Orthopaedic tumour surgery is performed at Royal Prince Alfred Hospital and the Institute of Rheumatology and Orthopaedics (IRO) for a wide range of malignant and benign tumours.
For many sarcomas, an operation is the main treatment and often the first step. The goal can be put simply: take out the whole tumour, and with it a surrounding cuff of healthy tissue. Surgeons call that cuff a margin. Leaving a margin catches the stray cancer cells that are too small to see at operation, and lowers the chance of the tumour regrowing where it started.
Exactly how this is done depends heavily on where the tumour is and how big it is. The main types of operation are set out below — but please read the note at the end of the page before assuming any of them applies to you.
Wide resection
This is the standard sarcoma operation. The tumour is taken out in one piece together with the healthy tissue immediately around it, so that the edge of what is removed is clear of cancer on every side. For many soft tissue sarcomas, a wide resection is the entire surgical treatment.
Bone or joint replacement (endoprosthetic reconstruction)
When a tumour involves bone, removing it with a proper margin can mean taking a significant length of bone — sometimes including a joint. In that case the missing bone is rebuilt with an implant (an endoprosthesis), allowing you to keep the limb. These reconstructions are generally more extensive than a standard hip or knee replacement, and they are one of the reasons this surgery is done at a specialist centre.
Skin grafts and flaps
If removing the whole tumour leaves a wound too large to close with stitches, a plastic surgeon — part of the same team, often in the same operation — closes it with a skin graft: a thin layer of skin taken from a healthy area and carefully placed over the surgical site. Larger defects are sometimes closed with a flap, tissue moved with its own blood supply.
Amputation
Sometimes part or all of a limb must be removed to treat the cancer — when the tumour is too large, or involves critical structures such as major nerves and blood vessels, and cannot be removed any other way. This is much less common than it once was, but for some tumours it remains the operation that gives the best chance of cure.
If amputation is being considered in your case, it will be discussed with you fully and honestly, with time for your questions, and with support around you — including rehabilitation specialists, prosthetic services and psychological support. You will not be walked into that decision.
One important note
Because the operation depends so much on the individual tumour, everything above is general information and may not match your situation. Ask your surgeon what is actually planned for you, and keep asking until you could describe your own operation in your own words. Far from being a nuisance, that is exactly what the team hopes you will do.