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Whether you need a second opinion or you’re just starting out, it’s time to work with an oncology specialist at Best In Class MD. Find your condition or recommended treatment below and see how we can help.

Ewing’s sarcoma is a rare type of bone cancer that is most common in children and teenagers. Ewing’s sarcoma often begins in the bones of the leg and pelvis, though it can sometimes start in the soft tissues of the limbs, chest, and abdomen, as well. Surgery to remove the sarcoma, as well as chemotherapy and radiation therapy, are the standard treatment for Ewing’s sarcoma.

For more information and resources on Ewing's Sarcoma or if you have been diagnosed with Ewing's Sarcoma and would like to understand your treatment options, please contact our orthopedic specialists, by clicking on “Get Started.” You will be connected to one of our orthopedic telemedicine experts through our state-of-the-art telemedicine platform.

What is Pigmented Villonodular Synovitis (PVNS)?

Pigmented villonodular synovitis or PVNS is a painful condition that causes the synovium within the joint to overgrow or thicken. The synovium is a thin, connective tissue that lines the inside of the joint capsule. The job of the synovium is to produce fluid which lubricates the joints. When this tissue thickens, it causes a growth of a tumor called pigmented villonodular synovitis (PVNS). The tumor, or PVNS is not cancer and does not metastasize (spread). PVNS is however, a progressive joint disease that continues to worsen and will eventually lead to bone damage and osteoarthritis. Pigmented villonodular synovitis can affect people of all ages, but it occurs most often in young adults from 20 to 50 years of age and most commonly occurs in the knee. PVNS is rare, only 2 out of every 1 million people will be affected. Due to the complexity of PVNS, it is important to find an orthopedic expert who has experience in identifying and treating PVNS. Our “best-in-class” orthopedic doctors are well versed in PVNS and can offer the best treatment advice during a telemedicine visit on our state-of-the-art virtual care platform.

What are the types of pigmented villonodular synovitis, or PVNS?

Orthopedic experts classify PVNS in two categories:

  • Non-localized PVNS – Also known as “Diffuse” PVNS and involves the entire joint lining. Diffuse PVNS is more common and can be more difficult to treat than local PVNS.
  • Local PVNS – Affects one area of the joint or only the tendons supporting the joint. Local PVNS usually responds well to treatment.

Who is susceptible to PVNS?

PVNS is rare in children and usually affects adults 20 to 50 years old. Women are at a slightly higher risk for PVNS than men. The condition is rare, just 2 in every 1 million individuals will have PVNS.

What causes pigmented villonodular synovitis?

The cause of this rare condition is unknown but some doctors suspect a link between PVNS and a recent injury. Heredity may also play a role for individuals more prone to inflammatory diseases or unchecked cell growth (growing benign tumors).

What are the symptoms of PVNS?

As the synovium in the joint thickens and enlarges it can cause the following symptoms:

  • Stiffness in the joint
  • Decreased range of motion
  • Rapid swelling of the joint
  • Mild to moderate pain the joint
    • PVNS is most commonly found in the knee, with the second most common area being the hip.
  • Pain that worsens with use or movement
  • Locking or catching sensation in the joint
  • Feeling of instability, like the knee or hip will not hold your weight
  • Hemarthrosis – when blood collects in the joint space, often with no associated trauma

How is PVNS – pigmented villonodular synovitis diagnosed?

PVNS may require several different diagnostic tests including:

  • X-ray – PVNS may not be detected initially by an x-ray, however PVNS can affect the bones by creating holes in the bone, caused by tumors. If not visible, an x-ray can help rule out other causes of pain.
  • MRI – Helpful in showing the soft tissues and the synovial lining. Synovial thickening and a tumor will show up on an MRI.
  • Joint aspiration – Fluid is removed from the joint and analyzed. PVNS will have a bloody joint fluid.
  • Biopsy – Often required in the presence of a tumor to determine if it is cancerous.

What is the treatment for pigmented villonodular synovitis?

PVNS does not “go away” and will not resolve on its own. Pigmented villonodular synovitis that goes untreated has the potential to destroy bone and cause long-term damage to the joint. Surgery to remove the tumor and painful synovial lining is called a synovectomy.

The experts at BICMD often prefer a minimally invasive procedure called arthroscopic surgery. This type of surgery involves smaller incisions than traditional “open” surgery and uses a small camera along with small, specialized instruments to complete the surgery within the joint capsule.

An open synovectomy may need to occur if the tumor is large and affects both sides of the joint (non-localized PVNS). If there is significant bone damage other treatments for PVNS may include:

  • Total joint replacement or an arthroplasty
  • Radiation – if the tumor cannot be removed completely through surgery
  • Drug therapy – Currently being studied for their ability to reduce cell growth within the joint.

Is there a cure for PVNS – pigmented villonodular synovitis?

Surgery is usually highly successful at treating PVNS, especially the local or non-diffused type of PVNS. Studies show between 10 percent and 30 percent of diffuse PVNS tumors grow back after surgery. It is important to see your doctor for several years after surgery to make sure the tumor has not returned.

For more information and resources on PVNS or pigmented villonodular synovitis, or if you have been diagnosed with PVNS and would like to understand your treatment options, please contact our orthopedic specialists, by clicking on “Get Started.” You will be connected to one of our orthopedic telemedicine experts through our state-of-the-art telemedicine platform.

What is metastatic bone disease?

The term “metastasis” means that cancer has spread to a different body part from where it originally started. Metastatic bone disease (MBD) refers to tumors that develop when the cancer cells break away from the original area of growth and move into bone tissue. Metastatic bone disease is considered an advanced form of cancer and is considered a secondary cancer. Secondary cancers within the bones can be difficult to cure but new treatments are being developed to lessen the symptoms of MBD and lengthen patient life. The oncology experts at BICMD diagnose and treat many different types of bone disease including metastatic bone disease. Our best-in-class doctors can offer an expert second opinion during a telemedicine consultation and will suggest the best treatment options available for your specific condition.

What types of cancer can spread to the bones?

Cancer that begins in an organ, such as the lungs, breast, or prostate can spread to the bones and is called MBD or metastatic bone disease. 1.2 million people are diagnosed with cancer each year and approximately half of the new cancers can spread to the bones. Cancers that most commonly metastasize to the bones are:

  • Breast
  • Lung
  • Thyroid
  • Prostate
  • Kidney
  • Colon

Is bone cancer and metastatic bone disease the same thing?

Osteosarcoma (also called osteogenic sarcoma) is bone cancer that begins in the cells that make up the bone. Osteosarcoma is the most common primary bone cancer and occurs most often in young people between the ages of 10 and 30. Metastatic bone disease (MBD) is a tumor or cancer cell that traveled to the bone from somewhere else in the body. MBD is not technically considered bone cancer but is a secondary type of cancer. Read more here about Osteogenic Sarcoma.

What are the symptoms of MBD or metastatic bone disease?

MBD causes pain in the area the cancer cells spread to. Other symptoms may include:

  • Brittle bones that break easily
  • Weakness in the legs or arms
  • High levels of calcium in the blood – may cause confusion and nausea
  • Loss of bowel or urinary control
  • Decreased red blood cell production (Anemia)

Which bones are most likely to have MBD?

The most common areas for bone metastases include:

  • Spine
  • Femur or Tibia (long bones of the leg)
  • Pelvis
  • Ribs
  • Skull
  • Humerus (upper arm bone)

How is metastatic bone disease diagnosed?

If you have been diagnosed with cancer it is important to talk to your doctor about the risk of cancer cells moving to the bones (metastasizing). Diagnostic testing will often include an x-ray to visualize the affected bone. A bone scan or bone density scan will help determine if other bones in the body are involved. CT Scans and MRI Scans can help pinpoint the location of tumors or other bone damage. Blood tests and biopsies are not uncommon to help form an exact diagnosis.

How is MBD, metastatic bone disease treated?

Treatment of MBD often depends on the location, severity and the source tumor cells. Treatments can include surgical and non-surgical therapies.

Radiation – can be highly effective at treating MBD and is the most common therapy used. Radiation kills the cancer cells, stops the tumor from growing and relieves pain. Radiation can prevent the bone from breaking and can even help repair a broken bone. Radiation does have limitations and is not considered “curative.” However, radiation can help lessen the symptoms and, in some cases, destroy the disease in the affected bone.

Medication – Medications can vary, based on the type of cancer, symptoms and where the cancer came from. Medications may include:

  • Bone building medication – Strengthen bones and reduce pain
  • Chemotherapy – Drugs that kill fast-growing cells, such as cancer cells
  • Hormone therapy – Block the hormone producing cancer cells; often used with prostate, testicular, breast and ovarian cancers.
  • IV Radiation – Used for multiple bone metastases; contains a radioactive material that has a strong attraction to bones. It travels to the areas of bone metastasis and releases radiation.
  • Steroids – Relieve pain and helps with complication
  • Pain Medications – Relieve pain caused by MBD

Surgery for MBD –

Surgery for MBD is done as a preventative measure – to decrease the risk of a broken bone. The goal of surgical treatment for metastatic bone disease is to reduce pain, restore bone strength and to help the patient regain the ability to do daily activities.

During this very specialized surgery, a weakened or broken bone is carefully fixed into position and supported with a combination of wires, plates, rods, pins, nails or screws. If a tumor is present, it is removed and bone cement is placed into the defect, giving the bone added strength.

For more information and resources on metastatic bone disease or MBD and the different treatment options available; or if you’ve been diagnosed with MBD and would like an expert 2nd opinion, please contact our orthopedic specialists, by clicking on “Get Started.” You will be connected to one of our orthopedic telemedicine experts through our state-of-the-art telemedicine platform.

What is Osteosarcoma (osteogenic sarcoma)?

Osteogenic sarcoma, also called osteosarcoma is the most common form of cancer that starts in the cells that form bones. Unlike metastatic bone disease, where the cancerous cells come from another part of the body, osteosarcoma originates in the bone itself. It is most often found in the long bones in children and young adults. Teens are most commonly diagnosed with osteogenic sarcomas, but they can occur at any age. This rare form of bone cancer, osteosarcoma produces malignant (cancerous) cells which create irregular bone tissue and tumors. The bone tumor usually develops at the ends of the long bones and most often around the femur, near the knee, or in the humus, near the shoulder. In very rare instances, osteosarcoma can occur in the soft tissue outside of the bone. The experts at BICMD have extensive experience diagnosing and treating patients with osteogenic sarcoma. We can offer the most up-to-date treatment options available during a telemedicine visit, done through our state-of-the-art telehealth platform.

 Where does osteosarcoma start?

Osteosarcoma can develop in any bone, including the bones of the pelvis (hips), shoulder, and jaw. This is especially true in older adults. In younger adults and children, osteosarcoma usually begins in the area where bone growth is rapidly occurring. This growth is usually near the growth plates at the ends of the long bones in the legs and arms.

What are the types of bone tumors?

Osteosarcomas are tumors, or bone cancer that originate in the bones. They are a type of malignant (cancerous) tumor. Malignant bone tumors can spread to other parts of the body and can be life threatening. Benign bone tumors are non-cancerous and are not life threatening. Benign bone tumors will not spread to other parts of the body and can usually be cured by surgery.

What are the grades of osteogenic sarcomas?

Doctors classify osteogenic sarcomas into grades based on how the cells look under a microscope. The type or grade of tumor tells doctors how likely the cancer will grow or spread (metastasize) to other parts of the body. Grades of osteosarcomas are:

  • High-Grade Osteosarcoma – The most rapidly growing type of osteosarcoma. Also, the most common grade among children and teens.
  • Intermediate-Grade Osteosarcoma – Between high and low grade and are treated in a similar manner to low-grade osteosarcomas.
  • Low-Grade Osteosarcoma – Slowest growing type of osteosarcoma. The cells of the tumor look more like normal bone.

What are the symptoms of osteogenic sarcoma?

  • Pain in the affected bone
  • Pain that may come and go
  • Pain that worsens to become severe and constant
  • Visible swelling (if the tumor grows)
  • Decreased range of motion
  • Limping – with tumors in the leg
  • Pain when lifting – with tumors in the arm or shoulder
  • Fracture at the site of the tumor (called pathological fracture)

How are osteogenic sarcomas diagnosed?

The first step in diagnosing an osteosarcoma is to obtain an x-ray of the affected bone. If the x-ray suggests a tumor a CT scan or an MRI scan will show the size, shape and location of the tumor. A skilled and experienced orthopedic oncologist, like the experts at BICMD, should perform a biopsy of the tumor in order to identify the type. It is important to have a physician who has expertise in cancer surgery to ensure that the biopsy is done in a specific way, so that subsequent surgical procedures are not put at risk. Follow up CT scans and a bone scan will be ordered to find out if the cancer has spread.

Proper diagnosis of osteogenic sarcomas includes the grading and staging of the cancer.

  • Grading – As mentioned above, the higher the grade, the more aggressive the cancer.
  • Staging – Once the biopsy of the tumor has been identified as an osteogenic sarcoma, the doctor will use the imaging studies and blood tests to determine if the cancer has spread. Doctors often use a simple system that divides osteosarcomas into 2 groups: localized and metastatic.
    • Localized – The osteosarcoma is found only in the bone where it began and possibly in the tissues next to the bone.
    • Metastatic – The osteosarcoma (cancer cells) have spread to other parts of the body from the point of origin.

What is the treatment for osteogenic sarcoma?

Treatment for the osteosarcoma is based on the size, grade and stage of the cancer. Treatment for an osteogenic sarcoma may include:

  • Surgery – Surgery may include amputation (removal of a limb) or removal of part of the affected bone, which is then replaced by a prosthesis (artificial limb). A limb-sparing surgery that removes only part of the affected bone is used when the limb can be saved, while still removing the cancer.
  • Chemotherapy – Sometimes used before and after surgery. Chemotherapy is the use of drugs to kill quickly-growing cells. It is used before surgery to shrink the tumor and after surgery to prevent the spread of cancer cells and to kill any cells that have metastasized.
  • Radiation – The use of high-dose x-ray to kill cancer cells and shrink tumors. Radiation for osteosarcomas is usually appropriate for a select type of osteosarcoma and is not a common treatment.

For more information and resources on osteogenic sarcoma or osteosarcomas and the treatments available, or if you’ve been diagnosed with bone cancer and would like an expert 2nd opinion, please contact our orthopedic specialists, by clicking on “Get Started.” You will be connected to one of our orthopedic oncology telemedicine experts through our state-of-the-art telemedicine platform.

Adamantinoma is a rare cancerous tumor of the tibia that usually occurs in adolescents and young adults whose bones have not yet stopped growing. Adamantinomas are capable of spreading and require surgery to remove. Fewer than 1% of all cancerous tumors of the bone are adamantinomas. These slow-growing tumors are typically found in the tibia, but they can also affect the fibula and have even been found in the bones of the arms, ribs, spine, pelvis and foot. Adamantinomas are aggressive, and they may even spread to soft tissues if not addressed promptly.

For more information and resources on adamantinoma and the treatments available, or if you’ve been diagnosed with adamantinoma and would like an expert 2nd opinion, please contact our orthopedic specialists, by clicking on “Get Started.” You will be connected to one of our orthopedic oncology telemedicine experts through our state-of-the-art telemedicine platform.

Chondrosarcomas are malignant tumors that usually begin in the bones but can spread to other anatomical soft tissue in the vicinity of the origination area. Chondrosarcomas are typically found in the pelvis, hip and shoulder. The thing that makes these tumors unique is that their cells produce cartilage. Chondrosarcomas can be fast or slow-growing. Surgical removal of the tumor is the typical treatment.

For more information and resources on chondrosarcoma and the treatments available, or if you’ve been diagnosed with chondrosarcoma and would like an expert 2nd opinion, please contact our orthopedic specialists, by clicking on “Get Started.” You will be connected to one of our orthopedic oncology telemedicine experts through our state-of-the-art telemedicine platform.

The list contains some of our most commonly seen orthopedic oncology conditions, but it is by no means exhaustive. Our providers are orthopedic oncology specialists that handle the same wide variety of conditions and tumors that an in-person specialist would. If you don’t see your specific orthopedic tumor condition listed above, the providers at BICMD are still available to bring their vast expertise to your treatment.

Click on “Get Started” to reach one of our orthopedic telemedicine experts.

Best in Class Tumor & Oncology Specialists

  • Nicola Fabbri
    • Professor of Orthopedic Surgery
    • Advisory Panel of the National Comprehensive Cancer Network
  • Wakenda Tyler, MD MPH
    • Chief of Orthopedic Oncology Service
    • Associate Professor of Orthopedic Surgery, Columbia University Medical Center

What's bothering you?

Talk to the best shoulder specialists in the country

find out more about shoulder pain

Common chronic shoulder pain conditions and treatments

  • Rotator Cuff Tear
  • Shoulder Osteoarthritis
  • Shoulder Instability / Shoulder Labrum Tear
  • Frozen Shoulder
  • Clavicle Fracture
  • Rotator Cuff Repair
  • Shoulder Fractures
  • Other Condition / Treatment
  • Brian Forsythe, MD
  • Answorth Allen, MD

Talk to the best neck, back, & spine specialists in the country

find out more about neck, back, & spine pain

Common chronic neck, back, & spine conditions and treatments

  • Chronic Back Pain / Acute Back Pain
  • Degenerative Conditions of the Lumbar and Cervical Spine
  • Lumbar Disc Herniation
  • Radicular Pain / Sciatica Pain
  • Cervical Disc Herniation
  • Lumbar Spinal Stenosis
  • Scoliosis
  • Cervical Disc Replacement
  • Spinal Injections
  • Anterior Cervical Discectomy and Fusion (ACDF)
  • Lumbar Fusion
  • Lumbar Microdisectomy
  • Cervical Spinal Stenosis (Myelopathy)
  • Failed Back Surgery
  • Spinal Cord Injuries
  • Other Condition / Treatment
  • Federico Girardi, MD
  • Kathleen Davenport, MD

Talk to the best hand, wrist, & elbow specialists in the country

find out more about hand, wrist, & elbow pain

Common chronic hand, wrist, & elbow pain conditions and treatments

  • Carpal Tunnel Syndrome
  • Cubital Tunnel Syndrome
  • Lateral Epicondylitis (Tennis Elbow)
  • Medial Epicondylitis (Golfer’s Elbow)
  • Fracture of the Finger
  • Arthritis of the Hand and Wrist
  • Hand and Upper Extremity Fractures
  • Dupuytren’s Disease
  • De Quervain’s Disease
  • Trigger Finger
  • Elbow Osteoarthritis
  • Other Condition / Treatment
  • Charles Goldfarb, MD
  • David Altchek, MD

Talk to the best knee specialists in the country

find out more about knee pain

Common chronic knee pain conditions and treatments

  • Knee Arthritis
  • ACL Tear
  • Meniscus Tear
  • Osteochondral Defect
  • Patellar Tendon / Quadriceps Tendon Rupture
  • ACL Reconstruction and Repair
  • Meniscus Repair
  • Knee Replacement
  • Unicompartmental Knee Replacement
  • Other Condition / Treatment
  • Riley Williams III, MD
  • Michael Cross, MD

Talk to the best hip specialists in the country

find out more about hip pain

Common chronic hip pain conditions and treatments

  • Hip Osteoarthritis
  • Femoroacetabular Impingement / Hip Labrum Tear
  • Gluteus Medius & Minimus Tear
  • Trochanteric Pain Syndrome
  • Hip Fractures
  • Hip Replacement
  • Hip Resurfacing
  • Hip Arthroscopy and Labral Repair
  • Pelvic and Acetabular Fracture
  • Pediatric Hip Conditions
  • Other Condition / Treatment
  • Edwin Su, MD
  • Benedict Nwachukwu, MD MBA

Talk to the best foot & ankle specialists in the country

find out more about foot & ankle pain

Common foot & ankle pain conditions and treatments

  • Flat Feet
  • Foot Neuromas
  • Hallux Valgus
  • Ankle Arthritis
  • Hammertoes
  • Ankle Sprains
  • Ankle Fracture
  • 5th Metatarsal Base Fracture
  • LisFranc Injury
  • Calcaneus Fracture
  • Achilles Tendon Injuries
  • Bunion
  • Congenital Club Foot
  • Foot Fractures
  • Plantar Fasciitis
  • Other Condition / Treatment
  • Robert “Bob” Anderson, MD
  • Martin O’Malley, MD

Talk to the best oncological specialists in the country

find out more about Tumor & Oncology

Common oncological conditions and treatments

  • Ewing’s Sarcoma
  • Pigmented Villonodular Synovitis (PVNS)
  • Metastatic Bone Disease
  • Osteogenic Sarcoma
  • Adamantinoma
  • Chondrosarcoma
  • Other Condition / Treatment
  • Nicola Fabbri
  • Wakenda Tyler, MD MPH

My doctor treating me in my area recommended BICMD for an expert second opinion. His ability to help me was limited, and he suggested I explore the possibility of meeting with a BICMD expert.

-Ed Leskauskas

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