Orthopaedic Oncology

Oncology Image

Marshall Orthopaedics’ Division of Orthopaedic Oncology is led by Felix H. Cheung, MD, along with Jaclyn Kiser, PA-C. Dr. Cheung offers the latest treatments in orthopaedic oncology while providing the caring support you have come to expect from the physicians at Marshall Orthopaedics. Finding out you may have cancer can be very devastating, but our staff will be here to guide you every step of the way. Marshall Orthopaedics has developed this webpage to be used as a resource for your pre-procedure and post-recovery concerns.

Watch Dr. Felix Cheung's Interview on Vital Signs

FAQs About Orthopaedic Oncology

Q: Because I am seeing an orthopaedic oncologist, does that mean I have cancer?

A: Not necessarily. There are very many conditions that can look like cancer on an X-Ray and turn out to be completely benign (not cancerous). Because Dr. Cheung and his team of musculoskeletal pathologists and radiologist have the most experience in the region in dealing with bone and soft tissue tumors, often times your doctor will refer you to him to make sure there is nothing dangerous going on.

Q: What is the difference between a tumor and a lesion?

A: The terms are used interchangeably. Neither word implies cancer or danger, only that there is an abnormality there.

Q: What is cancer?

A: In general terms, cancer happens when a cell loses its ability to control its growth.  This may be  caused by genetic mutations.  This causes the cell to multiply rapidly, creating a mass or lump.  Eventually the cells also develop the ability to spread beyond where they started.  This condition is known as metastasis.

Q: What is sarcoma?

A: Sarcomas are cancers that start from connective tissue like muscles, fat, blood vessels, nerves, and bones.  Examples of sarcomas include rhabdomyosarcomas, liposarcomas, angiosarcomas, MPNSTs, and osteosarcomas.  They behave differently than "carcinomas" which come from glands and the lining of organs.  Examples of carcinomas include the more common Breast, Prostate, Colon, Lung, Thyroid, and Ovarian cancers.

Q: How common are sarcomas?

A: Very rare.  There are only 15,000 cases of sarcomas reported in the US each year, compared to over 250,000 cases of breast cancer alone.  This means it is very important to have surgeons and oncologists who have experience with these rare cancers provide the appropriate treatments for you.

Q: What causes sarcomas?

A: There are very few risk factors for the development of sarcomas.  Most are from random mutations of the genetics of the tissue.  Exposure to high doses of radiation is a known risk factor, and there are some genetic associations, with retinoblastoma and Li Fraumeni syndrome.   This is in contrast to many carcinomas, which have associations with correctable issues, such as smoking, fatty diets, or obesity.

Q: What are some non-cancerous tumors found in the bone?

A: Most bone lesions are benign.  In children, common ones include unicameral bone cysts, aneurysmal bone cysts, fibrous cortical defects, non-ossifying fibromas, fibrous dysplasia, osteoid osteoma, osteoblastoma, chondromyxoid fibroma, chondroblastoma, enchondromas, osteochondromas, EG.

Q: What are some non-cancerous tumors found in soft tissue?

A: Most soft tissue lesions are benign.  The most common ones are lipoma, myositis ossificans, heterotopic bone, benign fibrous histiocytoma, solitary fibrous tumor, intramuscular myxoma.

Q: What are some conditions that are commonly confused with tumors?

A: These are most often benign, such as synovial cysts, ganglion cysts, abscesses, osteomyelitis, tumoral calcinosis.

Q: What is osteosarcoma?

A: Osteosarcoma is a cancer that comes from bone forming cells (also called osteoblasts.)  There are less than 1500 cases each year in the US, predominantly in children, although there are some cases that occur in patients over the age of 55.  The cancer can affect any bone, but is most common in the pelvis, hip, shoulder and knee.  The vast majority of patients can be treated by chemotherapy and limb salvage surgery. Marshall University and Cabell Huntington Hospital have teamed up to study a particular gene found in osteosarcoma called p53.  The hope is by inactivating this gene, we can prevent this cancer from coming back in even more people.

Q: What is Ewing's Sarcoma?

A: Ewing's Sarcoma is a cancer than affects children, most commonly the pelvis, hip, knee, and shoulder.  The origins of the cells are unknown, and there are around 500 cases in the US each year.  The vast majority of patients can be treated by chemotherapy and limb salvage surgery.  Occasionally, radiation therapy is useful for non-operative cases.  Survival rates exceed 70% at five years.  The most common site of metastasis (or spread of disease) is the lung.

Q: What is Chondrosarcoma?

A: Chondrosarcoma is a cancer that comes from cartilage forming cells (also called chondrocytes).  There are between 500-1000 new cases each year in the US, mainly affecting middle-aged to elderly adults.  The vast majority of patients can be treated by limb salvage surgery alone; radiation and chemotherapy are usually effective.  Survival rates exceed 80% at five years for low grade tumors, but are below 40% for high grade tumors.  The most common site of metastasis (or spread of disease) is the lung.

Q: What is Malignant Fibrous Histiocytoma or Undifferentiated Soft Tissue Sarcoma?

A: Malignant Fibrous Histiocytoma (MFH) or Undifferentiated Soft Tissue Sarcoma are cancers of the soft tissue that have mutated so that we can no longer tell what cell the original cancer came from.  There are over 5,000 of these every year in the US, mainly affecting  middle-aged to elderly adults.  At our center, we treat these with radiation therapy and surgical resection, with emphasis on limb salvage if possible.   Occasionally, chemotherapy may be used if the patient can tolerate it.  Survival rates average 60% at five years.  The most common site of metastasis is to the lung.

Q: What is a Liposarcoma?

A: Liposarcoma is a cancer that developed from fat cells in the body.  It is the second most common soft tissue tumor, affecting middle-aged to elderly adults.  Depending on the histological grade (how aggressive it looks like under the microscope), this is treated with surgery alone or surgery with radiation and maybe chemotherapy.  Survivorship depends on the grade and stage.  The most common site of metastasis is to the lung.

Questions and Answers from American Academic of Orthopaedic Surgeons. For more information visit