Conditions We Treat

Not all tumors are cancerous, but even benign tumors can affect your quality of life. At UR Medicine, we treat all kinds of bone tumors successfully on a regular basis. Contact us to schedule an appointment for an exam, diagnosis, and treatment plan for your orthopaedic tumor.

Benign (Non-cancerous) Bone Tumors

• Aneurysmal Bone Cyst (ABC): Usually found in people younger than 20, this blood-filled sac forms on a vertebra (a bone in the spine) or in an arm or leg. A bony wall surrounds the sac. While this tumor is not cancerous, it can cause pain, swelling, stiffness, and difficulty with movement, and it can disrupt normal growth in children and teenagers. The tumor must be surgically removed.

• Benign Vascular Tumor: This rare tumor is solitary, occurring in just one bone in the body. It may have no symptoms at all—so treatment often consists of watchful waiting until the tumor causes pain, swelling, or a fracture. The tumor can be removed surgically if it becomes uncomfortable.

• Chondroblastoma: This very rare tumor occurs most frequently in adolescent boys, making its appearance at the end of a bone in an arm or leg. This places it very close to a growth plate, where it can disrupt normal growth of the limb. Surgery is usually the best option.

• Chondromyxoid Fibroma: Young adults between 20 and 30 most often develop this rare tumor, though it can appear in people of any age. The mucous-like tumor usually develops in the leg, and it requires surgery to remove it completely. After the surgery, your doctor will want to see you regularly for several years to be sure the tumor has not returned.

• Enchondroma: The most common tumors of the hand, these non-cancerous tumors can form in the hands, feet, or long bones of the arms or legs, and they are usually found in children as young as 10 or in early adulthood. You may notice an enlarged finger or other deformity, or your hand or foot may fracture for no obvious reason. Correct diagnosis is very important to be sure that you do not have one of several syndromes that cause these tumors—and that your tumor is indeed an enchondroma and not a cancerous growth.

• Fibrous Cortical Defect (Non-Ossifying Fibroma):As many as 40 percent of all children between the ages of 4 and 8 may have this common tumor (also called a lesion) in the thighbone. Chances are your doctor will discover it during an x-ray for another purpose—the defect causes very little pain and is harmless if it does not weaken the bone. Left alone, the tumor will disappear by the time the child reaches adulthood. If the bone looks weakened, however, your doctor may recommend that the tumor be surgically removed to avoid a fracture.

• Fibrous Dysplasia: In this uncommon genetic disorder, a fibrous tissue grows in place of part of the normal bone. The bone becomes weak in the area that has this tissue, causing a deformity or a fracture. Fibrous dysplasia tends to reveal itself in adolescents and young adults.

• Giant Cell Tumor of Bone (GCT): When several individual cells fuse together to form a complex of cells, they may create this benign bone tumor. GCTs usually occur at the end of the long bones of the arm or leg, near the joint. You may have pain when you bend the affected joint, or you may see a swollen area near the joint. While these tumors are not cancerous, they will continue to grow and destroy bone—so your bone may fracture in the area of the tumor. A surgeon will use a procedure called curettage to scoop out the tumor and fill the gap with a bone graft taken from another part of your body.

• Langerhans Cell Histiocytosis (Eosinophilic Granuloma): Found mainly in adolescents and young adults, this rare bone disorder occurs when the body produces too many of a specific kind of white blood cell (Langerhans cell), one of the cells that helps fight infection. While only one or two adults per million are diagnosed with this LCH annually, 46 percent of people who have LCH have bone tumors—and many of these patients will be affected in other parts of their bodies as well. UR Medicine's Orthopaedics will work closely with all of the specialists required to treat your LCH. 

• Multiple Enchondromatosis (Ollier Disease): When benign tumors known as enchondromas (see above) form close to the growth plates in children, they can cause the affected limb to be shorter than the unaffected one. When these tumors are found, a surgeon can remove them and fill the area with a bone graft from another part of the body.

• Osteoblastoma: This rare, noncancerous tumor develops in a leg, hand, foot, or the bones of the spine. Most often found in male adolescents and young adults, it can become quite large and destroy bone as it grows. Osteoblastomas need to be removed surgically to prevent them from doing significant damage.

• Osteochondroma: Children and adolescents may develop one or more of these benign tumors. The tumor grows on the surface of a bone, and it usually appears near a growth plate—an area of cartilage that hardens into bone when the child is fully grown. Doctors will monitor the tumor for any changes, but treatment is not required in most cases. If the tumor causes pain or puts pressure on a nerve, it can be removed surgically.

• Osteoid Osteoma: Found most commonly in the long bones of the thigh and leg, these small tumors can appear in any bone in the body. They cause a dull ache in the area of the tumor, and people often bear this nagging pain for years before seeing a doctor for a diagnosis. Surgery is the fastest and most effective way to remove the tumor and end the pain. In many people, however, the tumors will shrink and disappear over a period of years, so some patients choose pain management over surgery.

• Solitary Osteocartilaginous Exostosis (OCE) or Osteochondroma: Unlike many of the tumors mentioned above, this benign bone tumor is caused by a genetic defect. It appears as a hard, painless, stationary lump at the end of a bone, with a cartilage cap that allows it to continue to grow. A surgeon can remove this tumor if it begins to cause pain or if the bone is in danger of fracturing.

• Unicameral Bone Cysts: These cysts are found in children, usually on the long bones of the arm or leg, and they reveal themselves in an x-ray for another purpose (such as a bone fracture). Therapy for bone cysts usually involves a series of injections in an outpatient procedure, during which you will be under general anesthesia. In a few cases, inpatient surgery may be required to scoop out the cysts and fill the area with a bone graft from another part of your body.

Benign Soft (Connective) Tissue Tumors

• Fibroma and Fibromatosis: Fibromatosis refers to a group of benign tumors that wind their way through the muscles connected to bones. They can be very painful, and they will grow aggressively if not treated. Your medical team will discuss the various options for treatment, which may include radiation therapy, surgery, or both.

• Ganglion or Synovial Cyst: These round or oval lumps may form on the tendons or joints of your ankles or feet. They are non-cancerous and filled with a jelly-like fluid, and they may be painful if they press on a nerve. These often go away on their own, but your doctor can treat your cyst as well.

• Hemangioma: A tumor that involves the blood vessels, a hemangioma can take a number of forms: It may include only the smallest blood vessels (capillaries), or it may invade the tissue and involve the large vessels—or it may capture some of both. Once you have had an MRI and your doctor has determined the location and extent of the tumor, you will have a number of options for treatment.  Many hemangiomas can be treated with over-the-counter pain relievers and compression stockings, while others require surgery. Several new therapies may be appropriate for your specific situation.

• Lipoma: This soft tissue tumor is made of fat, and it usually will not cause any issues unless it begins to press on the surrounding nerves. You may have this slow-growing tumor for many years before you consider having it treated, especially if it is in a place on your back, shoulders, or abdomen that the general public does not see. If it becomes so large that it interferes with your daily life, or if it is simply unsightly, surgical removal is an option.

• Myositis Ossificans: This soft tissue mass appears after a major blow—after an accident, for example. A bony mass may form and continue to grow over the tendons or muscles for about 8 to 12 weeks, and it may or may not be painful. In most cases, this tumor will appear on the buttock, upper arm, or thigh. An x-ray and a CT scan will help your doctor determine if the growing mass is a myositis ossificans or a sarcoma (cancer tumor). The myositis can be removed after it has matured (at 12 weeks), when recurrence is less likely.

• Neurofibromas and Neurofibromatosis: Tumors made of nerve tissue may occur in groups or as a single tumor, and they may appear just about anywhere on the body. Your doctor may refer to this kind of growth as a nerve sheath tumor or schwannoma, because the tissue resembles the envelope around the nerve itself. These tumors are a genetic disorder that reveals itself in childhood, and while some neurofibromas are very small, others can grow to become a deformity. Large or painful tumors can be removed surgically.

• Pigmented Villonodular Synovitis (PVNS):The lining of a joint is called the synovial membrane, and when it becomes thick, the joint swells and fills with fluid. This condition usually appears in the hip or knee, and while the initial symptoms may be similar to many other conditions, an MRI will show the thick joint lining and fluid that signal PVNS. The tumor can be removed in surgery, and additional procedures may be required if the condition has spread and the joint has been damaged.

Malignant Bone Tumors

• Adamantinoma: This very rare tumor forms in one of the long bones (arm or leg), most often in the tibia (shinbone). You may feel a mild pain in your shin, as well as a firm but palpable mass in the shin area. The skin over this mass will be stretched and shiny. Once diagnosed, your surgeon will remove the tumor and a section of the bone, and will replace it with a bone donation from a cadaver. In some cases, amputation may be required to keep the cancer from spreading.

• Chondrosarcoma: A malignant tumor that makes cartilage as it grows, chondrosarcoma occurs most often in adults between the ages of 40 and 60, in the hip, pelvis, thighbone, shoulder or knee. A persistent ache that feels like arthritis is often the first symptom, along with a mass under the skin that grows over time. Surgery is required to remove the tumor and the surrounding bone, and to reconstruct the bone using a metallic insert or a donation from a cadaver (allograft).

• Chordoma: This slow-growing tumor establishes itself in the sacrum, the triangular bone at the base of the spine. Chordoma may cause uncomfortable symptoms like constipation, pain radiating down the legs, lower leg weakness, and loss of bowel or bladder control. Surgery is required to remove the tumor, and radiation therapy may be used before and after surgery. UR Medicine's Orthopaedics and the Wilmot Cancer Center keep abreast of new developments in therapies for chordoma, including heat ablation and proton beam therapy.

• Ewing's Sarcoma: An uncommon cancer that affects children and adolescents, this cancer comes from a change in a chromosome that takes place sometime after birth. It usually starts in the long bones of the legs and arms, but we do find it in the chest, pelvis, back, or head as well. Early diagnosis can make an important difference in treating this bone cancer.

• Malignant Fibrous Histiocytoma of Bone: This rare bone tumor makes itself known first with pain and swelling in a bone or joint, or with a bone that breaks for no obvious reason. Doctors at UR Medicine's Orthopaedics & Physical Performance will use x-rays, a CT scan, and an MRI to determine the exact position of the tumor, and a biopsy to diagnose its cause. Surgery to remove the tumor is the first option, followed by chemotherapy.

• Malignant Lymphoma of Bone: Less than 5% of all malignant bone tumors are lymphomas. These cancers usually are discovered when a patient has pain that begins in one area—most often the thigh—and gets worse over time, while a mass of soft tissue develops in the painful area. Doctors will use imaging to find the damaged area of bone, and a biopsy to examine the cells in that area to determine if lymphoma is present.

• Metastatic Bone Tumors of the Skeleton: When cancer begins in an organ and spreads to the bone, this advancement of the disease is called metastasis. Many forms of cancer can spread to the bones—the most common ones begin in the breast, lungs, thyroid, kidney and prostate. When cancer moves into a bone, it causes pain and fractures that can alert your doctor to its presence in a limb or other area. Treatment focuses on managing pain and keeping the disease from spreading further.

• Myeloma Bone Diseases/Multiple Myeloma: This cancer affects the marrow of the bone, where stem cells develop into blood (plasma) cells. In a healthy person, new bone cells constantly replace older, worn out cells, keeping the bones strong. When a person has multiple myeloma, the bone marrow produces malignant cancer cells instead of healthy plasma cells and new bone. These malignant cells travel into the bone, replacing the fatigued bone cells with cancerous cells. The bones weaken and fracture, and an x-ray shows dark areas that look like holes in the bone. Many treatment options are available for this disease—your doctor will work with you to discover which therapies are right for your case.

• Osteosarcoma (Osteogenic Sarcoma): This is the most common form of bone cancer, one that begins in the bone cells that form new bone tissue. Children and adolescents produce a lot of new bone as they grow, so these cancers tend to show up in teenagers, appearing first at the end of the long bone in an arm or leg. Once the tumor has been found, surgery and chemotherapy are used to remove the affected tissue and reduce the chances that the cancer will return.

Malignant Soft Tissue Tumors

• Angiosarcoma: In this rare form of cancer, malignant tumors develop from blood vessels in muscles, tendons, or ligaments. Symptoms may include bone pain, fatigue, anemia, swelling, and a visible lesion on the skin over the tumors. Surgery, chemotherapy and radiation are all treatment options, and you may require additional treatment for conditions caused by the cancer, including pain and anemia.

• Fibrosarcoma: This cancer affects the fibrous tissue that forms muscles, ligaments, and tendons. Usually found in the arms, legs, or torso, it occurs most often in adults between the ages of 20 and 60. Fibrosarcoma grows slowly and generally does not spread to other parts of the body.

• Leiomyosarcoma: Found most often in the area behind the abdomen, these tumors affect internal organs including blood vessels, the reproductive system, and the stomach and intestines. This cancer affects women in their 50s and 60s twice as often as men, usually emerging as a painless mass that gets larger over time. You may lose weight for no obvious reason, and you may have discomfort in the abdominal area. Treatment depends on the kinds of leiomyosarcoma you have, but you will be treated by UR Medicine's team of sarcoma specialists at the James P. Wilmot Cancer Center, where you may have surgery, radiation therapy, and/or chemotherapy based on the stage of your disease.

• Liposarcoma: This rare cancer begins in the fat cells in any part of the body, but it most often emerges in the limbs and abdomen. You may discover a large mass in the soft tissue of an arm or leg, and it may not be painful for some time—so many patients do not realize that this mass is a tumor until it affects their ability to function. Your doctor will use a biopsy of the tumor to determine if it is a sarcoma. Surgery to remove the cancer is usually the best option for treatment, followed by radiation to defeat any remaining cancer cells.

• Malignant Fibrous Histiocytoma (MFH): The most common soft tissue cancer, MFH occurs in thousands of patients annually—but researchers have not yet discovered what causes it. It can appear in any part of the body, but it most often emerges in the thigh or other parts of the leg. Patients first notice a firm mass in the leg that grows larger over time, usually without causing pain until it begins to compress a nerve. Your doctor will use an x-ray and an MRI to examine the mass, followed by a biopsy if he or she believes you have a sarcoma. Surgery, radiation and chemotherapy are possible treatments.

• Malignant Peripheral Nerve Sheath Tumor (Malignant Schwannoma, Neurofibrosarcoma): A cancer of the connective tissue surrounding the nerves, this kind of sarcoma is found in the nerve plexus, the central point from which nerves branch out into the limbs. Patients may have swollen arms or legs, trouble moving the affected arm or leg, soreness, pain, numbness, burning, tingling, dizziness, and loss of balance. While researchers don't know exactly what causes the disease, it seems to come from a defect in a specific chromosome, making it possible that this form of cancer is genetic. Your doctor will take a biopsy of the tumor to test it for cancer, and he or she may follow this with an MRI, X-ray, CT scan, and bone scans to determine if the cancer has metastasized. Surgery will be required to remove the tumor, followed by radiation therapy and/or chemotherapy.

• Rhabdomyosarcoma: These malignant tumors appear in the connective tissues of your arms or legs, and they are made of cells that normally would become tendons, ligaments, or muscles. They are found most often in older children and teens, in the large muscles of the arms, legs, and trunk. These cells multiply quickly, making this kind of tumor difficult to treat. Surgery, chemotherapy, radiation, and (in rare cases) stem cell transplant are all possible treatments.
  
  
• Synovial Sarcoma: Found most often in the arms or legs, this cancer comes from a genetic mutation and affects three in a million people annually, making it a rare form of the disease. It comes to light as a painless, slow-growing mass, and fewer than 10 percent of cases have any metastasis at the time of diagnosis. Your doctor will use x-rays, ultrasound, a CT scan, and/or an MRI to evaluate the mass. If he or she suspects a sarcoma, you will have a biopsy of the mass to see what the cells contain. Surgery to remove the tumor is likely, and you may have chemotherapy afterward to prevent any spreading of cancer cells.