Dr. Vincent Ng is an orthopaedic oncologist with the University of Maryland Greenebaum Comprehensive Cancer Center and an Assistant Professor or Orthopaedics with the University of Maryland School of Medicine. Dr. Ng specializes in treating bone cancer and soft tissue sarcoma. Below he answers common questions about orthopaedic oncology.
What is an orthopaedic oncologist? How do they differ from surgical oncologists?
“An orthopaedic oncologist specializes in bone and soft tissue tumors. I treat any adult or pediatric patient with any bone or soft tissue tumor/lesion/mass, whether benign or malignant, whether it is originating from the bone or soft tissue itself or spread from another part of the body, regardless of how large or small, in the upper or lower extremities, pelvis or shoulder region. I am often the first provider patients see when they find a concerning lump. I can help direct their care in terms of imaging, biopsy, and referral to other providers like medical oncology and radiation oncology.
Surgical oncologists are general surgeons who tend to specialize in tumors of the organs within your abdominal cavity (pancreas, liver, colon, etc).”
What are cartilage tumors? Are they treatable?
“There is a definite spectrum of cartilage tumors and they can present in a variety of fashions. We are seeing many patients with a variety of cartilage tumors. Many are very small and benign, while some can be large and life-threatening. Cartilage tumors can be challenging in diagnosis and treatment.
While tissue sample analysis can identify a lesion as a cartilage tumor and can separate the most aggressive tumors from the least aggressive ones, it is difficult to necessarily predict the future behavior based on this alone. A comparison of the relationship between the tumor and normal bone on imaging can often be more helpful. Whether the patient has pain is often helpful information as well.
Making careful treatment decisions for cartilage tumors (chondrosarcoma) can require a very subtle approach and it is important to have a team of radiologists, pathologists and surgeons that deal with a lot of cartilage tumors. Sometimes cartilage tumors may be simply observed over time to make sure they remain stable while some may require very large and complex surgery to safely remove them.”
How can surgery help treat tumors in the pelvis?
“Surgical management of tumors affecting the pelvic bones is one of the most challenging areas of orthopaedic oncology. Because of the complex anatomy associated with this region of the body, successfully removing malignant tumors from the pelvis requires a surgeon with extensive knowledge of the critical structures and how they work together.
It requires a large team to do these operations, from anesthesia and interventional radiology to the ICU and physical therapists, dozens of dedicated healthcare providers are essential to the success of the patient.
Personally, I enjoy these surgeries and have been blessed to have trained at two cancer centers with a high volume of pelvic operations and excellent surgeon mentors. By the nature of University of Maryland being a tertiary referral center, we see many patients with pelvic tumors, some of which can be managed with radiation for which we have the new Maryland Proton Treatment Center, and some of which benefit from surgery. The road to recovery for these patients can be long, but with rehab and a positive attitude, they often do well. As a surgeon, seeing them succeed is one of the most rewarding parts of this profession.”
What are some misconceptions about soft tissue sarcoma?
“Soft tissue sarcoma is a life-threatening condition and I believe strongly that it needs to be addressed swiftly and aggressively. Part of our job is educating non-oncologic physicians that any soft tissue mass could potentially be a soft tissue sarcoma and should be evaluated to avoid missing, and therefore delaying treatment for, a soft tissue sarcoma.
When the soft tissue sarcoma is localized (only in one location, the original location) and has not spread to other parts of the body, it is curable in many instances. Treating it with radiation and surgery before it has a chance to send microscopic cells to other parts of the body is important. It is hard to predict when a tumor will release these cells elsewhere and they sometimes do not appear until many months or even years later. We currently do not have an effective treatment for these cells once they have spread and established themselves elsewhere in the body. This is one of the areas that we are examining in a clinical immunotherapy trial, NEXIS, which I have designed. If it is successful, it has the potential to help many soft tissue sarcoma patients.”
Explain the challenges of treating Ewing sarcoma.
“Ewing sarcoma often presents in a delayed fashion and can be missed by non-oncologic practitioners. It affects children and teenagers and is truly a life-threatening condition. Luckily, we have strong chemotherapy regimens that can usually cure the disease, particularly in younger patients. Successfully treating Ewing sarcoma is a very long process with many weeks of chemotherapy. Because it can occur in any part of the body, but oftentimes in the pelvis or major bones of the limbs, surgery to remove the tumor can be quite extensive and the recovery from skeletal reconstruction can be prolonged. Nevertheless, the most important thing is removing the cancer. I am a strong believer in wide surgical margins and radiation when possible to eliminate the primary tumor and make sure it does not return. The success rate of treating recurrent disease is suboptimal. You really only get one good chance to cure Ewing sarcoma.”
What’s new in the world of metastatic bone cancer?
“Patients are living longer and more productive lives even when diagnosed with metastatic and incurable disease. When cancer spreads from one part of the body to the bone, our job as orthopaedic oncologists is to minimize its impact on patients’ lives. While we cannot cure them of their original cancer, we can stabilize the bones with surgery to significantly reduce pain and prevent fractures where the cancer has eroded through the structural integrity of the bone. Some types of metastases such as those from thyroid or kidney cancer may be better treated with a complete resection of the cancer rather than a palliative procedure.”
How is research playing a part in improving treatment options for bone and soft tissue cancer?
“Moving the needle forward, particularly in cancer research, requires a team approach. Each person brings their own set of experiences, perspectives, and ideas to the table. An effective leader must have a creative vision, an untiring spirit, and the ability to think outside the box in order to solve a variety of challenges. Here at University of Maryland, we hope to parlay the success of immunotherapy in other areas of oncology to soft tissue sarcoma in the NEXIS trial. It is the first neoadjuvant checkpoint inhibitor immunotherapy trial that adds the potential benefit of combination immunotherapy to the existing standard of care for soft tissue sarcoma. On a preclinical level, we are looking for potential treatments in the future with retinoic acid and chondrosarcoma, and new targeted therapy combinations for osteosarcoma. The opportunity for me to collaborate as a clinician with these scientists is one of the advantages of working at a large University with many PhD’s and award-winning researchers.”
To learn more about UMGCCC’s Bone Cancer and Soft Tissue Sarcoma Service, please click here, or call 410-448-6400.