Musculoskeletal Oncology

Our Musculoskeletal Oncology service is one of the most comprehensive in Singapore. With 2 full-time orthopaedic oncologists and various ancillary staff, we are able to handle most of the challenges that the field offers. Being the only government-restructured hospital in Singapore to treat both paediatric and adult patients, NUH offers the ability to combine the knowledge and expertise of paediatricians and orthopaedic surgeons under one roof. Our orthopaedic surgeons also provide a musculoskeletal surgical oncology service to KK Women's and Children's Hospital, which is the country's dedicated children's hospital.

Musculoskeletal oncology is a challenging field of medicine in which only a small group of doctors in Singapore are trained. It involves the management of tumor and tumor-like conditions of the bones, joints and soft-tissues of the extremities and spine. These are broadly classified as benign (tumors that grow and expand and cause local problems and diagnostic difficulties) and malignant (these are the cancers of the bones and soft tissues). Malignant tumors can be primary or originally derived from the bones and soft tissues (also known as sarcomas) or secondary or spread from a distant site. Sarcomas are very difficult life-threatening problems and require great expertise not just in surgery but also in organising multidisciplinary teams to tackle individual specific problems. Some musculoskeletal oncology conditions may not be life-threatening but, nevertheless, these problems provide unique challenges for medical practitioners because they often hamper daily activities and hence need to be dealt with urgently.

Research and Teaching

Affiliated with the premier teaching facility in Singapore, the National University of Singapore, the musculoskeletal oncology service is able to draw on the basic science expertise of a wide number of scientists to pursue novel therapeutic measures - some of which have been emulated by other centers around the world.

Through collaborative efforts with various laboratories in the National University of Singapore and overseas, we explore various aspects of tumor physiology by implanting tumors into mice and allowing them to grow (a) and then testing these tumors for grades of aggressiveness (b) and genetic regulation (c). This allows us a better understanding of the disease process far beyond traditional clinical approaches.

We are at the stage where tumors resected are now investigated in the laboratory in cell culture systems that look at how aggressive these tumors are. Furthermore, other collaborative efforts help us better understand the disease process at many levels other than the basic imaging and surgical methods available to us presently.

Selected publications of our musculoskeletal oncologists include:-

1. Survival in patients operated on for pathologic fracture: implications for end-of-life orthopedic care. Nathan SS et al. J Clin Oncol. 2005 Sep 1;23(25):6072-82.
2. Elevated physiologic tumor pressure promotes proliferation and chemosensitivity in human osteosarcoma. Nathan SS et al. Clin Cancer Res. 2005 Mar 15;11(6):2389-97.
3. Ankle instability after vascularized fibular harvest for tumor reconstruction. Nathan SS et al. Ann Surg Oncol. 2005 Jan;12(1):57-64. Epub 2004 Dec 27.
4. Extremity osteosarcoma-a Southeast Asian experience. HC Chang et al. Ann Acad Med Singapore. 2002 Sep;31(5):598-606.
5. A gastrocnemius-pedicled femoral bone graft in resection arthrodesis at the knee. Pho RW et al. J Bone Joint Surg Br. 1988 May;70(3):354-7.
6. Late metastases from osteogenic sarcoma. A case report. Pho RW et al. J Bone Joint Surg Am. 1985 Jan;67(1):147-50.
7. Function following limb salvage for primary tumors of the shoulder girdle. 10 patients followed 4 (1-11) years. Kumar VP et al. Acta Orthop Scand. 1994 Feb;65(1):55-61.
8. Radial reconstruction in segmental defects of both forearm bones. Kumar VP et al. J Bone Joint Surg Br. 1988 Nov;70(5):815-7.
9. Malignant giant-cell tumor of the distal end of the radius treated by a free vascularized fibular transplant. Pho RW. J Bone Joint Surg Am. 1981 Jul;63(6):877-84.

For more information on musculoskeletal bone and soft tissue tumours, click here.

Our musculoskeletal surgical oncologists, Professor Robert Pho and Dr Suresh Nathan are available for consultation at NUH Specialist Outpatient Clinics daily. For appointments, click here.

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