Care pathway for a bone tumor patient

Bone lesions are a very broad concept and can refer to any abnormal structure of the bone. An abnormal structure can be caused by an injury, or it can be a congenital abnormality, a change in bone structure, or an actual bone tumor. A bone tumor can be benign or malignant.

The majority of benign bone tumors develop during bone growth and are later completely asymptomatic incidental findings, which are observed in X-rays taken of the patient.

Some benign bone tumors continue growing during adulthood and require treatment. The treatment is usually surgical, but some tumors can be treated with procedures performed by radiologists, such as heat treatment or pharmacological treatment injected into the tumor.

Malignant bone tumors, or bone cancer, i.e., osteosarcomas, typically grow rapidly, can spread to the surrounding tissues or other organs and can be life-threatening. The nature of a cancerous tumor, such as its growth rate, propensity for spreading or its appearance, can vary a great deal. For most of the osteosarcoma cases, there are no predisposing factors. In malignant bone tumors, treatment options include surgery, cytotoxic drug treatment and radiation therapy, or a combination of these.

Each year, we examine more than 1,000 bone lesions and treat more than 40 new cases of osteosarcoma.

We treat patients from all over Finland arriving with a referral. A referral will be made when an abnormal lesion is observed in the radiological imaging conducted. The referral can be made by a health center physician, occupational physician, a private physician, a physician at a central hospital, or a university hospital physician.

Our bone tumor nurse or a secretary in our unit will be in contact with the patient after we receive the referral. If necessary, we will carry out more detailed further examinations. Decisions on the required examinations will be made individually according to the bone lesion and the overall situation. These usually include additional imaging examinations such as X-rays, CT, MRI or ultrasound scans, or scintigraphy. Sometimes we take a sample, i.e. a biopsy, of the tumor. Blood tests are also often taken.

During an outpatient clinic visit, you will have an appointment with our physician who specializes in bone lesions. At the appointment, we will go through the illness, future treatments and surgery in detail, as well as any resulting problems. Your loved ones are also welcome to participate in the appointments.

Once we have received the results of the examinations and discussed the matter at a multiprofessional meeting, the bone tumor nurse will contact you and let you know about possible further plans.

Some bone tumors require utilizing cancer treatments. Some types of osteosarcoma are treated with cytotoxic drug treatment and radiation therapy prior to surgery. Cytotoxic drug treatment has been found to improve the prognosis in certain types of disease. Potential cancer treatments are most often given at the Comprehensive Cancer Center, but they may also be given at the department of oncology at the referring university hospital. The duration of cytotoxic drug treatment prior to surgery is usually approximately three months.

On the day of the procedure

You will arrive in the unit according to your individual treatment plan. If necessary, we will carry out preliminary procedures or additional examinations before the surgery. Surgery days are usually Monday and Wednesday.

Surgery

In surgery, we will remove the cancerous tumor. The scope and duration of the surgery varies greatly depending on the size and location of the tumor. Surgery can be an extremely extensive procedure that will have a significant impact on your body and functional capacity. We will send the excised tumor to the pathologist who will examine it. We often get the pathology report within a few weeks. We will start you on postoperative pain relief already in the operating room and it will continue on the ward.

On the ward

After the surgery, you will be transferred via the recovery room to the inpatient ward. In addition to our surgeons and nurses, you will also meet a physiotherapist, occupational therapist, and social worker as needed. Depending on your surgery and condition, rehabilitation will start according to an individual plan. Good pain management, hygiene, adherence to rehabilitation instructions, nutrition and wound care are important during treatment.

Visiting hours on our ward are free between 1:00–6:00 p.m., but we hope for consideration for other patients with regard to the visits. If necessary, visiting hours can be agreed upon separately. Due to the backlog of telephone traffic in the office, we hope that you will pick a contact person among your friends and family who can relay your information to other relatives and friends.

In some of the bone tumors, we use postoperative cancer treatments. Postoperative cytotoxic drug treatment will be continued once the wounds have healed and you feel better after the surgery. The aim of cytotoxic drug treatment is to “kill” any cancer cells that may have entered the bloodstream. When the goal of the treatment is to cure the patient, we will administer cytotoxic drug treatment as accurately as possible according to a predetermined treatment plan.

Follow-up is individual and may last 5–10 years in case of a disease and, for example, in cases of implanted artificial joints, even for the rest of your life. Follow-up consists of check-up appointments and examinations carried out during the visits. Initially, a follow-up appointment will be scheduled every 3–6 months, and later every 1–2 years. Follow-up varies depending on the diagnosis and the size and location of the tumor.

We plan the follow-up at the multiprofessional meetings and they follow the national and international recommendations. Usually the check-ups take place at Töölö Hospital. In all unclear and troubling matters, we hope that you will contact the unit responsible for your treatment or follow-up care. In our Bone Tumor Unit, you and your family are kept up to date by our bone tumor nurse, who can be contacted at every stage of the care pathway when necessary.