Primary bone sarcomas are more common in children than adults. At Sylvester Comprehensive Cancer Center, the surgeons have experience in treating patients of all ages. If a patient is under 18 years of age, then our pediatric hematologist/oncologist who specializes in sarcoma will treat the patient. If a person is 18 years old or more, our sarcoma adult medical oncologist will be the treating physician.

Osteosarcoma
Osteosarcoma is the most common primary bone cancer. Depending on location and subtype it is typically treated with chemotherapy and surgery.

Chondrosarcoma
The tumors arise in bone but the cell of origin is cartilage. There are several different subtypes of chondrosarcoma and treatment is based on why type.

Ewing’s Sarcoma
These tumors can arise in the bone or soft tissue but are treated with same with a combination of chemotherapy, surgery and/or radiation.

Giant Cell Tumor of the Bone
This is a benign tumor but can behave aggressively. Treatment involves surgery and molecularly targeted treatment.

Tests

In addition to a physical exam and review of your medical history, the following tests and procedures may be used to diagnose primary bone cancer:

X-ray
Doing an X-ray of bones and organs in the region of symptoms can give important information.

Computed Tomography (CT or CAT) Scan
Computed tomography is a procedure in which detailed pictures are taken inside the body from different angles. A colorful dye helps the organs or tissues to show up clearly.

Magnetic Resonance Imaging (MRI)
An MRI uses magnets, radio waves, and a computer to create images showing the inside of the body and any abnormalities.

Bone Scan
Allows us to see any rapidly dividing cells, such as cancer cells, in the bone. A safe, very small amount of radioactive material is injected into a vein. The material collects in the bones and can be detected by a scanner.

Positron Emission Tomography (PET) Scan
Similar to a bone scan, PET scans use a slightly radioactive sugar that is injected into the bloodstream. The radioactive sugars collect in tumors, where it can be detected with a special camera. PET scans help locate tumors and determine if cancer cells are spreading.

Biopsy
In nearly all cases, the doctor will remove (biopsy) a sample of cells and tissue from your tumor to confirm the diagnosis. A pathologist, or cellular expert, will look at the sample under a microscope to check for cancer.

• Tumor biopsy: A tumor biopsy occurs when the biopsy and the surgery to remove the tumor are planned together.

• Light microscopy: With the removed tissue, the pathologist looks for certain changes in the cells. Your surgeon can measure what tissues and length of bone are involved to judge what has to be removed, and what can be saved.

Treatments

Surgery
Decisions are based on the size and stage of the cancer, as well as other individual factors. After the doctor removes all the cancer that can be seen at the time of the surgery, patients are then given chemotherapy to kill any cancer cells that are left, or that have spread to other parts of the body. Types of surgery include:

• Wide Local Excision: In this surgery, your doctor removes the cancer and some healthy tissue around it.

• Limb-Sparing Surgery: In this procedure, your surgeon removes the tumor in an arm or leg without having to amputate, so the use and appearance of the limb are protected. The tumor is extracted by a wide local excision. If the surgeon removes additional tissue and bone, it may be replaced with a graft or with an implant such as artificial bone.

• Amputation: Surgery to remove (amputate) an arm or leg is rarely needed. In some cases, it may be the best option. Today, Sylvester surgeons have the ability to replace any joint in the body, including shoulders, knees, hips, or elbows with custom-designed artificial prostheses or bone grafts. The choice of technique depends on your individual situation.

Radiation Therapy
Precisely targeted to your tumor and delivered from outside the body (called external beam radiation therapy) to treat the cancer or to relieve symptoms. Advanced technology working for you includes intensity modulated external radiation therapy (IMRT) and ViewRay™ MRI-guided radiation therapy. These tools offer you better tumor targeting and less potential damage to surrounding healthy tissue.

Chemotherapy
Chemotherapy is usually given in a treatment plan with surgery or radiation therapy to increase its cancer-killing impact. Typically a combination of cancer-fighting drugs is administered intravenously or by pill orally (by mouth).

If you require intravenous (infusion) chemotherapy, you can have it at the Comprehensive Treatment Unit (CTU) at Sylvester's main location in Miami, a 12,000-square-foot unit that includes 33 recliners and 11 private rooms. If you prefer, you may have your infusion treatments in the many different satellite locations throughout South Florida.

Targeted Therapy
Designed to attack the molecular changes/alterations that make cancer cells grow and spread. Target therapies are available for select patients, as recommended by your Sylvester oncologist. Some medicines are delivered along with chemotherapy medicines, while others may be used by themselves. The objective of these treatments is to prevent the cancer from growing. It may also be used to direct chemotherapy more effectively to the tumor.

Clinical Trials
Clinical trials may be considered and discussed with you as either as a standalone treatment or as an addition to another therapy. Clinical trials are the newest research studies available, focused on creating the improved next-generation standard of care.

Immunotherapy (Biologic Therapy)
Drugs or combinations tap into the power of the body’s own immune systems to fight cancer.

Why Choose Sylvester Comprehensive Cancer Center?

Sylvester is an NCI-designated cancer center. The National Cancer Institute has recognized Sylvester for its outstanding work conducting research in its laboratories, treating patients in its clinics and hospitals, and reaching out to medically underserved communities with innovative prevention strategies.

High volume experience treating many cases of sarcoma, bone, and soft tissue cancers. Because we see so many patients with sarcoma, bone, and soft tissue cancers, we have the experience needed to provide better outcomes with fewer potential complications.

Targeted therapies and clinical trials for patients with tumor mutations. We offer the most advanced treatment options available in South Florida.

Advanced radiation oncology tools. Sylvester was the first medical center in Florida, and the fourth in the country to offer resonance magnetic-guided radiation therapy. Our team is a leader in that domain. Our RapidArc^® radiotherapy system delivers intensity-modulated external radiation therapy (IMRT). These tools lead to more efficient and effective treatments, shorter treatment times, pinpoint accuracy in tumor targeting and less damage to surrounding healthy tissue. Finally, our radiation oncology department also offers proton beam therapy in our state-of-the-art Dwoskin Proton Therapy Center.

The only designated Cancer Centers of Excellence in South Florida. You can rest easy knowing you are in the best possible place to treat your cancer.

Comprehensive sarcoma tissue bank and registry. You can help future patients by participating in research that helps create tomorrow’s improved therapies.