Tumors of the Musculoskeletal System

Tumors of the musculoskeletal system encompass a broad array of lesions that arise from bone, cartilage, muscle, or other connective tissue. They are a heterogeneous group of tumors and range from benign lesions with no aggressive potential to high-grade sarcomas with rapid metastatic spread. Sarcomas are rare, comprising about 1% of malignancies. Contrary to carcinomas, many sarcomas are more common in young patients. In addition, sarcomas displace normal tissue as they grow as opposed to carcinomas which invade into the surrounding tissue. A careful history and clinical examination is important in the evaluation of a patient with a musculoskeletal system. After this, imaging is obtained. Many bone tumors can be diagnosed off plain radiographs alone. MRI and CT are also frequently used. If malignancy is suspected, staging should then be performed to assess for metastatic disease, and a biopsy should be performed to complete the evaluation. Benign lesions often require no treatment at all. When treatment is required, simple excision or an intralesional procedure is often sufficient. Malignant lesions are usually treated with wide excision, which most often can be performed in limb-sparing fashion. For malignant tumors, adjuvant treatment is often required with chemotherapy commonly used in bone tumors and radiation commonly used in soft tissue tumors. Treatment of carcinomas that have metastasized to the bone is centered on preserving function and minimizing pain. This chapter discusses common bone and soft tissue sarcomas, their characteristic patient demographics, clinical exam, radiographic and histologic findings, treatment options, and outcomes in the literature.