Neglected orthopedic oncology ‑ Causes, epidemiology and challenges for management in developing countries.
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Date
2015-07
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Abstract
BACKGROUND: Management of malignant bone and soft tissue tumors remains an overwhelming confront to orthopedic surgeons. The challenge
is discriminating in developing countries due to inadequate diagnostic and therapeutic amenities and unawareness. A lot has been discussed
about the neglected orthopedic trauma, but the published literature on the causes and management of neglected bone and soft tissue tumors
is sparse. Hence, current study was undertaken to highlight the causes of neglect and therapeutic challenges for managing these neglected
tumors in developing countries. AIMS AND OBJECTIVES: To determine the causes of neglect of malignant bone and soft tissue tumors, their
epidemiology (including their relative frequencies, age, gender discrimination, anatomical sites of occurrence and histological characteristics)
and difficult aspect of management due to neglect or delayed presentation. MATERIALS AND METHODS: This was an appraisal of the neglected
malignant bone and soft tissue tumors presented to J. N. Medical College and Hospital from June 2008 to May 2013. Criteria for labeling the tumor
as neglected malignant bone and soft tissue tumor was delayed presentation (>3 months), locally advanced disease, ulceration, sepsis, fungating
mass or metastasis at the time of presentation. All the cases were reviewed and analyzed for age, gender, histological types, educational status
and socioeconomic status of the family, any prior treatment by traditional bone setters or registered medical practitioner, cause of delay for seeking
medical advice. We have also analyzed the treatment given at our institute and the outcome of the tumor. OBSERVATIONS AND RESULTS: Eighteen
patients fulfilled the criteria for neglected malignant bone and soft tissue tumors, hence were included in study. Eight cases were of osteosarcoma,
five cases were of Ewing’s sarcoma, three cases were of chondrosarcoma and 1 case each was of pleomorphic liposarcoma and primary lymphoma
of bone. According to Enneking staging system 11 cases were of stage III (distant metastasis) and 7 were stage II‑B. Seven were females, and
11 were males. Age range was 5–68 years. 15 patients (83.3%) belonged to low socioeconomic status with 17 patients (94.4%) belonged to
uneducated background. Cause of delay in seeking medical advice was neglect by the patient and family due to financial constraints, cultural and
religious believes, lack of access to health care facilities, consultation with traditional bone setters and even misdiagnosis by qualified orthopedic
surgeons. The tumors included were all unresectable and of huge sizes, hence were managed with amputation/dis‑articulation, chemotherapy or
radiation. CONCLUSION: The current study tries to highlight the causes and quantity of neglect of malignant bone and soft tissue tumors prevalent
in our country, which poses a therapeutic challenge for management and consequent mutilating surgeries with poor outcome resulting in loss of
extremity and existence.
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Keywords
Bone/soft tissue tumors, malignant, metastatic, neglected, orthopedic oncology
Citation
Siddiqui Y S, Sherwani M K A, Khan A Q, Zahid M, Abbas M, Asif N. Neglected orthopedic oncology ‑ Causes, epidemiology and challenges for management in developing countries. Indian Journal of Cancer. 2015 July-Sept; 52(3): 325-329.