Most lumps and most abnormal findings on a bone scan or X-ray are not cancer. However benign and malignant tumours can look similar at first, and the small number that are malignant behave very differently — so both need proper assessment before anything is removed.
Island Orthopaedics provides assessment, diagnosis and surgical treatment for tumours of bone and soft tissue. This includes benign lumps and bone lesions, primary bone and soft tissue sarcoma, and secondary (metastatic) bone disease in patients with a known cancer.
Conditions We Assess and Treat
Bone and soft tissue tumours cover a wide range of conditions. The ones we see most often include:
- Osteochondroma (bone spur / exostosis)
- Enchondroma
- Osteoid osteoma
- Non-ossifying fibroma
- Simple (unicameral) bone cyst
- Aneurysmal bone cyst
- Fibrous dysplasia
- Chondroblastoma
- Giant cell tumour of bone
- Osteosarcoma
- Ewing sarcoma
- Chondrosarcoma
- Chordoma
- Lymphoma of bone
- Lipoma (fatty lump)
- Ganglion cyst
- Epidermoid (sebaceous) cyst
- Schwannoma and neurofibroma (nerve sheath tumours)
- Tenosynovial giant cell tumour, including pigmented villonodular synovitis (PVNS)
- Haemangioma (vascular malformation)
- Desmoid tumour (desmoid-type fibromatosis) — benign, but locally aggressive
- Liposarcoma
- Undifferentiated pleomorphic sarcoma
- Myxofibrosarcoma
- Synovial sarcoma
- Leiomyosarcoma
- Malignant peripheral nerve sheath tumour
- Dermatofibrosarcoma protuberans
If your diagnosis is not listed here, it does not mean we do not treat it. Please contact the clinic.
Cancer That Has Spread to Bone
Cancers of the breast, lung, prostate, kidney and thyroid can spread to bone, as can multiple myeloma. This is more common than primary bone cancer, and it is often treatable.
Bone affected by a secondary deposit can become painful or weak enough to break after a minor injury — a pathological fracture. Where a bone looks at risk of breaking, it can often be strengthened before that happens, which is a smaller operation with a faster recovery than fixing a fracture after the event.
We assess and treat:
- Painful bone metastases in the arm, leg or pelvis
- Impending pathological fracture (a weakened bone at risk of breaking)
- Pathological fracture that has already occurred
- Bone involvement from multiple myeloma
- Patients under the care of a medical or radiation oncologist who need a surgical opinion on a bone lesion
Surgery is planned alongside your oncology team so that it fits with your chemotherapy, immunotherapy, hormonal treatment or radiotherapy.
Why the First Operation Matters
If you have been offered removal of a lump, it is worth asking one question first: has it been scanned?
Most lumps are benign and can simply be removed. But a soft tissue sarcoma can look and feel like an ordinary lipoma from the outside. If a sarcoma is removed without being recognised, the operation is usually done through the tumour rather than around it, leaving tumour cells behind in the surrounding tissue. A second, larger operation is then needed to clear them, and the options for reconstruction are narrower than they would have been.
This is avoidable. The sequence that protects you is:
- Imaging first — ultrasound or MRI before excision, for any lump that is large, deep, enlarging or painful
- Biopsy second, if the imaging is not clearly benign — taken through a planned route that can be removed with the tumour at the definitive operation
- Surgery last — planned once the diagnosis is known
If you already have a lump booked for removal and are unsure whether it has been imaged, you are welcome to seek an opinion first.
Getting to a Diagnosis
Not every patient needs every test. Assessment is stepped, and often stops early once a lesion is clearly benign.
- Clinical assessment — history and examination, including the size, depth and rate of growth of a lump
- X-ray — the first and most informative test for a bone lesion
- Ultrasound — useful for superficial soft tissue lumps, and often enough to confirm a simple cyst
- MRI — defines the extent of a tumour and its relationship to nerves, vessels and muscle compartments
- CT — assesses bone detail and integrity
- Staging scans — CT of the chest, bone scan or PET-CT where a malignant tumour is suspected or confirmed
- Image-guided core needle biopsy — taken along a route planned with the definitive operation in mind
- Multidisciplinary review — imaging and pathology discussed with radiologists, pathologists, and medical and radiation oncologists before a treatment plan is confirmed
Your specialist will explain what each result shows and what it means for your treatment.
How Bone and Soft Tissue Tumours Are Treated
Treatment depends entirely on the diagnosis. Many benign lesions need no surgery at all.
Monitoring
- Surveillance with periodic imaging for benign lesions that are stable and not causing symptoms
Surgery for benign tumours
- Excision of benign soft tissue lumps
- Curettage — scraping out a benign bone lesion, with bone graft or bone cement to fill the cavity
- Internal fixation where a bone has been weakened
- Image-guided radio-frequency or cryo-ablation for certain lesions such as osteoid osteoma, performed with interventional radiology
Surgery for malignant tumours
- Wide local excision — removing the tumour together with a margin of surrounding normal tissue
- Limb-salvage surgery — removing the affected bone or muscle and reconstructing the limb, which is possible in many cases
- Reconstruction using an endo-prosthesis (a custom metal implant replacing the removed bone), bone graft or allograft
- Soft tissue reconstruction to restore function and cover the wound
Surgery for secondary bone disease
- Prophylactic stabilisation of a bone at risk of fracture
- Fixation or joint replacement for a pathological fracture
Non-surgical treatment
- Chemotherapy, immunotherapy, hormonal therapy and/or radiotherapy, coordinated with medical and radiation oncology where these form part of your treatment
- Long-term follow-up and surveillance after treatment is completed
Your specialist will explain which of these apply to your diagnosis, and what recovery involves.
When Should a Lump or Bone Pain Be Checked?
Most lumps and aches are harmless. The features below are worth having assessed — not because they mean cancer, but because they are the ones that cannot be reliably judged by feel alone.
For a lump
- Larger than about 5 cm — roughly the size of a golf ball
- Feels deep or fixed, rather than moving freely under the skin
- Getting bigger
- Painful
- Has come back after being removed before
For bone pain
- Pain at night, or pain at rest that is not related to activity
- Pain that is not relieved by rest and is getting worse
- A fracture after a minor injury or no injury at all
- New bone pain in anyone with a previous cancer diagnosis
Also worth an opinion
- An unexpected finding on an X-ray or scan done for another reason
- You have been advised that a lump or bone lesion needs further assessment
If any of these apply, arrange an assessment rather than waiting to see whether it settles.
Book an AppointmentWhat to Bring
Bringing these to your first visit often means a plan can be made on the same day, rather than after a second appointment:
- Your referral letter, if you have one
- Any previous X-rays, MRI, CT or PET scans — the images themselves on a disc or USB, not only the report
- Reports from any previous biopsy, and details of where the tissue samples are held
- Operation notes, if the lump has been removed or biopsied before
- A list of your current medications
- Details of any previous cancer diagnosis and treatment
If your scans were done overseas or at another centre, please let our staff know before your appointment so we can arrange for the images to be transferred.
Common Questions
No. The large majority of soft tissue lumps are benign — lipomas, cysts and similar. Sarcoma is uncommon. The reason assessment matters is that benign and malignant lumps can feel identical, so size, depth and growth are used to decide who needs a scan.
No. Many bone lesions are benign, and a number are found by chance on an X-ray taken for something else. Some need no treatment at all, only periodic monitoring.
Most do not. The risk depends on the specific type of lesion, and for a small number of conditions it is high enough to justify regular surveillance. Your specialist can explain which applies to you.
For a small, clearly benign lump, it often can. For anything larger, deeper or uncertain on imaging, knowing the diagnosis first changes how the operation is done. A tumour removed without a diagnosis may need a second, larger operation to clear the margins properly.
Standard results are usually available within one to two weeks. Some tumours need additional genetic or molecular tests to confirm the exact subtype, which takes longer. You will be told which applies to your case and when to expect the result.
Amputation is now uncommon for limb tumours. Limb-salvage surgery — removing the tumour and reconstructing the bone or soft tissue — is possible in many cases, and is the usual approach where it can achieve a complete removal. Whether it is suitable depends on a number of factors, including the size and position of the tumour and its relationship to the nerves and blood vessels, which your specialist will discuss with you once the imaging is complete.
Not always. Benign tumours are treated with surgery or monitoring alone. Some malignant tumours are treated with surgery alone; others do better with chemotherapy and/or radiotherapy before or after the operation. This is decided together with medical and radiation oncology.
A lump that recurs after removal should be reassessed and imaged before any further surgery. Please bring the original operation note and pathology report, and details of where the tissue samples are stored, as the original slides can often be reviewed.
Appointments for a suspected bone or soft tissue tumour are usually offered as early as possible. Please tell our staff when you call that this is the reason for your visit.
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