Diagnosis and Treatment

Diagnosing your tumor

Before we can treat your bone or soft-tissue tumor, we need to identify what it is and, if possible, why it occurred. To identify it as accurately as possible this process involves several steps:

  • Medical history: We will review your medical history to look for clues that might show what type of lesion or tumor you may have and what caused it.
  • Physical exam: You will receive a thorough examination of the organ systems relevant to the location and possible diagnoses of your tumor.
  • Imaging studies: We will review any prior x-rays, CT (CaT) scans, MRIs, or other scans you have received. You may be asked to undergo more imaging. Some tumors can be identified successfully based on their imaging characteristics, and others cannot.
  • Lab studies: Laboratory tests are useful in helping to pinpoint some diagnoses.
  • Biopsy: For tumors that cannot be identified with imaging or lab studies, a biopsy may be required. Biopsies can be performed in our clinic by a radiologist using an ultrasound or CT machine to visualize the tumor. Biopsies can also be performed in surgery. Many factors dictate the type of biopsy you will receive, but some of the most common factors include the tumor’s location and potential diagnosis.

Treating your tumor

Your diagnosis will determine your treatment options. Many lesions are treated by continued observation, physical exam, and imaging studies.Some benign tumors need surgery and/or the use of additional treatment such as chemotherapy and radiation, but this is rare. Malignant tumors generally need some combination of surgery, chemotherapy, and radiation.

Treatment is comprised of three primary approaches. Your combination of these treatments will vary based on your diagnosis and individual case.

  • Surgery is the physical removal of the tumor. Malignant tumors are removed along with a region of healthy tissue around the tumor to ensure that no tumor is left behind. Successful tumor removal is determined by a pathologist, who assesses the margins of the tumor. The goal is to get “negative” margins, which means that the tumor is not present at the margins of the specimen. Benign tumors may be removed with positive margins.
  • Chemotherapy is the intravenous infusion of medications that are toxic to the tumor with the goal of killing the tumor.
  • Radiation therapy is the application of ionizing radiation to the tumor to cause damage to the tumor’s DNA and prevent the tumor cells from dividing.

The Center for Surgical Innovation - part of Dartmouth-Hitchocck -  is the only surgical center in the world that permits intraoperative MRI and CaT scanning. All patients with sarcomas and other tumors of the bones and joints can have their surgery performed in the Center for Surgical Innovation at no extra cost.

Follow-up care

After your initial visit, you will receive a follow-up appointment unless you have a bone or soft-tissue tumor-like condition that requires no further evaluation.

If you have lesions that appear benign, you may have only one or two follow-up appointments where additional examination and imaging is performed. If you need surgery or other treatment for a benign condition, you will be followed for a period of time determined by the diagnosis.

If you have malignant tumors, you will be followed for at least ten years. The diagnosis determines the frequency of follow-up.