Cancers and Tumors

Bone and Soft Tissue Tumors Treatment

Your child's treatment will depend on several factors, including the type of tumor, the progress of the tumor and your child's medical history.

Benign Bone Tumors Treatment Options

Some benign bone tumors only need to be checked once a year and may clear up on their own. Sometimes children with benign bone tumors need to wear a brace, splint or boot for four to six weeks to allow their bones to heal.

If your child needs surgery, we often can use techniques that are not as hard on the child as more traditional operations.

These newer, less invasive techniques do not require your child to stay in the hospital. They include radiofrequency ablation and cyst injections.

Radiofrequency ablation

In radiofrequency ablation, the doctor inserts a tiny needle into the tumor. The needle contains wires that transmit an electrical current. The current heats the tumor to a high temperature and destroys it.

Doctors most often use radiofrequency ablation to treat a tumor called osteoid osteoma.

In most cases, your child can go home after the procedure and will be able to resume their usual activities right away.

Cyst injections

Unicameral bone cyst. A radiograph showed the typical cyst with a pathologic fracture (red arrow). The lesion was treated by steroid injection (yellow arrow) with satisfactory healing (orange arrow). The cyst has reoccurred a year later (white arrow), but not to a degree that required more treatment. Courtesy of Fundamentals of Pediatric Orthopedics, 2003 Lippincott Williams & Wilkins

Treatment by injection of unicameral bone cyst.

We can sometimes heal unicameral cysts by injecting them with a drug (steroid), and with bone marrow or bone matrix .

If your child's doctor is using bone marrow, the material will come from your child's pelvis . We will give your child medicine (anesthesia) to make them sleep during the operation. Bone matrix comes from healthy human donors through the Northwest Tissue Center .

To inject the cyst, the doctor first inserts needles into the cyst and removes liquid. Next, the doctor fills the cyst with a contrast fluid that helps show if the cyst is benign and contains no tumor tissue.

If it is benign, the doctor injects a paste of the steroid and bone marrow or bone matrix.

This treatment works because the steroid calms down the cyst while the bone marrow or bone matrix paste makes bone to fill the hole.

Usually, a single injection heals the cyst only partially, so we must repeat the procedure. Your child may go through this procedure every few months for six months to a year.

Curettage and bone grafting

The main operation for benign bone tumors is a procedure that scrapes the tumor out of the bone (curretage) and fills the hole left behind with a bone graft.

The graft most often comes from the bone bank (allograft). Your child does not have to have another operation to get the graft.

Seattle Children's works with a special bone bank, the Northwest Tissue Center . The bone grafts we use come from healthy donors and are carefully screened for diseases.

It usually takes about four to six weeks for children to heal after this procedure. In many cases, children use crutches and a brace, splint or boot to protect their bones while they heal.

After Treatment for Benign Bone Tumors

No matter which treatment your child has, we will monitor their progress. Benign bone tumors have a significant risk of coming back (recurrence) after surgery, so it is important to keep an eye on your child's condition.

In some cases, children have to have more than one treatment.

If your child has the curettage and bone grafting procedure, we provide physical therapy to help your child return to usual activities. Generally children recover from this surgery in two to three months.

Malignant Bone Tumors Treatment Options

Most children with malignant bone tumors have surgery to take the tumors out. The kind of surgery depends upon the size of the tumor, where it is located and whether the cancer cells have spread.

In the past, some children had amputations for malignant bone tumors. Now, children rarely have to have amputations. Most of the time, doctors can remove only the part of the bone that is affected by the tumor.

Limb-sparing surgery

The director of our Department of Orthopedics and chief of our Bone Cancer and Sarcoma Clinic, Dr. Ernest "Chappie" U. Conrad , has been a pioneer in developing techniques to save the limbs of children with malignant bone tumors.

In limb-sparing surgery, also called limb salvage, the doctor removes the tumor and any bone and cartilage affected by it, but leaves the surrounding nerves, muscles and tendons so that your child can keep their leg or arm.

Depending on the location of the tumor, the bone that the doctor removes is replaced by a bone transplant or a metal implant, such as a knee joint replacement.

Children younger than age 12, who have more growing ahead of them than older children, need an additional operation that will lengthen their limb so that it keeps pace with their growth as they get older.

Limb-sparing surgery is complex, and it requires doctors to make careful decisions about which children are likely to respond well to the operation.

Learn more about limb-sparing surgery .

Amputation

In rare cases - for about two or three out of every 100 patients - doctors have to remove (amputate) a limb to remove the tumor. Doctors most often do it because the tumor is unusually large or is likely to come back.

This shows why early treatment is so important. It is best to treat the tumor before it gets big.

Children who have amputations can do almost anything they want to do. Using an artificial limb (prosthesis), they can play sports and be active. Read more about our orthotics and prosthetics services .

After surgery for malignant bone tumors

Whether your child has limb-sparing surgery or an amputation, they will have extensive physical therapy after treatment. If your child has had limb-sparing surgery, they most likely will use crutches for three to six months while the bone graft or implant heals.

Children who have leg amputations can walk on their new prosthesis within three months. At Children's, we provide prostheses and help with your child's adjustments.

Soft Tissue Tumors Treatment Options

If a benign soft tissue tumor is painful or growing larger, your child may need to have it removed. With some painless tumors, we simply watch for changes.

If your child has a malignant soft tissue tumor, it must be treated. The expertise of our staff stretches from diagnosis to rehabilitation.

We use special techniques to get the best information about your child's tumor. Within two months of beginning chemotherapy treatment, for example, your child will most likely have a PET scan . This imaging test allows us to judge how fast a tumor is growing and whether the chemotherapy is working to slow its growth or shrink it.

Our clinic provides chemotherapy to reduce the size of soft tissue sarcomas before we do surgery. We also use radiation therapy, a treatment that uses high-energy rays emitted by a special machine to destroy cancer cells and shrink tumors.

We use surgery to remove malignant soft tissue tumors. Together, these treatments can be very successful in helping your child.

Surgery for soft tissue tumors

During the operation for a soft tissue tumor, the doctor removes the tumor. The doctor may have to remove muscle along with the tumor, but your child most likely will not have a serious loss of strength.

After surgery, your child may have physical therapy to regain strength, movement and confidence.