Media Release

(24 September 2019 – Hong Kong) When it comes to cancer, breast or colon cancer becomes the first thing in mind. But tumours do occur in any parts of the body, including our bone marrow, bones, adjacent periosteum, soft tissues, and skeletal muscles, hence the term ‘musculoskeletal tumours’. Symptoms can be vague, including unexplained lumps, pain, swelling, even a limp, making patients difficult to find the way to answers. As these symptoms have no specific characteristics, the risk of misdiagnosis is quite high. In view of this, Gleneagles Hong Kong Hospital (Gleneagles) has set up the Musculoskeletal Tumour Centre. With the Centre’s interdisciplinary team of medical specialists, Gleneagles aims to provide comprehensive and accurate musculoskeletal tumour services for patients, from making diagnosis to individualized treatment solutions. 

According to Dr Timothy So, Director of the Musculoskeletal Tumour Centre and Honorary Consultant in Orthopaedics & Traumatology at Gleneagles Hong Kong Hospital, there are benign and malignant musculoskeletal tumours. Malignant musculoskeletal tumours are divided into primary tumours and metastatic tumours. Primary malignant tumours (also known as sarcoma) can be further divided into two major categories: bone sarcomas and soft tissue sarcomas. The former refers to lesions arising in bone marrow, bone itself or adjacent periosteum; the latter is found in soft tissues, including fat, muscle and fibrous tissue etc. The causes of these tumours are still largely unclear, and they can be found in people of all ages, from the very young to the elderly.

Diagnostic investigations necessary for unexplained lumps or persistent pain

Common symptoms include unknown lumps, pains, or walking problems. "Bone sarcoma is characterised by pain and swelling around the tumour. Pains may be localised around the joints. They are mostly intermittent at first, and will then slowly grow persistent and stronger. Meanwhile, the painful areas will swell, forming tender lumps that will increase in size, limiting joint activity, while muscles may shrink. If the tumour develops in the lower limbs, patients are more likely to have limping problems. As the condition worsens, joint effusion and pathological fractures could occur," Dr So explained.

Soft tissue sarcomas present slightly different symptoms. Dr So says that although the patient may have unexplained swelling or lumps, these are not necessarily painful or tender. Only about half of patients with these lumps will feel pain; the remaining patients may have no pain at all. Because it is malignant sarcoma, the lump often grows rapidly in a short time. People with these symptoms should consider seeking medical treatment for a preliminary diagnosis.
  

Avoiding misdiagnosis and the risks of improper surgery

Malignant musculoskeletal tumours (sarcomas) are not common. The number of new cases holds steady at just about 250 per year, according to figures from the Hong Kong Cancer Registry of the Hospital Authority. Many people have never heard of the disease, so the public’s awareness of it or alertness to symptoms is low. "Without proper image scanning and pathological examinations, it can be easily misdiagnosed. What’s more, a hastily planned surgery without a concrete diagnosis exposes the patient to unnecessary risks, including the possible spread of tumour cells during surgery. This could also increase the complexity of subsequent surgeries, even requiring amputation due to lack of proper treatment, or affect the survival rate of patients," Dr So said.

Dr So urged caution in these cases. "Doctors must have sufficient knowledge of the diagnosis and treatment of sarcoma before they can provide appropriate diagnostic and treatment solutions. Any suspicious lumps should be investigated thoroughly, through image scanning such as an MRI scan. This is usually followed by well planned biopsy, the approach of which has to be aligned with any subsequent surgical plan.  
  

Multidisciplinary team for collaborative management strategies

The new Musculoskeletal Tumour Centre at Gleneagles Hong Kong Hospital was established to deal with complex malignant sarcoma cases that call for exceptional teamwork. The Centre’s multidisciplinary team will collaborate on diagnostic imaging and image-guided biopsy, based on which treatment plan would be developed – a process that requires close communication and cooperation between various specialties, including orthopaedic tumour surgeon, radiologist, pathologist, clinical oncologist, etc. 

Dr So explained that, because the approach of biopsy affects subsequent surgical plan, it is best to develop a preliminary surgical plan hand in hand with a biopsy plan, to ensure safety and effectiveness of the definitive surgery. Image scanning techniques such as MRI and sometimes positron emission tomography would be used to locate representative areas for biopsy. Image guided (ultrasound for soft tissue or CT for bone) needle biopsy is our gold standard to ensure accurate sampling.
  

Meeting patients’ needs with a well-trained medical team and professional equipment

To offer patients and their families comprehensive and professional services, the Centre's multidisciplinary team is well-trained and experienced. The team consists of orthopaedic tumour surgeon, radiologists, pathologists, clinical oncologists, and anaesthesiologists, in addition to other specialists, nurses, and rehabilitation therapists. They work closely together to provide patients with precise biopsy tests and treatment solutions, precise operations, optimal perioperative management, and quality rehabilitation.

The Centre is equipped with complete facilities, including image scanning facilities such as ultrasound, CT scanning, MRI, scintigraphy, positron emission tomography, histopathology laboratory with immunohistochemical and molecular pathology capability. It also boasts an operation suite well equipped for complex surgery such as custom or modular megaprosthesis operations, and an oncology department that features brachytherapy, external radiation therapy, chemotherapy and immunotherapy to meet the needs of different patients.

Gleneagles Hong Kong Hospital

Located at Wong Chuk Hang on Hong Kong Island South, Gleneagles Hong Kong Hospital (Gleneagles) is a multi-specialty private hospital, providing 500 beds, cutting-edge medical technologies and a comprehensive range of clinical services spanning more than 35 specialties and subspecialties. As Hong Kong’s top-notch private teaching hospital, Gleneagles also contributes to the training and development of healthcare professionals and advancement of clinical research.      Gleneagles is a joint venture between Parkway Pantai Limited, one of Asia’s largest integrated private healthcare groups and the largest operating subsidiary of IHH Healthcare which is the second largest healthcare groups in the world by market capitalisation, and NWS Holdings Limited. The University of Hong Kong is Gleneagles’ exclusive clinical partner and is responsible for providing Gleneagles with clinical governance and clinical expertise.