopedic surgeons who are bringing the high level of MSK Kids care to other institutions.

Exceptional Patient Outcomes

MSK Kids pediatric orthopedic surgeons have subspecialty expertise, including in:

• joint replacement
• pelvic reconstruction
• hand surgery
• microsurgery
• and spine surgery.

They collaborate with medical oncologists, radiation oncologists, pathologists, interventional radiologists, nurses and nurse practitioners, physical and occupational therapists, social workers, and others who share a dedication to providing advanced, compassionate care to children with musculoskeletal tumors. Together, the team has achieved a very low rate of recurrence in children with osteosarcoma — just 3.5 percent, versus 13 to 14 percent elsewhere. When you bring your child to MSK Kids for treatment, you’re giving him or her the best chance of a successful outcome.

Personalizing Your Child’s Treatment

We customize your child’s care to his or her needs while considering future growth and development. Your team gets to know you and your child to learn what is most important to your family. Your child’s orthopedic surgeon tailors all treatment discussions to your child’s age and understanding, and takes his or her goals and preferences to heart. The doctor chooses the best surgical approach to create the most effective operation that minimizes the effects of the disease and its treatment on your child’s function and quality of life.

Who Do We Treat?

MSK Kids treats more young people with osteosarcoma and Ewing sarcoma than any other center in the country. Our pediatric orthopedic surgeons care for children with many other musculoskeletal cancers as well as noncancerous tumors and cysts, including:

• Rhabdomyosarcoma: a rare childhood cancer that begins in the muscles
• Fibrosarcoma in infants and children: a cancer that starts in the fibrous connective tissue at the ends of bones in the arms and legs
• Chondrosarcoma: a bone cancer composed of cartilage-producing cells
• Osteochondroma and other hereditary bone spurs (“exostoses”): common abnormal growths that form near the growth plates at the ends of long bones
• Chondroblastoma: a rare bone tumor that grows toward the ends of the long bones
• Hemangioma of the bones and soft tissues: a benign tumor made of blood vessels which we treat if it is causing discomfort or other symptoms
• Aneurysmal and unicameral (simple) bone cysts: blood- or fluid-filled sacs which we may treat with surgery and interventional radiology techniques to prevent bone damage

Limb-Preserving Surgery

At MSK Kids, our pediatric orthopedic surgeons do everything possible to preserve the bone where a tumor has developed. Our goal is to completely remove the tumor while maintaining the arm or leg and supporting your child’s ability to move and function freely. We do not perform amputation unless all other treatment options have been exhausted first.

Customized Prosthetic Implants

Our surgical team has one of the best published track records in the world for implanting highly durable prostheses. These are rod-like devices inserted into the bone after a tumor has been removed. They include joint replacements and expandable devices that lengthen as a child grows. Our exceptional long-term survival rates for children with bone cancer means that sometimes our patients wear out their prostheses, and our surgeons are skilled in replacing them if that time comes. Three-dimensional custom-built devices are increasingly being used to customize treatment.

Limb-Lengthening Techniques

MSK Kids surgeons are leaders in limb lengthening, an approach that takes advantage of the fact that bone can heal itself by regenerating new bone that is just as strong and healthy as normal bone. With a technique called “bone transport,” surgeons remove the segment of a bone containing a tumor and cleanly cut the remaining ends of the bone. The bone is stretched, “tricking” the body into thinking there is a fracture, which triggers the healing process. Patients are fitted with a metal rod in the bone that can be elongated in a controlled way by a magnet, or with a special external device that a parent or caregiver adjusts using a dial that lengthens the bone by one millimeter per day. The remaining bone then makes new bone which bridges the gap over time. Not all patients are candidates for this treatment; your surgeon will let you know if it is an option for your child.