Orthopedic surgery and cancer
Orthopedic surgery is a specialized field of medicine focused on the restoration and preservation of the musculoskeletal system, which includes bones, joints, ligaments, tendons, and muscles. In the context of cancer, orthopedic surgery plays a vital role in treating tumors of the musculoskeletal system, including various bone and soft-tissue sarcomas, as well as cancers that may metastasize to the skeletal structures, such as breast, prostate, and lung cancers. The treatment often involves surgical excision, limb salvage procedures, and sometimes amputation, supplemented by adjuvant therapies like chemotherapy and radiation.
Orthopedic surgeons undergo extensive training, including medical school, a general surgery internship, and a five-year orthopedic residency, followed by a rigorous certification process. This ensures they are well-equipped to handle complex cases, particularly in musculoskeletal oncology, which has seen increased importance as patients live longer with metastatic diagnoses. Advances in technology, such as robotics and 3D printing, have further enhanced the capabilities of orthopedic interventions for cancer patients. Overall, orthopedic surgery is integral to comprehensive cancer care, combining medical expertise with innovative techniques to improve patient outcomes and quality of life.
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Subject Terms
Orthopedic surgery and cancer
DEFINITION: Orthopedic surgery is the branch of medicine concerned with restoring and preserving the normal function of the musculoskeletal system. It focuses on bones, joints, tendons, ligaments, and muscles. Over the last half-century, surgeons and investigators in orthopedics have increasingly recognized the importance that engineering principles play in understanding the normal behavior of musculoskeletal tissues and in designing implant systems to model the function of these tissues.
Subspecialties: Hand surgery, shoulder and elbow surgery, total joint reconstruction (arthroplasty), pediatric orthopedics, foot and ankle surgery, spine surgery, musculoskeletal oncology, surgical sports medicine, orthopedic trauma
Cancers treated: Tumors of the musculoskeletal system, soft-tissue and bone sarcomas, osteosarcoma, synovial cell sarcoma, breast, prostate, and lung cancers, as well as multiple myeloma, which commonly spread to the bone
Training and certification: Orthopedic surgeons must first graduate from medical school, then complete a general surgery internship and a five-year orthopedic residency program. After residency training, a certification process is initiated. The initial process is a two-step evaluation. Completing a written examination qualifies the candidate to undergo an oral examination based on surgical case studies. Certification is based on the successful completion of both exams. Since 1986, the American Board of Orthopedic Surgery has issued time-limited certificates requiring recertification every ten years. The ten-year Maintenance of Certification (MOC) process requires:
- Evidence of high professional standing in the orthopedic surgery community, including a peer review
- Evidence of a commitment to life-long learning and a self-assessment through the completion of 240 related continuing medical education (CME) credits over the ten years; a specific breakdown of credits is required
- Completion of one of three American Board of Orthopedic Surgery (ABOS) knowledge assessments
- Evidence of high performance in practice taken from colleagues
Services and procedures performed: Orthopedics is a broad-based medical and surgical specialty. Services and procedures are based on the following:
- Medical history
- Physical examination: investigation of symptoms and complaints
- Use of laboratory studies: biopsy, blood, and urine
- Imaging diagnostics: X-ray, computed (CT), (MRI), ultrasound, and nuclear medicine
- Staging and classification: of injury, fracture, metabolic condition, or tumor
Treatment protocols are based on selective data. Often the treatment of sarcomas requires surgical excision, limb salvage or amputation, joint reconstruction, and the concomitant use of adjuvant therapies (drugs, chemotherapy, and radiation). Rehabilitation (physical and occupational therapies) is also part of orthopedic treatment.
Related specialties and subspecialties: Orthopedics, which is dedicated to the prevention, evaluation, and treatment of diseases and injuries of the musculoskeletal system, has become subdivided into several subspecialties: trauma, sports medicine, spine, oncology (specialized treatment of and tumors of bones, joints, and muscles), adult reconstructive surgery, foot and ankle, hand and microsurgery, pediatrics, and musculoskeletal rehabilitation (gait, amputation, prosthetics, and orthotics). In the twenty-first century, orthopedic surgery has only increased in importance in oncological care. Patients live longer even with a metastasis diagnosis, and orthopedic treatment has become increasingly critical. Technological advancements, such as robotics and three-dimensional (3D) printing, have increased the effectiveness of orthopedic interventions for cancer patients.
Bibliography
Bernstein, J., editor. Musculoskeletal Medicine. Rosemont: American Academy of Orthopedic Surgeons, 2003.
Canale, S. Terry, editor. Campbell’s Operative Orthopaedics. 12th ed., St. Louis: Mosby, 2012.
Green, W. B., editor. Netter’s Orthopedics. Philadelphia: Saunders/Elsevier, 2006.
Menendez, L., editor. Orthopaedic Knowledge Update: Musculoskeletal Tumors. Rosemont: American Academy of Orthopedic Surgeons, 2002.
Miller, M., and M. Brinker, eds. Review of Orthopedics. 6th ed., Philadelphia: Saunders, 2012.
“MOC.” ABOS, 1 Jan. 2024, www.abos.org/moc. Accessed 28 June 2024.
“Orthopedic Oncology - Overview.” Mayo Clinic, 19 Oct. 2023, www.mayoclinic.org/departments-centers/orthopedic-oncology/sections/overview/ovc-20553274. Accessed 28 June 2024.
Skinner, H. B., editor. Current Diagnosis and Treatment in Orthopedics. 5th ed., New York: McGraw, 2014.
Weinstein, S. L., and J. A. Buckwalter, editors. Turek’s Orthopaedics: Principles and Their Application. 6th ed., Philadelphia: Lippincott, 2005.
Wold, L. E., C. Adler, F. Sim, and K. Unni, editors. Atlas of Orthopedic Pathology. 3rd ed., Philadelphia: Saunders, 2008.
Organizations and Professional Societies
American Academy of Orthopedic Surgeons (AAOS)
, 6300 North River Road, Rosemont, IL 60018.
American Board of Orthopedic Surgery (ABOS)
, 400 Silver Cedar Court, Chapel Hill, NC 27514.