Highly specialized treatment for bone and soft-tissue tumors

What sort of tumors are there?
There are many different types of bone and soft-tissue tumor. The three most common cancers in bone are osteosarcomas, chondrosarcomas and Ewing’s sarcomas. Liposarcoma (in fatty tissue) is the most common malignant tumor found in soft tissue. Each type of tumor requires individual treatment.

What causes bone and soft-tissue cancer?
Compared with other types of cancer, bone and soft-tissue cancers are very rare. No clear cause has yet been discovered: lifestyle and diet in particular do not seem to affect their development.

How are bone and soft-tissue tumors discovered?
In most cases, pain or a palpable lump brings the patient to their general practitioner or an orthopedic surgeon. X-rays or MRI scans are the best way of showing changes in the bones or growths in the tissues. Tumors are often incidental findings, for example seen on an X-ray taken after an accident.

What investigations are necessary?
Whenever a bone or soft-tissue tumor is suspected, our tumor team takes over the further diagnostic investigation and imaging. We get referrals from GPs and specialists throughout Switzerland. Naturally, patients can also contact us directly to investigate any unexplained findings. We invite patients to an appointment in our outpatient clinic. We often need to take a tissue specimen (a biopsy) to confirm the diagnosis.

What is a biopsy?
A biopsy consists of taking a small piece of tissue from the tumor and examining it under the microscope. The biopsy tells us what type of tumor is present and how aggressively it is growing. At Balgrist University Hospital, we perform all biopsies as gently as possible, using minimally invasive techniques. A fine needle is inserted into the tumor under CT or ultrasound guidance. This procedure can be done as an outpatient and our anesthetists make sure that it is as comfortable as possible for the patients.

Planning the tumor resection
Balgrist is the only hospital in Switzerland where specialists can establish a 3D model of the tumor and use the computer to plan its removal to the millimeter. During the operation, specially made templates from the 3D printer are used to convert the planning precisely into surgical reality. Before the operation, we have a personal discussion with the patient to explain the various steps in the surgical procedure and answer any questions they may have.

How can you replace the bone that has been removed?
After the complete resection of a tumor, a defect is often left in the bone. To preserve the function of the limb as much as possible, team leaders and the senior consultants look at the possibility of joint replacement: if the cancer also involves the joint it is possible to use a special prothesis. Balgrist University Hospital has internationally renowned expertise in replacement joints. If the cancer does not affect the joint, we can use bone from a donor (an allograft).

How can you replace soft tissues?
In rare cases, the cancer grows around important soft-tissue structures such as blood vessels and nerves, which also have to be removed at the time of operation. Our senior consultant in hand and nerve surgery has many years’ in-depth experience in suturing blood vessels and nerves. Short sections of nerve can be replaced with a cutaneous nerve from the lower leg; arteries can be ‘bridged’ with a vein graft. In Dr. Dominik Kaiser, the tumor team has an expert in soft-tissue reconstruction. Such surgical procedures are necessary when the removal of a large tumor makes to impossible to close the skin with sutures. In this situation, the tissue is covered with a skin graft or a muscle flap. And there is always the possibility of cooperating with other surgical disciplines.