Common Questions

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Dr. Wittig’s philosophy is a multidisciplinary team approach, including physicians and advanced practice providers who work together in close communication to tailor treatment to individual patients. Education and research are essential to my practice, providing the best setting for extraordinary patient care. Because of this, we have some of the top results in the country.

This means having a team of experts from different subspecialities who work together to provide optimal care for bone and soft tissue tumors. Many of these tumors are rare and require collaboration between an orthopedic oncologist, musculoskeletal radiologists, pathologists, medical oncologists, radiation oncologists, physician assistants, nurse practitioners, social workers and therapists. Dr. Wittig’s philosophy is that optimal extraordinary care is delivered to the patients with a multidisciplinary approach and dedicated team to see them through diagnosis, surgery and postoperative care. Dr. Wittig has always believed that patients are best cared for in a busy clinical practice that focuses on orthopedic oncology and combines education of residents, students, advanced practitioners and incorporates research and other academic activities.

Oncology is the study of cancer. An oncologist is a doctor who treats cancer and provides medical care for a person diagnosed with cancer. An oncologist may also be called a cancer specialist. The field of oncology has 3 major areas based on treatments: medical oncology, radiation oncology, and surgical oncology.

Orthopedic oncology is a specialized field of medicine focused on the treatment of tumors and cancers that affect the bones, joints, cartilage, fibrous tissues, muscles, nervous tissues, soft tissues, and vessels. Orthopedic oncologists are specialized orthopedic surgeons that treat bone and soft-tissue tumors, bone sarcomas, soft tissue sarcomas, benign bone tumors and benign soft tissue tumors as well as metastatic cancers to bone and pathological fractures. Orthopedic oncologists are highly specialized in performing complex limb spring surgeries for sarcomas and saving limbs and lives as opposed to performing amputations. Specialized fellowships and training are required. Dr. Wittig is one of the few orthopedic oncologists in the country to perform a two year clinical fellowship gaining extra experience with separating large tumors from blood vessels and nerves, major rare resections as well as special plastic surgical techniques. Dr. Wittig has been named one of the top 13 orthopedic oncologists in the United States by his peers. He has also been featured in New York Magazine and Castle Connolly as one of the Top Doctors in the New York Metro area and one of Top Cancer Doctors.

A physician assistant is an advanced practitioner. PAs work with a surgeon and may diagnose illnesses, develop and manage treatment plans, prescribe medications, and may serve as a principal healthcare provider. They help to coordinate the care of our patients. Dr. Wittig’s team consists of several physician assistants who are integral to the extraordinary care provided to his patients.

A nurse practitioner is an advanced practice registered nurse. NPs are trained to assess patient needs, order and interpret diagnostic and laboratory tests, diagnose disease, formulate and prescribe medications and treatment plans. They help coordinate the care of our patients. Dr. Wittig’s team includes nurse practitioners who are integral to the extraordinary care he provides to his patients.

A medical assistant, also known as a "clinical assistant" or healthcare assistant is an allied health professional who supports the work of physicians, nurse practitioners, physician assistants and other health professionals. Medical assistants will often room the patient and go over their medical and surgical history, medications and social history. They also assist with biopsies, wound care, changing bandages, applying splints, removing sutures and staples as well as gathering important test results and drawing blood for lab tests.

Dr. Wittig treats both benign and malignant bone and soft-tissue tumors. With over twenty years of experience, Dr. Wittig is recognized as a top doctor in orthopedic oncology and has expertise on various tumors and their treatment. For more information on specific tumors, please visit “conditions we treat.”

A tumor refers to an abnormal growth in the body. Tumors are made up of abnormal cells that are uncontrollably dividing and replicating themselves. Tumors can be classified as benign or malignant (cancerous). Depending upon the type of cell that the tumor is derived from, a malignant tumor can be classified as a sarcoma or a carcinoma. Malignant tumors can also be considered primary or secondary.

In reality, nobody knows what causes a sarcoma or a benign bone tumor. Because of the rarity of these tumors it has been difficult to perform extensive research on these types of tumors. Some tumors are related to genetic alterations that can actually be identified with special laboratory tests.

Sarcomas and carcinomas are types of malignant tumors that can affect bones. They are derived from different types of cells. Sarcomas are derived from mesodermal (mesenchymal cells) and carcinomas are derived from epithelial types of cells. Sarcomas and carcinomas grow and spread differently. Sarcomas grow like "ball-like" masses and tend to push adjacent structures like arteries, nerves, veins away. The compress adjacent muscles into a pseudocapsule that contains microscopic projections of the tumor referred to as satellite nodules. The local growth of sarcomas like a ball enables resection in most instances. Sarcomas tend to arise primarily (directly) from bone as opposed to spreading to bone from another site.

The hematological cancers that affect bone include myeloma, lymphoma and leukemia. These are cancers that arise from the blood and bone marrow. They can also spread to multiple bones through the bone marrow and create defects or “holes” in the bone risking the bone breaking (fracturing). Sarcomas tend to arise primarily (directly) from bone or soft tissues. They do not arise from bone marrow elements but from other types of cells in the bone or soft tissues. Sarcomas originate from special types of stem cells called mesenchymal stem cells.

These two terms are very general terms. A bone tumor refers to any abnormal growth from the bone or in the bone, benign or malignant. Bone cancer refers to a malignant bone tumor. It can be a primary malignant tumor like an osteosarcoma, Ewing's sarcoma or chondrosarcoma. It can also be a metastatic carcinoma such as a breast cancer, lung cancer, prostate cancer, kidney cancer and thyroid cancer. It is important to differentiate between the various types of cancers that affect the bone because each has its own type of treatment and prognosis.

Sarcomas are graded by pathologists. When the pathologist views a biopsy specimen or the final tumor under the microscope, he assigns a grade to the tumor. The grade is based on particular characteristics of the cells that compose the tumor. The grade reflects the degree of malignancy of the sarcoma. The degree of malignancy reflects the potential for the tumor to come back locally (local recurrence) and spread to other parts (metastasize).

Staging is a way of assessing specific characteristics about a sarcoma and correlating it with a prognosis. It is a way of estimating a prognosis for patients. There are separate staging systems for bone and soft tissue sarcomas. There are also a few different types of staging systems. In general, staging systems assess tumor size, grade, superficial or deep location, intracompartmental or extracompartmental involvement, and whether it has spread to any other area of the body.

The tumor cells have been killed and can be indicative of a positive response to chemotherapy or your immune system effectively fighting off the cancer cells. Cancerous tumors can often grow very rapidly and cut off their own blood supply that results in cell death in the tumor. Sometimes almost the entire tumor may die. Tumor necrosis as detected on an MRI often indicates a high grade rapidly growing sarcoma. It is also one of the signs of malignancy on pathological examination (looking at it under a microscope). When portions of sarcomas die they often also hemorrhage and have swelling that can be seen on an MRI.

Small round blue cell tumors receive this name because of their appearance under the microscope, as they are viewed as small, round, blue-stained, undifferentiated cells. Sarcomas consist of malignant cells that usually produce a substance called a matrix. Small round blue cell sarcomas consist of all cells and no matrix. They do not produce any additional substances or tissues. Small round blue cell tumors sarcomas are malignant (cancerous) and are more common in children. Examples include, Ewing’s Sarcoma/primitive neuroectodermal tumor, rhabdomyosarcoma, desmoplastic round cell tumor, small cell lymphoma, and neuroblastoma.

A mesenchymal tumor refers to a bone tumor or soft tissue tumor that develops directly from the bone or soft tissues. It is named after mesenchyme, which is composed of mesodermal cells that develop into connective tissues, like bone, cartilage, fibrous tissue (tendon and ligament tissue), blood vessels, nerves, fat. Mesenchymal tumors can be benign bone tumors, benign soft tissue tumors or cancerous bone or soft tissue tumors called sarcomas. The mesoderm or mesenchymal cells differentiate down different pathways and form the various tissue types. The tumors are named according to the type of tissue being produced.

It develops in the bone and grows to a certain size but then stops growing and does not destroy the bone like an active or aggressive benign bone tumor. It stops growing and does not grow uncontrollably. They tend to cause a weakness in the bone depending on the size. They may need to be treated to prevent the bone from breaking or treat an actual fracture through the tumor. In many instances these types of tumors are observed. When treated they rarely if ever come back.

A musculoskeletal tumor is a benign (non-cancerous) or malignant (cancerous) mass that originates in the soft-tissues or the bones of the musculoskeletal system.

Plasma cells are immune cells found in bone marrow that produce and secrete antibodies. These are the cells that can become abnormal and cause myeloma.

Lesion is a term radiologists use when they describe an abnormality on an MRI, CT scan or X-ray. Lesions are often tumors. Tumors refer to an abnormal growth and can be benign or malignant. A bone lesion is usually a bone tumor that can be benign or malignant.

A neoplasm is an abnormal mass due to the uncontrollable growth and division of cells. Neoplasms may be benign or malignant (cancerous). Another name for neoplasm is tumor.

Dedifferentiation is the process in which cells that have previously developed to more specialized cells return to their original state. If a tumor is labeled as “dedifferentiated,” that means immature cells were found in the biopsy sample when viewed under the microscope.Dedifferentiation can occur with chondrosarcomas, parosteal osteosarcomas and liposarcomas most commonly. In this situation, cells change and become more aggressive. A second type of more aggressive and higher grade, rapidly growing sarcoma develops from the low grade, slow growing chondrosarcoma, liposarcoma or parosteal osteosarcoma. This makes the tumor much more aggressive and the prognosis is poor. There is a high rate of cancer spreading.

There are three layers of an embryo: the endoderm (innermost layer), mesoderm (middle layer), and ectoderm (outermost layer). The endoderm gives rise to many internal organs and the gut. The mesoderm gives rise muscles, bones, and connective tissues. The ectoderm gives rise to the nervous system and epidermis. Most musculoskeletal tumors are formed from the mesoderm, as this layer gives rise to musculoskeletal tissue.

A fracture is a break in the bone. Fractures can be easily identified on X-rays. Fractures can be non-displaced, minimally displaced or completely displaced and separated. Symptoms of a fracture include pain, swelling, bruising, and difficulty moving the injured bone or adjacent joint. There are various types of fractures, including compound fractures (when the bone breaks through the skin), transverse fractures (when the fracture line is horizontal), comminuted fracture (when the bone shatters), and pathological fractures (when the bone breaks due to a tumor) to name a few. Treatment varies, however treatment options include, a cast or brace, external fixation, or open reduction and internal fixation. Orthopedic oncologists treat pathological fractures most often. The tumor grows and destroys and weakens the bone like a cavity in a tooth. The bone can more easily break with normal activities because of it being weakened.

A pathological fracture is essentially a fracture, which is a break in the bone, due to an underlying condition, such as a tumor. Such conditions weaken the bone, posing an increased risk for fracture. Treatment for pathological fracture ultimately depends on the underlying condition and location of the fracture, however, surgical intervention with plates, screws, or pins is likely.

An impending pathological fracture refers to a bone with a tumor in it where the tumor has caused significant destruction of the bone and has placed it at risk of fracturing but has not completely fractured yet. Generally, tumors that erode the cortex of the bone place the bone at a higher risk of fracturing. Many patients will have pain especially with walking or using the extremity. It is important to identify these patients and fix their bone prophylactically to prevent the bone from completely breaking. The outcome is usually better and the surgery simpler with less potential complications when treated before the bone breaks as opposed to the bone breaking and the patient requiring urgent surgery.

Osteoporosis is a condition characterized by low bone mineral density and low bone mass, which predisposes an increased risk of fracture in individuals affected by this condition. Although osteoporosis may occur at any age, it is significantly more common in older men and women, particularly in women after menopause. Other risk factors include diet, family history, hormone levels, medication, and lifestyle. A bone mineral density (BMD) exam can be used to assess bone density and diagnose osteoporosis. A patient with a tumor in the bone who also has osteoporosis would be at a higher risk of fracture (breaking the bone) than with either condition alone.

Disuse osteoporosis is a condition characterized by bone loss due to a lack of stress or pressure on the bones. It is due to lack of usage of the arm or leg. It can occur postoperatively in patients who are non weight bearing or who must immobilize the extremity to allow healing. Chemotherapy may cause osteoporosis worse. Radiation can lead to bone necrosis that can also weaken the bone. Due to the weakened nature of the bone, the risk of fracture is increased. A bone mineral density (BMD) exam can be used to assess bone density and diagnose osteoporosis.

Osteopenia is another bone condition characterized by weakened bones and low bone mineral density, however not low enough to be labeled as osteoporosis. Similar to osteoporosis, age, gender, pre-existing family history of the condition, diet, hormone levels, and lifestyle are all risk factors for osteopenia. If osteopenia remains untreated or changes to lifestyle and diet are not made, osteopenia can progress into osteoporosis. With osteopenia the bones are thinned. With osteoporosis there are microscopic pores in the bones that are created. Osteoporosis is the more severe form of osteopenia.

You can go to the CONDITIONS WE TREAT section of the website to learn more, or visit tumorsurgery.org to view detailed information on specific pathologies.

A biopsy is the act of obtaining a piece of tissue from a tumor. It is then studied under a microscope by a pathologist (a physician who specializes in this area) to determine the type of tumor. Determining the type of tumor, and whether it is benign or malignant (cancerous) enables the doctors to determine the type of treatment. It is essential to have a biopsy before any surgery or treatment is administered. Biopsies can be performed in several ways. The safest and best way, in my opinion, is to have the biopsy performed in a minimally invasive manner (without having to cut the skin and make an incision) by means of a core-needle biopsy.

An open biopsy is a procedure in which a surgical incision is made through the skin to expose and remove a piece of the tumor to be analyzed. The biopsy tissue is examined under a microscope by a pathologist. An open biopsy may be done in the doctor's office or hospital, and may use local anesthesia or general anesthesia.

A core needle biopsy uses a long, hollow tube to obtain a sample of tissue to test for cancer. Samples are sent to the pathologist, who can confirm the diagnosis. Core needle biopsies are minimally invasive procedures that are performed during an office visit. They can also be performed under CT or ultrasound guidance.

A fine needle aspiration (FNA) is a diagnostic tool, which samples a small amount of fluid or tissue extracted by a small fine needle. Samples from the FNA are reviewed by a pathologist, who can confirm a diagnosis. FNAs are performed in the doctor's office and are minimally invasive. They may also be performed under CT or ultrasound. FNAs are not accurate for diagnosis of sarcomas and benign and malignant musculoskeletal tumors. FNAs lack tissue architecture to assess mesenchymal tumors accurately. Core needle biopsies demonstrate architecture and are more accurate for diagnosis of mesenchymal primary bone and soft tissue tumors and sarcomas.

Differential diagnoses are possible conditions that share similar symptoms. The patient’s medical history, signs and symptoms, lab results, and a physical examination are all used to help the orthopedic oncologist come up with differential diagnoses. The diagnosis is confirmed with additional tests and a biopsy.

An MRI is a medical imaging technique using a magnet to take photos of your body’s soft tissues, bones, inner organs and other tissues and allows the doctor to examine them with great detail. MRI is useful for determining the size and extent of the tumor and the tissues involved. It is also useful for determining the involvement of adjacent structures including the important. MRI is rarely diagnostic as many different benign and malignant entities can have similar appearances. MRI also can show edema around tumors.

The machine sends a beam of radiation through your body. Your hard, dense bones block that beam, so they show up as white on the X-ray. The radiation also goes through softer tissue like muscle and fat, which appear in shades of gray on the X-ray. It allows the doctor to examine your bones. X-Rays of bone tumors are important in determining the differential diagnosis. The differential diagnosis is based on an X Ray. In terms of soft tissue tumors, X-Rays are important for determining if there is any mineralization (calcification or ossification) in the tumor that may help in categorizing and diagnosing the specific type of tumor. They also show if the underlying bone is eroded or involved in some manner.

The PET scan uses a safe, mildly radioactive drug to show up areas of your body where cells are more active than normal. Cancer tends to be more active than normal cells because it is rapidly dividing and requires a lot of energy to do so. You will drink radioactive sugar which is used to help diagnose cancer. It can also help to find out where and whether cancer has spread. Some cancers may not show up on a PET Scan. Usually a CT scan of almost the entire body is also performed and fused with the PET scan portion for more precise identification of abnormal areas. This is called and ordered a CT-PET scan. The SUV is a number reported for those areas that show up on the PET scan. It represents the degree of uptake. An SUV greater than 6 correlates with malignant (cancerous) tumors.

CT scans are a type of more advanced imaging. It is a series of X-rays which are put together to provide imaging of tissues, organs, and skeletal structures. CT scan is sometimes used to assess the adjacent bone quality and look for flecks of calcium in the tumor to aid in diagnosis. It is also useful for detecting bony erosion from soft tissue masses. The information from a CT scan is often used to supplement that of an MRI. It can aid in diagnosis and help determine proximity to important structures. It is more useful than MRI in evaluating some types of bone tumors like osteoid osteoma. A CT scan of the chest is used to detect lung metastases from bone sarcomas. Soft tissue sarcomas can also spread to the liver so a CT scan of the chest, abdomen and pelvis may be performed. A CT scan is associated with radiation exposure since it involves X-rays.

MRI provides advanced imaging of the soft tissues that is not always readily apparent on X-rays and CT scans. MRI shows us the extent of the tumor and proximity to the important nerves and blood vessels that need to be preserved for a functional extremity. The MRI provides a map for surgery. CT scans and X-rays can help with evaluation of soft tissue masses by determining if calcification or mineralization exists in the tumor or if there is invasion of adjacent bones. Soft tissue sarcomas can spread to the lungs, bones and liver. CT scans of the chest, abdomen and pelvis and a whole body bone scan can be used to evaluate for spread. Sometimes, a whole body CT-PET scan is substituted for these studies.

Typically, X-rays and MRI are used to evaluate a bone sarcoma. The MRI must include the entire bone and adjacent joint. The differential diagnosis is based on the X-ray. MRI can help with the diagnosis but is more important to show the size and extent of the tumor and proximity to the neurovascular structures. Bone scans can be helpful in determining extent in the bone and presence of any skip metastases (metastatic spread in the same bone or across the joint) or distant metastases to other bones. Sometimes, a CT-PET scan may substitute for the CT scans and bone scan. Bone sarcomas are malignant and can spread to the lungs or to other bones. If the bone sarcoma metastasizes to another bone it will usually be shown on a whole body bone scan.

An incidental finding is one where a tumor is found on imaging, including X-rays, MRIs, or CT scans, for other unrelated reasons, such as a sports injury. There are no signs or symptoms associated with the tumor. The cause of the pain is from some other mechanical condition or injury. These tumors are usually indolent and are observed. They usually do not need surgery. Rarely, a malignant tumor is discovered.

Chemotherapy is the administration of certain toxic drugs in an attempt to kill cancer cells and cure patients of their cancer, shrink tumors to facilitate surgical resection or prolong a patient's life. Chemotherapy is typically administered for high grade bone sarcomas. It is usually given before surgery (preoperative chemotherapy=neoadjuvant chemotherapy=induction chemotherapy) to try to kill the tumor before taking it out. The terms induction chemotherapy and neoadjuvant chemotherapy refer to giving the chemotherapy before surgery. Giving chemotherapy before surgery makes it easier to remove the tumor and makes it less likely for the tumor to come back in the area where it was removed. At the same time, any microscopic tumor cells that have spread throughout the body are killed. Certain tumors may shrink dramatically following chemotherapy which makes the surgery easier.

Whenever radiation is prescribed, the benefits of radiation must be weighed against the risks. The complications include stiffness and scarring, burns, muscle contractures, chronic swelling and lymphedema, muscle atrophy, muscle weakness, hair loss in the exposed area, skin burns, radiation induced cancers of bone and soft tissue, malignant degeneration of benign tumors, nerve damage, nerve pain, nerve paralysis. Radiation induced changes and damage continue to progress with time and compound year after year. The severity of these complications varies according to the dose of radiation administered and varies between patients. Most patients experience minor radiation induced changes or complications. Precautions are taken to minimize these complications. Physical therapy is required during and after radiation. Specific exercises should be continued for the rest of the patients life. The entire course of radiation depends upon the dose that is administered. Typically 3-4 weeks of treatment is required. The patient goes for the treatment daily, 5 days per week.

Bisphosphonate limits the loss of bone density resulting from osteoporosis or bone cancer. It helps prevent your bone from weakening or potentially fracturing. Patients with metastatic cancer to bone are often treated with intravenous bisphosphonates. In certain cancers, this treatment has been shown to decrease the number of tumors that develop or spread to the bone, strengthen the bone and also decrease the risk and number of pathological fractures. There are rare instances of osteonecrosis of the jaw that can develop.

Xgeva is a bone targeting medicine preventing the breakdown of bone. It inhibits the function of cells that break down bone (osteoclasts) and inhibit bone resorption. They differ because Xgeva has a stronger effect than a bisphosphonate. Xgeva can also strengthen the bone and decrease the number of metastatic cancers that spread to the bone and decrease the risk of a pathological fracture.

A stem cell transplant utilizes hematopoietic stem cells to treat several types of cancer. Hematopoietic stem cells are specialized cells found in the bone marrow that further differentiate to blood cells, including red blood cells, white blood cells, and platelets. In stem cell/ bone marrow transplants, healthy hematopoietic stem cells are transplanted in order to restore blood cell count and production.

Non-steroidal anti-inflammatory drugs (NSAIDs) are medications commonly used for pain relief and reduce inflammation and fevers. Common NSAIDs are Aspirin and Ibuprofen.

The latest, "State of the Art Treatment" for Osteoid Osteoma is percutaneous radiofrequency ablation (also known as RFA). This is a minimally invasive procedure that is performed under a CAT Scan, usually by a highly specialized musculoskeletal radiologist, in which a needle or probe is inserted into the lesion and the lesion is heated and destroyed. The CAT scan is utilized to localize the Osteoid Osteoma so the needle can be guided directly into the tumor. It is an outpatient procedure. The patient goes home the same day. It is minimally invasive and therefore only a small stab incision or poke hole is made for the needle. The procedure does require that the patient be put to sleep with general anesthesia because insertion of the needle into the Osteoid Osteoma is very painful. The patient must also lie motionless during the procedure. The procedure is greater than 90% effective. This is the same success rate as with actual surgical removal.

The Argon Beam Coagulator is a surgical tool used in various surgeries. The Argon Beam Coagulator destroys tissues with an electrical current passed through a stream of argon gas. This tool may be used to coagulate or to burn and destroy residual, microscopic, malignant (cancerous) cells after a tumor has been removed. It is successful at achieving non-contact hemostasis with minimal thermal injury of adjacent or underlying tissues.

The Midas Rex Saw, created by Medtronic, is a surgical tool used in various orthopedic surgeries. This tool is used for incisions and cutting, removal, drilling, and sawing of bone or metals. It consists of various blades and handpieces for specific functions and procedures.

Proton beam radiation is a type of radiation treatment that utilizes a proton beam to target the tumor. The precise delivery of the proton beam allows for the targeted destruction of tumor cells, while sparing healthy tissues and cells surrounding the tumor. Proton beam radiation is an example of external beam radiation and is a treatment option for sarcomas. Other examples of external radiation therapy include MRI linear accelerator and stereotactic body radiation therapy. In contrast, internal radiation uses a radioactive source near the cancer site and examples of internal radiation include brachytherapy, intraoperative radiation therapy, and stereotactic radiosurgery. Overall, the goal of radiation is to shrink and kill the tumor and malignant (cancerous) cells.

Surgeries are scheduled by the office's administrative staff, and you are asked to discuss your scheduling preferences with the Surgery Coordinator. Changes are made to the surgery calendar daily, and the administrative staff will do their best to accommodate your needs accordingly.

A limb sparing surgery is also called a resection. Resections are usually performed for malignant tumors and very large benign agressive tumors that have destroyed almost the entire bone. A radical resection is typically performed for high grade tumors. Limb sparing surgery can be performed for approximately 95% of malignant bone tumors. With a resection, the tumor is removed with the bone (or part of the bone) and usually the adjacent joint. The bone and joint must be restored. This part of the procedure is called a reconstruction. Usually a metal prosthesis (replica of the bone and joint) is used to restore (reconstruct) the bony and joint deficiency. Metal prostheses restore the patient to good function rapidly and are associated with few short term complications (ie. Infections) so that chemotherapy can be resumed promptly after surgery (few complications to delay chemotherapy if the type of tumor being treated requires chemotherapy). Ninety to 99% of prostheses last 10 years depending upon the anatomic site in which they are placed.An amputation refers to removal of the entire extremity without replacing it. There are several different types of amputations. The name given to the type of amputation depends upon how much of the limb is removed.

Tumors are resectable and amenable to limb sparing surgery as long as they do not encase the neurovascular structures. In some situations the blood vessels and nerves can be removed with the tumor and reconstructed as opposed to an amputation. Other things that may make a limb sparing surgery impossible include: inappropriately performed biopsies that contaminate important tissues or neurovascular structures; infected tumors; fungating bleeding and infected tumors; limb sparing resections that would remove so much tissue that the extremity will not function; recurrent sarcomas especially those in heavily irradiated tissues; resection of bone sarcoma in the lower extremities that will result in major limb length differences; a pathological fracture through a bone sarcoma spreads the cells a far distance and is often a relative contraindication for a limb sparing surgery.

These refer to surgical procedures designed to remove cancerous tumors. When it comes to a bone sarcoma a wide or radical resection, refers to removing the portion of the bone containing the cancer including additional normal appearing bone and soft tissues around the cancer for clear margins. Clear margins means that there are no microscopic cancer cells left that can be detected under a microscope. When it comes to a soft tissue sarcoma, a wide or radical resection means removing the sarcoma with a margin of normal soft tissue around it. These types of resections are used for cancerous tumors to minimize their chances of coming back.

This removes a lesion in one piece by dissecting along the outside surface of the tumor. If done for cancerous tumors (soft tissue sarcomas), it leaves microscopic disease around the wound in a high percentage of the cases. It is most common in treating benign (noncancerous) soft tissue tumors.

The tumor is entered through surgical procedure and the inside is removed, leaving behind microscopic and macroscopic cancer cells. This is most commonly used for for benign tumors. This approach prevents surrounding tissues from being damaged while removing most of the tumor. For benign aggressive bone tumors additional steps may be taken such as shaving the walls of the tumor cavity with a midas rex burr (high speed dental drill) and using liquid nitrogen (cryosurgery) or the argon laser beam to get rid of the microscopic cells and minimize the chances of the tumor coming back.

An en bloc resection is a surgical procedure in which the entirety of the tumor is removed, in addition to a margin of tissue surrounding the tumor. It is an effective treatment option for benign and malignant tumors. It is technically a wide or radical resection.