Surgery, Limb-Sparing, Implants for Sarcoma

Patients with sarcoma will probably need surgical treatment combined with radiation or chemotherapy, as a general rule. At SCCA, physicians like to give radiation therapy and chemotherapy before surgery to reduce tumor size.

Surgery follows chemotherapy or radiation therapy for fast-growing sarcomas. Chemotherapy is given before surgery, to shrink the tumor and also to help prevent the cancer from spreading to the lungs or elsewhere.

Giving chemotherapy or radiation treatment before surgery is referred to as neoadjuvant therapy.

Surgery for SCCA's adult sarcoma patients is performed at University of Washington Medical Center by surgeons who provide care at both UW Medical Center and SCCA.

Our surgeons perform about 600 surgeries a year on adult sarcoma patients, including 100 surgeries to save the limbs of patients with bone cancer. Surgery involves removing the tumor and saving the extremity in the vast majority of cases.

Most people with bone cancer will have surgery to remove the cancer. In some cases however, amputation will be necessary. If the cancer has spread to the lymph nodes, the affected glands will be removed as well. A bone transplant or a metallic implant will replace the damaged bone. 

Cryosurgery

Cryosurgery is a procedure that uses liquid nitrogen to freeze the diseased area to kill microscopic tumor cells, decreasing the chances that the tumor will return. At SCCA, we use cryosurgery to treat aggressive benign bone tumors and some malignant tumors.

Limb-Sparing Surgery

The Sarcoma Service's Limb-Sparing Program is one of the largest in the United States.

Our goal is to safely treat your cancer without amputating your arm or leg if at all possible. For 19 out of 20 patients with bone cancer, we are able to spare the limb, removing only the cancerous bone and replacing it with either a metallic implant or a bone transplant, thanks to the Northwest Tissue Center.

If your cancer is close to a joint, such as a knee, your doctor will want to use a metallic implant, or artificial joint. If your surgery will not require removing a joint, then your doctor will use a bone transplant to replace the diseased bone.

In limb-sparing surgery, radiation therapy or chemotherapy (or sometimes both) are used to shrink the tumor before surgery. Then the tumor and some surrounding bone and tissue are removed and replaced with either bone or a metallic implant. In some cases, surgery is done first, followed with radiation, chemotherapy, or both to kill any remaining cancer cells.

Typically, you will have just one operation to remove the cancer and place the implant or transplant. In some cases, follow-up surgeries are needed to take care of problems with an artificial joint.

Our doctors are working to improve both surgical techniques and the implants themselves. In 2001, the Sarcoma Service won a five-year grant for $750,000 to build new knee implants for tumor patients.

Our patients who receive joint replacements are tracked through the Implant Registry.

Implants

Our goal at SCCA is to safely treat your cancer without amputating your arm or leg if at all possible. For 19 out of 20 patients with bone cancer, we are able to spare the limb, removing only the cancerous bone and replacing it with either a metallic implant or a bone transplant, thanks to the Northwest Tissue Center. Amputations are sometimes unavoidable.

If your cancer is close to a joint, such as a knee, your doctor will want to use a metallic implant, or artificial joint, to replace the diseased bone. Both children and adults can be treated with these procedures.

The most common joint involved by bone cancer is the knee, and we do more surgeries to replace the knee joint than any other location. It is also possible to use a metallic implant to replace an elbow, hip, or shoulder, if your cancer is close to one of these joints.

During your surgery, your doctors will remove several inches of bone on either side of the joint. The implant, which is something like a flexible hinge made of metal and plastic, will be cemented in place. Your own muscles and ligaments will be reattached, as will your knee cap, if possible.

You can learn more about these implants at Stryker Howmedica Osteonics or Zimmer, Inc.

Possible complications with implants include infection, loosening of the cement that holds the implant, and wear and tear on the joint from use, and the need for multiple surgeries. For young patients in particular, the joint may have to be replaced after several years. Some people experience weakness in the limb, because of muscles and other tissues that were lost during surgery.

Implant Registry

Patients treated with a metallic tumor prosthesis (joint replacement) at SCCA will have their surgery at one of SCCA's parent organizations, UW Medical Center or Children's Hospital & Regional Medical Center, and will be carefully tracked through the Implant Registry. The registry tracks patients' functional results and causes of implant failure, if any.

The Implant Registry is sponsored by Stryker Howmedica Osteonics or Zimmer, Inc. It allows our patients to receive accurate information on the need for follow-up and also receive education on their future limitations and performance abilities with an artificial joint.  

Tissue Bank

When bone or tissue is removed during cancer treatment surgery it is often replaced with donor tissue or bone from the Northwest Tissue Center.