When Bone Pain Is More Than Growing Pains
Parents bring children to me at EPIC Multispecialty Hospital, Ahmedabad, after weeks or months of bone pain that was initially attributed to growth, sports, or minor injury. Adults come with persistent aching in a limb that was treated as tendonitis or arthritis before someone decided to order an X-ray.
Bone tumours — abnormal growths within bone — are rare, but they are also a diagnosis that can be significantly delayed because the initial symptoms are not obviously alarming. My role as an orthopaedic oncosurgeon is to diagnose them accurately, manage them appropriately, and — wherever possible — save the limb while removing the tumour.
I want to explain what bone tumours are, which are benign and which are malignant, and what modern orthopaedic oncology can offer patients in Ahmedabad and Gujarat.
Benign vs Malignant — Most Bone Tumours Are Not Cancer
The most important thing to know about bone tumours is that the large majority are benign — they grow locally, they do not spread to other parts of the body, and they can often be managed conservatively or with straightforward surgical removal.
Common benign bone tumours include osteochondromas (bony outgrowths near joints), enchondromas (cartilage-containing benign tumours inside bones), non-ossifying fibromas (fibrous tissue replacement within bone), and giant cell tumours (which are locally aggressive but rarely truly malignant).
Malignant bone tumours — primary bone cancers — are rarer. Osteosarcoma is the most common, typically affecting children and young adults between ten and twenty-five years old, most commonly arising around the knee. Ewing sarcoma affects younger patients and can involve both bone and soft tissue. Chondrosarcoma typically affects adults. Metastatic bone disease — cancer that has spread to the bone from a primary tumour elsewhere (breast, prostate, lung, kidney) — is more common than primary bone cancer in adults over forty.
An X-ray, followed in most cases by MRI and CT scanning, defines the tumour’s characteristics. Biopsy — taking a small tissue sample — confirms the diagnosis. I perform bone tumour biopsies using a technique specifically designed to ensure the biopsy track can be included in the surgical resection, so that the biopsy does not compromise the definitive surgery.
Limb Salvage Surgery — Keeping the Limb While Removing the Tumour
Twenty years ago, the treatment for malignant bone tumours frequently involved amputation — removing the limb to achieve complete tumour clearance. The development of effective chemotherapy protocols for osteosarcoma and Ewing sarcoma, combined with advances in surgical reconstruction techniques, has dramatically changed this.
Today, limb salvage surgery — removing the tumour with adequate margins while reconstructing the bone and joint — is performed in over eighty percent of bone sarcoma cases in experienced centres. At EPIC Multispecialty Hospital, Ahmedabad, this reconstruction uses a combination of metal implants (megaprostheses), bone allografts, and biological reconstruction techniques depending on the tumour location, patient age, and reconstruction requirements.
The goal is always clear margins — removing the tumour completely — while preserving a functional limb. For a child with osteosarcoma around the knee, limb salvage with a growing prosthesis (which can be extended as the child grows) means they can walk, run, and lead a normal life after treatment. Amputation, while occasionally still necessary for specific situations, is now a last resort rather than a first choice.
The Role of Chemotherapy in Bone Cancer Treatment
For osteosarcoma and Ewing sarcoma, surgery alone is not sufficient — chemotherapy is an essential part of the treatment. The chemotherapy used for these tumours is given before surgery (neoadjuvant) to shrink the tumour, reduce the risk of surgery-related tumour spread, and assess the tumour’s sensitivity to the drugs used. After surgery, more chemotherapy is given to address any remaining microscopic disease.
The degree to which the tumour responds to pre-operative chemotherapy — assessed by examining the resected specimen under the microscope and estimating what percentage of tumour cells are still alive — is one of the most important prognostic factors in bone sarcoma. A strong responder — more than ninety percent tumour cell death — has a significantly better long-term outlook than a poor responder.
Chemotherapy for bone tumours is managed by our medical oncology colleagues at EPIC Multispecialty Hospital, Ahmedabad, and coordinated closely with my surgical plan. The timing of surgery is determined by the chemotherapy schedule, and both teams work together throughout the patient’s treatment.
Follow-Up After Bone Tumour Treatment
After completion of surgery and chemotherapy, bone tumour patients require regular follow-up — typically every three months for the first two years, then every six months, then annually. Follow-up includes clinical assessment of the limb and reconstruction, chest CT scans to screen for pulmonary metastases (the most common site of distant spread for osteosarcoma), and local MRI where indicated.
For children with growing prostheses, periodic adjustments are needed as they grow. For all patients, the integration of the prosthetic or allograft reconstruction into normal function is monitored and supported with physiotherapy.
My patients who complete treatment and enter long-term follow-up go on to live active, meaningful lives. I have patients who were children when I operated on them who are now adults, working, raising their own families. That is the outcome that makes orthopaedic oncology one of the most rewarding fields in medicine.
Common Questions Patients Ask
Is a bone tumour always cancer?
No. Most bone tumours are benign — they grow locally without spreading and can often be managed conservatively or with straightforward surgery. Malignant primary bone tumours are rare. Accurate imaging and biopsy are the only reliable ways to distinguish benign from malignant bone tumours.
What are the symptoms of a bone tumour?
Persistent bone pain — particularly pain that does not relate clearly to an injury, that is present at rest or at night, or that is progressive — is the most important symptom. A visible or palpable lump, swelling around a bone or joint, or an unexplained fracture through a bone (pathological fracture) are also important warning signs.
Is bone tumour surgery very major?
This depends entirely on the tumour — its type, size, and location. Benign tumour removal can be a short procedure. Limb salvage surgery for malignant tumours involving major joints is a significant operation requiring careful reconstruction. I discuss the specific procedure in detail with every patient before operating.
Can children have bone tumour surgery?
Yes. Osteosarcoma and Ewing sarcoma frequently affect children and young adults, and limb salvage surgery specifically designed for paediatric patients — including growing prostheses that extend as the child grows — is available at EPIC Multispecialty Hospital, Ahmedabad.
Is orthopaedic oncology available in Ahmedabad?
Yes. EPIC Multispecialty Hospital, Ahmedabad, has a dedicated orthopaedic oncology service with expertise in benign and malignant bone and soft tissue tumour management, biopsy, limb salvage surgery, and coordination with medical oncology for chemotherapy.
Dr. Mandip Shah M.S.
Ortho Oncosurgeon, EPIC Multispecialty Hospital, Ahmedabad.