By Hans K. Uhthoff MD, FRCS(C) (eds.)
During the earlier decade, the diagnosis of bone and gentle tissue tumors has better significantly. This development has not just been because of superior therapeutics and diagnostic equipment but additionally because of a crew process now universally followed. comparability of effects, attainable this present day, have been hampered some time past through loss of a clinically suitable staging method and definitive therapy proto cols. The complexity of the healing administration of bone tumors re quires a continuing publicity to tumors, hugely expert diagnostic tech niques, and really expert services. it truly is for that reason no longer magnificent to profit that small and medium-sized hospitals embarking at the prognosis and therapy of bone and delicate tissue tumors are in most cases much less luck ful than larger outfitted significant facilities. This truth has already been well-known via so much physicians and surgeons who now refer their sufferers to really expert oncologic facilities. however, all of them need to be aware of the current cutting-edge. This symposium was once hence often addressed to them. This overseas symposium, equipped through the department of Orthopaedic surgical procedure, collage of Ottawa, and cosponsored by means of the organization des Chirurgiens Orthopedistes du Quebec, used to be held in Ottawa from may well 12-14, 1983. all of the forty displays sincerely demonstrates that forget for correct staging sooner than initiation of remedy and omission of a in actual fact outlined therapy protocol is easily unacceptable in view of the information we have now acquired.
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Extra resources for Current Concepts of Diagnosis and Treatment of Bone and Soft Tissue Tumors
Tumors of bone may arise from the various mesenchymal elements present in and around bone, and have been assumed to recapulate the biologic and histomorphologic characteristics of the tissue of origin of the tumor cells. This histogenetic concept is the basis of all classifications of bone tumors. However, our incomplete knowledge of the cell of origin of several bone tumors (eg, Ewing's sarcoma) has resulted in confusion and difficulty. Historically, Virchow made the first attempt at a classification of bone tumors in 1865.
Complications and difficulties are still possible, particularly in cases of rare or unusual lesions, when the tumor site is inaccessible, or when tissue trauma results in hemorrhage, infection or fracture. with some attention to the details outlined below, however, such complications can be reduced considerably or even prevented by skillful management. General concepts It must be emphasized that in orthopedic oncology biopsy is the only and usually the final part of the staging process. As has been suggested by Enneking, Spanier and Goodman (1980) in their landmark text on staging of musculoskeletal tumors, a series of investigations must be carried out to define the anatomic extent of the lesions (both bone and soft tissue) and to determine whether metastases are present.
41 Planning the biopsy In planning the biopsy, the first requisite is to review all the material obtained in the staging process with the surgical team and the radiologist and pathologist who are in part responsible for establishing the tentative diagnosis. The pathologist, moreover, has to establish the definitive diagnosis and grade the lesion. This is often performed best by a "miniconference" with these individuals as well as the oncologist and radiation therapist. They can all help to decide what sort of biopsy approach is indicated and what sort of primary and adjuvant treatment might be best for various possible diagnoses.