North of England Bone and Soft Tissue Tumour Service
Orthopaedic Oncology Syllabus
This list has been collated from the core and specialist curriculae and represents the
knowledge an d competencies an orthopaedic trainee in the Northern Region would
reasonably be expected to have at FRCSOrth in this specialist area. These are the areas of
specialist knowledge and competency that a trainee could be exposed to in an orthopaedic
oncology attachment.
This is a guide for trainees only, and has not been approved or validated by the exam board.
September 2014
Knowledge
1.
Basic science of neoplasia
 Pathology of tumours
 Classification of tumours
 Tumour development and growth including metastasis
 Principles of staging and grading of cancers
 Principles of cancer therapy including surgery, radiotherapy, chemotherapy,
immunotherapy and hormone therapy
 Principles of cancer registration
 Principles of cancer screening
 Treatment and outcome for common benign and malignant tumours Including
knee and spine
 Radiological features of neoplasia
 Modalities of treatment including non-surgical and surgical options.
 Surgical margin concepts
 Options for reconstruction of the surgically excised defect.
 Adjuvant treatments used in combination with surgery for malignant neoplasms.
2.
Metastatic bone disease
 Principles of management of patients with metastatic bone disease in terms of
investigation, prophylactic and definitive fixation of pathological fractures and
oncological management
 Metastatic spinal cord compression
 Principles of management of skin cancer occurring in the upper limb and
management of the regional lymph nodes.
3.
Orthotics and prosthetics
 Principles of design
 Prescription and fitting of standard prostheses
 Principles of orthotic bracing for control of disease, deformity and instability
4.
Soft tissue tumours
 Presenting features, management and outcome of soft tissue swellings,
including sarcomas
5.
Amputations
 Principles and techniques for amputations at the following levels: forequarter,
above elbow, below elbow, finger, hindquarter, above knee, through knee,
below knee, through ankle, hind foot, mid foot, toe
Competence levels
1= Knows of
2= Knows basic concepts
3= Knows generally
4= Knows specifically and broadly.
5= Knows specifically and in detail
Presentation, radiological features, pathological features, treatment and
outcome for common benign and malignant tumours
Principles of management of patients with metastatic bone disease in terms
of investigation, prophylactic and definitive fixation of pathological fractures
and oncological management
3
4
Presenting features, management and outcome of soft tissue swellings,
including sarcomas
4
Prosthetic principle and design
4
Prescription and fitting of standard prostheses
4
Principles of orthotic bracing for control of disease, deformity and instability.
4
Benign and malignant conditions in the knee and surrounding structures
4
Clinical Skills
Knows specifically and in detail – Outcome 5
Communication skills and team working:
1. Breaking bad news. To deliver bad news according to the needs of individual patients






Describe the impact of bad news on the relationship with the patient
Prepare appropriately
Outline different responses to bad news
Balance requirement for confidentiality with the patients wish to be accompanied
Explain cognitive capacity
Take stress relieving measures
2. Communication and working with colleagues: Define roles played by all members of a
multi-disciplinary team.



Describe features of good team dynamics
Formulate principles of effective inter-professional collaboration
Outline principles of confidentiality
Operative Skills
1. Surgical principles:
 Benign tumour excision
 Biopsy bone - needle
 Biopsy bone – open
 Cyst bone curettage +/- bone graft
 Biopsy cervical spine
 Safe biopsy for suspected tumours of the upper limb
 Excision of giant cell tumour of tendon sheath,
 Excision/curettage enchondroma,
 Removal of swellings from nerves e.g. Schwannoma
 Excision of other benign tumours of bone and soft tissue.
 Endoprosthetic replacement for malignant bone tumour
 Exostosis /osteochondroma excision
 Injection of bone cyst
 Malignant tumour excision
 Biopsy soft tissue
 Bursa excision
 Ganglion excision
 Muscle biopsy
 Split skin grafting
2. Wound management including VAC dressings
Competence Levels
0 = No experience expected
1 = Has observed or knows of
2 = Can manage with assistance
3 = Can manage whole but may need assistance
4 = Able to manage without assistance including potential common complications
5 = Able to manage complex cases and their associated potential complications
Benign tumour excision
Bone biopsy
Cyst bone curettage and bone grafting
Endoprostehtic replacement of malignant bone tumour
Exostosis/osteochondroma excision
Malignant tumour excision
Nerve decompression and neurolysis
Biopsy soft tissue
Ganglion excision
Muscle biopsy
Synovectomy
3
3
3
1
3
1
4
3
4
4
3
CBDs and PBAs
Critical conditions list


Metastatic spinal compression.
The painful spine in the child.
Surgical PBAs available within this attachment




Biopsy of tumours
Excision of benign tumours
Primary arthroplasty
Knee arthroscopic procedures.
Classic papers in orthopaedics:
CADE, S. (1955). Osteogenic sarcoma; a study based on 133 patients. Journal of the Royal
College of Surgeons of Edinburgh, 1(2), 79–111. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/13307660
Codman, E. A. (2009). The classic: the registry of bone sarcomas as an example of the endresult idea in hospital organization. 1924. Clinical Orthopaedics and Related Research,
467(11), 2766–70. doi:10.1007/s11999-009-1048-7
Dahlin, D. C., & Coventry, M. B. (1967). Osteogenic sarcoma. A study of six hundred cases.
The Journal of Bone and Joint Surgery. American Volume, 49(1), 101–10. Retrieved
from http://www.ncbi.nlm.nih.gov/pubmed/5225072
Enneking, W. F., Dunham, W., Gebhardt, M. C., Malawar, M., & Pritchard, D. J. (1993). A
system for the functional evaluation of reconstructive procedures after surgical
treatment of tumors of the musculoskeletal system. Clinical Orthopaedics and Related
Research, (286), 241–6. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/8425352
Enneking, W. F., Spanier, S. S., & Goodman, M. A. (2003). A system for the surgical staging of
musculoskeletal sarcoma. Clinical Orthopaedics and Related Research, (153), 106–20.
Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/7449206
Mankin, H. J., Lange, T. A., & Spanier, S. S. (1982). The hazards of biopsy in patients with
malignant primary bone and soft-tissue tumors. The Journal of Bone and Joint Surgery.
American Volume, 64(8), 1121–7. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/16951637
Mirels, H. (1989). Metastatic disease in long bones. A proposed scoring system for
diagnosing impending pathologic fractures. Clinical Orthopaedics and Related Research,
(249), 256–64. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/2684463
O’Sullivan, B., Davis, A. M., Turcotte, R., Bell, R., Catton, C., Chabot, P., … Zee, B. (2002).
Preoperative versus postoperative radiotherapy in soft-tissue sarcoma of the limbs: a
randomised trial. Lancet, 359(9325), 2235–41. doi:10.1016/S0140-6736(02)09292-9
Rosen, G., Murphy, M. L., Huvos, A. G., Gutierrez, M., & Marcove, R. C. (1976).
Chemotherapy, en bloc resection, and prosthetic bone replacement in the treatment of
osteogenic sarcoma. Cancer, 37(1), 1–11. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/1082364
Rosenberg, S. A., Tepper, J., Glatstein, E., Costa, J., Baker, A., Brennan, M., … Wesley, R.
(1982). The Treatment of Soft-tissue Sarcomas of the Extremities. Prospective
Randomized Evaluations of (1) Limb-sparing Surgery Plus Radiation Therapy Compared
with Amputation and (2) the Role of Adjuvant Chemotherapy. Annals of Surgery,
196(3), 305–315. Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1352604/pdf/annsurg00139-0081.pdf