Orthopaedic Oncology
sub-specialty forms new society

Doug Thomson
Executive Director
Canadian Orthopaedic Association
Dennis Jeanes

Special to the Canadian Orthopaedic Association

The last time osteosarcoma made headlines was about 30 years ago, when Terry Fox started out from Halifax on his legendary run across Canada. The lack of profile since is hardly surprising, given that this rare cancer (that would famously claim Fox's life in 1981) has an annual incidence rate of roughly one in a million.

What is a surprise, and seems to have escaped the headlines, is that where an osteosarcoma patient had a 5% chance of survival three decades ago, the odds have now improved substantially. "If Terry Fox were alive today and developed his tumour, there's a 75% chance that he'd be cured and a 95% chance he would keep his leg," says Dr. Peter Ferguson, an orthopaedic oncologist at Toronto's Mount Sinai and Princess Margaret Hospitals. "In fact, there are not many areas in cancer treatment where there has been such a significant improvement as in primary bone tumours."

Clearly there's some catching up to do. Advances in chemotherapy throughout the 1980s and 1990s has led to the modern era of orthopaedic oncology, says Ferguson: "We realized patients were surviving and that maybe we shouldn't be doing amputations. Now the vast majority of patients have limb-salvage surgery that preserves the limb and function."

For osteosarcoma, which usually arises in the femur just above the knee, orthopaedic oncologists essentially perform a replacement of the distal femur and knee joint, but, says Ferguson, since their patients are usually in their late teens and early twenties "they're looking at a lifetime - hopefully a long lifetime - of having a prosthesis and multiple revisions." Orthopaedic oncologists also treat soft-tissue sarcomas, some of which can "involve very large muscle resection, often done in concert with microvascular surgeons to provide soft-tissue coverage for the area." And since all of Canada's orthopaedic oncologists are affiliated with large cancer centres, they regularly work on metastatic bone disease - "fairly straightforward things such as fractures or impending fractures of the femur or humerus." Occasionally, they might take referred patients "with complex metatstatic acetabular disease that requires extensive reconstruction."

Recently, Ferguson has spearheaded an effort to bring together Canada's 17 orthopaedic oncologists (about half of whom have full-time oncology practices) as the Canadian Orthopaedic Oncology Society (CANOOS). "Our interest," he explains, "is to be able to garner a significant number of patients to do some national multi-centre studies. And with the number of surgeons we have, we'll probably be able to cover the catchment area for the entire country." One project under consideration is to build "a large data base and look prospectively at quality-of-life outcomes in patients with metastatic bone disease - something that's never been looked at, mainly because we try to minimize the number of visits the patients have to make to the hospital."

Continuing education is another concern. As a rule, according to Ferguson, general orthopaedic surgeons know how to accurately assess patients with bone and soft tissue tumours, what to do and not do, and where to refer them. But other sub-specialties are less sure-handed. "I see about three or four patients a week who have been inappropriately managed by other specialists," he says, "and it often has very significant consequences with respect to patient outcomes."

Noting that there is no standard, comprehensive textbook on orthopaedic oncology, Ferguson suggests half-jokingly that Society members might perhaps fill the void through a collective effort and that the end-result of such an enterprise "could be of value to residents and perhaps even to general orthopaedic surgeons who might deal with these problems once in a while. Let's see. I figure 17 chapters...one chapter per person...."

Truth be told, orthopaedic oncology is a relatively small clinical community; still, Ferguson welcomes any orthopaedic surgeons with a special interest in oncology to contact him about CANOOS at This e-mail address is being protected from spam bots, you need JavaScript enabled to view it .