Musculoskeletal Tumors

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What is a musculoskeletal tumor?

A musculoskeletal tumor is an abnormal growth that can develop in the bones, muscles or soft tissues of the body. These tumors can vary widely in their behavior and impact on health. Some tumors grow slowly and stay in one place, while others can grow quickly and spread to other parts of the body. The most common types of musculoskeletal tumors include osteosarcoma (a type of bone cancer), osteochondroma (a benign bone growth) and rhabdomyosarcoma (a cancer that starts in muscle tissue).

Benign (Non-cancerous) Tumors

A benign tumor is a non-cancerous growth. This means it doesn’t spread to other parts of the body and usually grows slowly. While some benign tumors only require observation and monitoring by a doctor, others may cause problems, especially in growing children. Without proper treatment, certain benign tumors can lead to pain, growth issues, deformities and differences in limb length.

Types of benign musculoskeletal tumors include:

• Osteochondroma: A growth made of bone and cartilage, usually found near the ends of long bones, like in the arms or legs.
• Chondroblastoma: A rare tumor that usually affects the growing parts of bones in children and teens.
• Enchondroma: A slow-growing tumor that forms in the cartilage, often found in the hands or feet.
• Giant Cell Tumor: An aggressive noncancerous tumor that usually develops near joints, like the knee.
• Aneurysmal Bone Cyst: A blood-filled cyst that can form in long bones or the spine.
• Baker’s Cyst: A fluid-filled cyst that forms at the back of the knee.
• Hemangiomas: Tumors made up of a cluster of blood vessels, which can occur anywhere in the body.
• Ganglion Cysts: Fluid-filled lumps that often form on the wrists or feet.
• Non-Ossifying Fibroma (NOF): A common, non-cancerous bone tumor that usually doesn’t cause symptoms.
• Fibrous Dysplasia: A condition where scar-like tissue replaces normal bone, which can lead to fractures and deformities.
• Osteoid Osteoma: A small, non-cancerous tumor that often occurs in the long bones of the legs.
• Unicameral Bone Cyst: A fluid-filled cavity that can weaken bones and increase the risk of fractures.
• Lipoma: A non-cancerous tumor made of fat tissue, usually found just under the skin.
• Desmoid Tumors: Tumors that develop from connective tissue and can grow aggressively, but they don’t spread to other parts of the body.
• Multiple Hereditary Exostosis (MHE): A genetic condition where multiple non-cancerous bone tumors, called exostoses, develop, often near the growth plates in long bones.
• Langerhans Cell Histiocytosis: A rare disease where the body makes too many blood cells (histiocytes) within the body.
• Avascular Necrosis (AVN): This condition occurs when a lack of blood supply causes bone tissue to die. It can also be called osteonecrosis.  

Malignant (Cancerous) Tumors

A malignant tumor is cancerous, which means it can grow quickly and spread to other parts of the body. Malignant tumors are serious and need to be treated as soon as possible. While a cancer diagnosis can be scary, know that our team is here to support your child and family every step of the way. Our goal is to remove the tumor and optimize your child’s recovery and function.

Types of malignant musculoskeletal tumors include:

• Osteosarcoma: A type of bone cancer that often starts in the long bones of the legs or arms.
• Ewing Sarcoma: A bone cancer typically found in children and teens that can start in the bones or in the soft tissue around them.
• Rhabdomyosarcoma: A cancer that begins in the muscles and can affect various parts of the body.
• Fibrosarcoma: A cancer that starts in fibrous tissue, which can affect soft tissues like muscles and tendons.

Treatment of Non-cancerous Musculoskeletal Tumors in Children

Our team of pediatric orthopedic surgeons and oncologists work together to manage noncancerous, or benign, musculoskeletal tumors in children, including:

• Observation and Monitoring: Many benign tumors are watched over time with regular check-ups and imaging. This helps our team keep track of the tumor’s growth and decide if treatment is necessary.
• Noninvasive Treatments: Some benign tumors can be treated without surgery using medications or injections. These options may help shrink the tumor or manage symptoms.
• Surgical Removal: If the tumor is causing problems like pain or affecting bone growth, surgery might be needed. Our surgeons are skilled at removing tumors while saving as much healthy tissue as possible.
• Curettage and Bone Grafting: For some tumors, the surgeon may scrape out the tumor from the bone in a procedure called curettage. Afterward, a bone graft might be used to fill the space, helping to strengthen the bone.
• Bone and Soft Tissue Transplants: If a tumor affects a large area of bone or tissue, transplants can be used to restore the damaged part.
• Microvascular and Muscle Transfer: This involves transferring tissue, such as skin, bone or muscle, along with its blood vessels from one part of the body to another.
• Rehabilitation Therapy: After treatment, your child might need physical or occupational therapy to help them regain strength and movement, especially if the tumor affected their growth or mobility.

Treatment of Cancerous Musculoskeletal Tumors in Children

We use a variety of treatments to help kids with cancerous, or malignant, tumors. While every tumor is different, treatment involves a multidisciplinary team of doctors and may include imaging or surgery options, including:

• Chemotherapy: Chemotherapy uses strong medicines to kill cancer cells or stop them from growing. It’s often given before surgery to shrink the tumor, making it easier to remove, or after surgery to target any remaining cancer cells.
• Radiation Therapy: Radiation therapy uses high-energy rays to destroy cancer cells. It can be used on its own or with chemotherapy and surgery, depending on the tumor’s location and size.
• EOS Imaging:  EOS imaging is an advanced X-ray technology that uses significantly less radiation than traditional X-rays or CT scans. An EOS scan can help doctors make a diagnosis, plan for surgery, monitor tumor progression and design prosthetics.
• Surgery: Surgery is usually needed to remove cancerous tumors. At CHOC, we focus on limb salvage surgery when possible. This means we try to remove the tumor while saving as much of the affected limb as we can.
• Limb Salvage Surgery and Reconstruction: When a tumor affects a limb, we aim to remove it without amputating the limb. Reconstruction may include bone and tissue transplants, bone graft substitutes or special devices that can grow as your child grows.
• Amputation: Sometimes, the surgical removal of a limb or body part is the best way to ensure a child lives a full and brighter future. If amputation is recommended, our medical team will do everything possible to maintain optimal mobility and functionality.  
• Custom Prosthetics: Often called artificial limbs, prosthetics are medical devices made to replace and restore the function of all or part of a missing or amputated body part, such as an arm or leg. CHOC specializes in creating custom prosthetics made for growing children.
• Plastic Surgery: After tumor removal, plastic surgery might be needed to restore how the affected area looks and works. This can include rebuilding bones, muscles and skin to help your child’s limb look and function naturally.
• Rehabilitation and Support: After surgery and treatment, rehabilitation is important for helping your child regain strength, mobility, and independence. Our team also offers emotional and psychological support to help your child and family deal with the challenges of cancer treatment.