Patient Care

Musculoskeletal Cancer

What are Musculoskeletal Cancers?

Musculoskeletal oncologic cancers include bone and soft tissue tumours for all age groups, from children to adults.

These are some of the common causes by age.

AgeBenign tumorsMalignant tumorsTumour-like conditions

Birth to 5 years


Eosinophillic granuloma



Metastatic neuroblastoma 


Non-accidental injury

5 to 15 years 

Unicameral bone cyst




Aneurysmal bone cyst


Osteoid osteoma




Non-ossifying fibroma


Chondromyxoid fibroma



Ewing's sarcoma 

Fibrous dysplasia




Osteofibrous dysplasia


Stress fracture

15 to 20 years 

Unicameral bone cyst




Osteoid osteoma


Aneurysmal bone cyst


Nonossifying fibroma


Giant cell tumour





Osteogenic sarcoma ibrous dysplasia 
What are the signs & symptoms of Musculoskeletal Cancers?

Symptoms include:

  • Unrelenting
  • Disturbs sleep
  • Systemic upset
  • Loss of appetite, loss of weight
  • Shortness of breath
  • Bladder, bowel disturbance
Family / Past History
  • Syndromes
  • “General cancer load”
Physical Examination
  • General physical examination
  • Springing sign
  • Spine
  • Masses
  • Cutaneous stigmata
  • Café-au-lait (hyperpigmented lesions on the body that vary from brown to dark brown)
  • Capillary malformations
  • Limb inequality
Who is at risk of Musculoskeletal Cancers?
  • Young patients in the first two decades of life are prone to primary bone cancers
  • Older patients above 50 years are prone to bone metastasis
What are the treatment options for Musculoskeletal Cancers?
Primary cancers of the bones

Also known as bone sarcomas, osteosarcomas and chondrosarcomas are the two most common variants. These affect individuals of all ages but in particular people who are in their twenties and sixties.

The challenges in managing these conditions revolve around removal of these tumours in a way that they do not recur, and then reconstruction of the structure to replace the missing anatomical structure and restore function.

The general approaches to reconstruction can be both biological and prosthetic. In biological solutions, the draw is that one is able to reconstruct the missing structure with biological materials and host bone which has a virtually life-long durability. These methods, however, do result in donor site morbidity and have a relatively high early complication rate.

The prosthetic approaches where joints and segments are replaced by metal implants have high patient acceptability and good function but are subject to wear and tear (Figure 1). Prosthetic approaches

Figure 1. This patient had an osteosarcoma of the lower femur (a).

This was biopsied and stabilised and the patient underwent chemotherapy for 9 weeks (b).

The tumour was then resected with oncological sound techniques (i.e. margins of resection were clear of tumour) and reconstructed with a tumour megaprosthesis (c). The tumour is replaced with a prosthesis which resembles the lost bone (d). The patient was able to bear weight and walk soon after surgery.

Primary cancers of the soft tissues

Also known as soft tissue sarcomas, liposarcomas and malignant fibrous histiocytomas more commonly occur in adulthood whereas rhabdomyosarcomas and synovial sarcomas occur in childhood.

The specific ability of the orthopaedic oncologists is in his ability to resect these tumours primarily to save life and yet secondarily reconstruct defects in a way that maintains function. In addition, resections are done in a way that facilitates radiation therapy that is often used in these conditions (Figure 2). Resections

Figure 2. This tumour recurred after two previous resections in a non-musculoskeletal oncology specialised unit in an overseas centre (a).

When cancers in other parts of the body spread to the bone and soft tissues, these structures become compromised. As a result, patients develop fractures that do not heal and they become invalid. This in turn reduces their life expectancy.

Find A Doctor

Click here to access our Find A Doctor directory for a list of doctors treating this condition across our NUHS institutions.

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National University Health System
  • National University Hospital
  • Ng Teng Fong General Hospital
  • Alexandra Hospital
  • Jurong Community Hospital
  • National University Polyclinics
  • Jurong Medical Centre
  • National University Cancer Institute, Singapore
  • National University Heart Centre, Singapore
  • National University Centre for Oral Health, Singapore
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  • Yong Loo Lin School of Medicine
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