A Mayo Clinic Orthopedic Oncology surgeon smiles in greeting.

The Division of Orthopedic Oncology at Mayo Clinic offers highly specialized care for people of all ages (infants to adults) with benign (noncancerous) and malignant (cancerous) bone and soft tissue tumors at Mayo Clinic.

Why contact Orthopedic Oncology?

Orthopedic oncologists at Mayo Clinic in Arizona, Florida and Minnesota offer specialized expertise that uniquely combines large surgical volumes for even some of the rarest tumors with cutting-edge technology.

  • Experience and surgical volume. Mayo Clinic evaluates one of the largest numbers of patients with bone and soft tissue tumors nationally or internationally, including some of the rarest tumors. This results in an immense level of experience in these issues.
  • Evidence based. Mayo Clinic orthopedic oncologists are intimately involved in research that translates directly into current patient care.
  • Individualized. Each patient coming to Mayo Clinic is unique. Our resources allow us to provide individualized care tailored to each person's need.
  • Cutting-edge technology. From mixed reality and robotics to point-of-care 3D printing of tumors, orthopedic oncologists are at the forefront of technology and innovation.
  • Multidisciplinary advantages. When you come to Mayo Clinic for your bone or soft tissue tumor evaluation, many other specialties collaborate as needed to assess your overall health, review imaging studies, and provide the best possible pain control and anesthesia techniques when surgery is needed.
  • Implant design. Our experts are intimately involved in the design of implants and instruments used for various orthopedic tumor procedures.
  • Expertise in rare cancers. Sarcoma is a very rare type of cancer that makes up less than 1% of all cancers diagnosed in the U.S. every year. The orthopedic oncologists at Mayo Clinic diagnose and treat hundreds of patients each year with this type of rare cancer, giving them unique expertise in the condition.

A team approach to care for the whole person

A surgeon explains a care approach with a patient using a 3D model.

Mayo Clinic orthopedic oncologists use an integrated practice model that coordinates care across multiple specialties and subspecialties. This team approach provides a thorough evaluation with well-rounded treatment recommendations for each person.

You'll receive a comprehensive consultation that includes evaluation by multiple specialists to assess any related or peripheral concerns before we determine the best treatment approach for your specific condition. Your team will recommend a treatment plan that's specific to your individual tumor and other medical needs.

During your consultation you'll meet with an orthopedic oncologist and others based on your specific tumor. You also may complete diagnostic or imaging studies such as X-ray, CT scan, MRI and PET-CT. Other teams commonly involved in your care include medical oncology and radiation oncology.

Mayo Clinic's advanced approach to sarcoma care

A Mayo Clinic Orthopedic Oncology surgeon smiles warmly.

If you have been diagnosed with a sarcoma or have a concerning lump, bump or mass, Mayo Clinic is ideal for you:

  • Multidisciplinary tumor treatment. The objective of all treatment is to completely remove the tumor and to kill any tumor cells that may have spread to other locations. This typically involves radiation (high-energy beams to destroy cancer cells) and surgery (to remove the cancer), and it sometimes involves chemotherapy (cancer-killing drugs). Our surgeons work with radiation oncologists and medical oncologists to make personalized treatment plans for each person.
  • Prompt evaluation and communication. For patients with cancer, waiting to hear about results and next steps can be very difficult. Our surgeons prioritize getting testing (images, biopsies, labs) done as quickly as possible — often the same day or week — and communicating results and next steps promptly.
  • Advanced imaging. Cutting-edge imaging is crucial to diagnose and treat sarcoma. Our surgeons have quick access to any type of imaging that might be needed, including MRI and PET-CT imaging. Our radiologists have specialized expertise in reviewing images for tumors and can also review images done outside of Mayo Clinic.
  • Tumor board. Multiple experts in sarcoma treatment (surgeons, medical oncologists, radiation oncologists, radiologists, pathologists and others) meet regularly to discuss challenging cases and come up with appropriate treatment plans.
  • Proton beam. When radiation is recommended to treat a sarcoma, Mayo Clinic radiation oncologists will consider treatment with the most advanced radiation technologies, including proton beam therapy.
  • Limb-sparing surgery. Most sarcomas in the arms, legs, and pelvis or hip can be removed without an amputation.
  • Onco-regeneration. Our surgeons prioritize not just preserving limbs but keeping the limb looking and functioning as normally as possible after the cancer is removed. Onco-regeneration often includes working with plastic surgeons who are experts in:
    • Wound closure.
    • Free functional muscle transfers to restore the function of a muscle that had to be removed with the cancer.
    • Targeted muscle reinnervation to reduce neuropathic pain.
    • Lymphovenous bypass to decrease limb swelling and lymphedema.

More about onco-regeneration at Mayo Clinic


Coming up on Mayo Clinic Q&A,

Dr. Steven Moran

At Mayo, we're really expanding what we can offer patients that have limb sarcomas. Not only are we working on ways of getting the muscle, and the nerve, and the lymphatics back, we're working on ways of controlling pain in those patients that still have to undergo amputations. And that's with essentially tricking the nerves into thinking that they're still going back to the muscles and the skin. And for patients that live with chronic phantom pain, this can be an amazing blessing.


Soft tissue sarcomas are a rare form of cancer that develop in places like muscle, fat, nerves, and tendons. Treating these cancers often involves complex surgery to transfer muscle and nerves. Today we'll discuss how new surgical techniques are helping patients recover faster and get back to life.

Dr. Steven Moran

And with the advent of microsurgery, and some newer materials that we can apply to these muscles, we can have this transferred muscle regenerate and take the place of the muscle that's been excised, and we've been very fortunate to have patients go back to ambulating and back to some of the activities that they were doing before surgery.

Dr. Halena Gazelka

Welcome, everyone to Mayo Clinic Q&A. I'm Dr. Halena Gazelka. Soft tissue sarcomas are rare forms of cancer that have been typically treated with what has been called limb salvage surgery combined with radiation therapy. While limb salvage surgery helps patients avoid amputations, patients are often left with substantial functional limitations. Now advancements in microsurgery are making it possible to harness the body's own ability to regenerate muscle strength after surgery that is performed to remove soft tissue sarcomas. This is a process called oncoregeneration, and it's our topic for today. Joining us to discuss our Mayo Clinic orthopedic surgeon, Dr. Matthew Houdek, and plastic surgeon Dr. Steven Moran. Thank you for being here today gentlemen.

Dr. Matthew Houdek

Thanks for having us.

Dr. Halena Gazelka

I think it's just wonderful to have all this brainpower together in one space. And I always say on this program that I love to learn something new every day. And I can tell already that I'm going to learn something new today. So, let's jump right in. Can you tell me what the standard course of treatment is for an individual who suffers from a sarcoma? What is limb salvage surgery anyway?

Dr. Matthew Houdek

Sure, I can take that one. So, limb salvage surgery is a process where you're able to remove the cancer with a negative margin, and still be able to preserve the function of the limb. And so, in the 1970s, and 80s, we didn't used to think about doing limb salvage for patients. Patients presented and then oftentimes they are treated with pretty much an immediate amputation. And it was through kind of the developments of different neoadjuvant treatments such as mainly radiation therapy for soft tissue sarcomas, but also chemotherapy for patient's bone sarcomas, that limb salvage would be now a viable treatment option for a vast majority of patients. And so, there's only certain times where we consider now amputations for patients, the vast majority of patients are getting limb salvage surgery. And so, it's through a multidisciplinary process where patients are first evaluated by either our service or the medical oncology service. We figure out what type of cancer they have, and then we go through the process of either referring them to radiation oncology for neoadjuvant radiation, which means giving radiation before the surgery. And then typically, we wait about three or four weeks, and then surgery is performed after that. And so, radiation helps with the local control of the tumor. So, it lets us be very close to the tumor where we have to be to save critical structures such as nerves and blood vessels. But there can be times where that's not possible, and that's where some of the regenerative stuff that we're working on can come into play.

Dr. Halena Gazelka

What an incredible difference it must make to your patients to retain their limbs and their function and also their appearance. Honestly, when they have a sarcoma like this that has to be incredible to see the advancements that are happening.

Dr. Matthew Houdek

It has really changed the way that we're able to approach patients. And then you know, the big thing is just the big teamwork that it does require to take care of these patients.

Dr. Halena Gazelka

Sure. We hear so much about regenerative medicine now is oncoregeneration a type of regenerative medicine?

Dr. Steven Moran

Well, I think, as you heard Dr. Houdek saying, you know, in the past I'd say 20 years we've been able to save these patient's legs, but many times they don't function very well. You know, Dr. Houdek talks about a negative margin. So, that means you have to take a rim of normal tissue around these tumors and that often results in patients losing the majority of their quadricep muscle which allows the knee to extend or their hamstring muscle which allows the knee to bend. So, we save the leg, but the patient can't play sports, they can't walk with their spouse, things like that. So, now we have the ability to take muscle that's expendable, we usually take a muscle from the back. And we can put that in place of the muscle that Dr. Houdek has to remove. We're able to then roll that muscle into a tube so that it can either replace the hamstring or the quadricep muscle. And then we repair the nerve that used to go to the quadricep into this new muscle that we've transferred in. And with the advent of microsurgery, and some newer materials that we can apply to these muscles, we can have this transferred muscle regenerate and take the place of the muscle that's been excised. And we've been very fortunate to have patients go back to ambulating and back to some of the activities that they were doing before surgery.

Dr. Halena Gazelka

That's amazing to me, Steve, because I am not an anatomist. But thinking about the function and the strength of the back muscle that has a very probably different function than what you'd have from your quadricep muscle. So, it's very interesting that a muscle can sort of learn to be a different type of muscle or to do a different function.

Dr. Steven Moran

Yeah, that's true. I think we've experimented with different ways of insetting the muscle, but I think the latest technology now that allows us to tension and insert the muscle directly back into the bone has been very favorable in getting these patients back to doing what they want to do.

Dr. Halena Gazelka

Tell me and tell our listeners a little bit about how you translate lab experimentation into clinical practice for patients?

Dr. Steven Moran

Well, I think many times we have an idea and then we go to the lab, and you know, we either work in a cell culture dish, or we can use animal models that try to approximate the human condition. But it's always difficult to get a perfect match. I think many of the things that we're working on now in the lab are working with a special material called an exosome, which allows the body to harness some of the potential in stem cells and accelerate healing. So, right now what we're working on in this oncoregenerative model is using some of these exosomes which are produced here at Mayo Clinic and using those in in the lab in a way that helps us regenerate our reconstruct missing muscle and missing nerve. And we're in the beginning process of an FDA trial right now, we hope that we can deliver this new research to our patients within the near future.

Dr. Halena Gazelka

Wow. That's amazing. Matt, you touched just very briefly on a team-based approach and how a team is required to care for these patients. How is the team-based approach used differently and oncoregeneration than it might be in limb salvage surgery, or is it different?

Dr. Matthew Houdek

I think, you know, the basics of it are kind of are on the whole framework of what kind of makes Mayo Mayo in the sense that we're all here to help the patient. And so, for oncoregeneration, these are cases that Steve and I typically do together. But you know, can we use other plastic surgeons as well? Yeah, well we do, but I think, you know, having the team we know pretty much exactly what I need to do. When I'm approaching the patient, I know what I need to make Steve's life easier putting the patient back. And so,

Dr. Steven Moran

I don't think that you ever do that really though.

Dr. Matthew Houdek

I'm kind of the destructor. Dr. Moran is the reconstructor. And so, you know, we have to take out what we have to take out in order to, you know, cure the patient of their cancer. However, I know that no matter what I do, I have Steve who can put the patient back together. And I think that's kind of having the team and the kind of, I guess, trust in the team too that knowing that no matter what you do, the patient's going to get through all this. But it does take a team in the sense that, you know, it starts with the initial workup. It starts with the initial scans and radiology and making sure the scans are done correctly. We get them to see radiation oncology right away. And, you know, we have a discussion with the radiation oncologist about, you know, what are we going to take, what are we going to leave behind, so that way they can plan their treatment fields appropriately to again, reduce the risk of recurrence. And then we take over for surgery. And Steve and I will talk about the case beforehand, and we'll know exactly what we're doing when we go in. And, you know, the vast majority of the time what we take out is what we plan to take out. And then Dr. Moran does an excellent job of putting the patients back together and we get the patients back. Because then afterwards too, i's the rehab and kind of working with the physical therapists and everything back here at Mayo.

Dr. Halena Gazelka

That was a lot of confidence in your ability, Steve.

Dr. Steven Moran

Oh, yeah, he gives me too much credit. I think that a lot of the stuff we're able to do now has really only been possible within the past decade we've had massive advancements in the microscope itself, allowing us to see things that at a much smaller level. Some of the things that Dr. Houdek is talking about removing are not only muscles, but nerves and lymphatic structures themselves. And all these things contribute potentially the patient's function but also to post-operative pain. And Dr. Houdek and myself have been working a lot with taking these nerves that normally would be left to scar into the wound bed and cause a source of pain and we're now reconnecting those to devitalized muscle. We're= also putting back together the lymphatic structures that are divided anytime you have surgery in an effort to prevent patients from developing post-operative lymphedema, which is essentially swelling that can occur in the leg or in the arm that can cause pain and disfigurement.

Dr. Halena Gazelka

What kind of outcomes are you seeing in your patients at this point?

Dr. Matthew Houdek

Sure. So, a vast majority of patients are returning to ambulation without the use of gait aids or a brace. You know, we talked about, you know, sciatic nerve resection, and there was a study that was done here that looked at, you know, patients that had their sciatic nerve removed, and they have acceptable function. And so, but that's based off of scoring systems that we use as physicians to say, you know, what is someone acceptable at. You know, a sciatic nerve resection, oftentimes, patients will have to wear a brace, they'll need to walk with a crutch or cane, and when they start having kind of increasing work of walking or so, say they're trying to like walk uphill or upstairs, it becomes very difficult for them. And so, what we're able to do is we're able to restore that function through, we've done some vascularized nerve grafting, but also through the functional muscle transfers we're able to restore the knee flexion strength that they lose, through taking out the nerve to the hamstrings. And so, it's not oftentimes just the muscle. You know, so we can do this sort of process too when we have to take nerves out as well in order to restore the function as well, but the vast majority of the patients will have a restoration and at least active flexion or extension past gravity. Most of the times, they're able to do this against a lot of resistance too, and they're able to go back to doing all the activities that they want to do. I recently had a patient come back who told me that he went out back to elk hunting, and so walking on uneven terrain, without any gait aids or anything with having pretty much the entire quadricep taken out. And so that's kind of a big thing for him, because, you know, it was a passion of his to do, and so they're still able to go back and do everything they want to do once they are recovered from it.

Dr. Halena Gazelka

Wow, that is wonderful. Amazing. It must be very gratifying to care for your patients in that way.

Dr. Matthew Houdek

It is.

Dr. Halena Gazelka

Tell me what you see ahead. What do you think the next decade holds for oncologic surgeries?

Dr. Steven Moran

Matt, maybe I could take this one. You know, I think at Mayo here we're really expanding what we can offer patients that have limb sarcomas. Not only are we working on ways of getting the muscle and the nerve and the lymphatics back. But for those patients that still cannot have limb salvage, we're working on newer options such as osteointegrated implants. So, this is something that really started in the military, and is just starting to come to fruition here at Mayo. But this is putting an implant into a patient's bone that allows them to kind of snap on a prosthetic that they can wear for the entire day. Some of the work from the military has shown that the people don't even take these off, they wear them for the entire day, which is something that's much different than what we have now. They can go back to much more, I guess, aggressive activities that we weren't able to achieve before in patients with standard amputations. In addition, we're working on ways of controlling pain in those patients that still have to undergo amputations. And that's with essentially tricking the nerves into thinking that they're still going back to the muscles and the skin. And for patients that live with chronic phantom pain, this can be an amazing blessing. And then finally, what we were talking about before by trying to harvest or harness I guess I should say, the body's ability to heal itself with this exosome material, which is something that can be made here at Mayo, for pennies, and put into these wounds and have the body essentially regenerate muscle and nerve. That's really where we see the future of this field going over the next 10 years.

Dr. Halena Gazelka

Wow, those are some amazing areas, and working in the pain clinic, I do see some of the unfortunate patients who have difficulty after they have surgeries for sarcomas or amputations for other reasons as well. So, that's exciting work. Matt, as you and Steve were speaking it struck me as I have heard from many others, how important it likely is for patients to seek out a center where there's a high volume and where there are experienced individuals when they want to be able to have the best surgical options that they can have. What would you say to that to patients? How do they know that they're getting the best care that they can get?

Dr. Matthew Houdek

Sure. So, you know, the Institute of Medicine has kind of put an emphasis on, you know, quality of care and, you know, quality of cancer care, because it is a vulnerable patient population. And there's lots of studies that have been done to look at, you know, outcomes of patients with sarcoma. And even some of the stuff that we've done here through the Kern center and Optum Labs, we've you know, found that patients who are treated at higher volume centers oftentimes are able to avoid amputation. And so, patients who were treated at smaller hospitals or non-teaching hospitals had a higher risk of having an amputation with a sarcoma compared to larger centers or teaching hospitals where a vast majority of the time they'll have a limb salvage surgery. And so, a lot of that is the expertise and being able to bring patients in to have them see the multidisciplinary team that these cases require and leads to the better outcomes for the patients. And so, you know, quality is driven by numbers of cases per year. And so, here at Mayo, we're doing hundreds of cases of these soft tissue sarcomas a year. And it just kind of shows in the outcomes as well, that that's been shown in lots of different studies to show that, you know, the quality is always better if it's done at the high volume center. And we're always happy to see people from wherever. We're happy to do virtual care for them too and discuss their cases as well at our tumor board.

Dr. Halena Gazelka

Oh, that's wonderful. Thank you so much. Any last thoughts that you'd like to share with our listeners today, either of you?

Dr. Matthew Houdek

You know, it's an exciting field and, you know, we're happy to go over anything that patients have any questions on. We're always happy to do virtual visits with them. We're happy to get in touch and help however we can.

Dr. Steven Moran

I would just echo that. If you have a question about your sarcoma care, please reach out to us. We're happy to always respond.

Dr. Halena Gazelka

Wonderful. Thank you so much. I did learn something today. Our thanks to Mayo Clinic orthopedic surgeon, Dr. Matthew Houdek, and plastic surgeon, Dr. Steven Moran, for being here today to talk to us about sarcomas and the use of oncoregenerative surgery to manage them. I hope that you learned something, I know that I did. We wish each of you a very wonderful day.


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  • Complex reconstruction. When a joint needs to be removed along with the cancer, orthopedic oncologists work directly with their colleagues who specialize in hip or knee surgery, shoulder or elbow surgery, hand surgery, and foot or ankle surgery to restore or replace the joint.
  • Modern amputation techniques. When and if amputation becomes necessary, orthopedic oncologists work with plastic surgeons to employ the most recent techniques:
    • Targeted muscle reinnervation and creation of regenerative peripheral nerve interfaces can decrease nerve pain and phantom limb sensation after amputation.
    • Osseointegrated implants are available when appropriate for your needs.
    • A multi-disciplinary amputee team, led by a physiatrist meets with people scheduled for amputation before surgery to discuss your ongoing needs following amputation, and is closely involved in care after surgery to guide your rehabilitation.
  • Anesthesia. Through an intimate collaboration with Anesthesiology and Perioperative Medicine, even the most complex operations can be carried out safely at Mayo Clinic with various techniques available to help control pain after surgery.
  • Technology in the operating room. Execution of the surgical plan is aided by computer-based planning, patient-specific guides, point-of-care 3D printing, mixed reality guidance, computer navigation and robotic surgery.
  • Rehabilitation. Physical medicine and rehabilitation doctors, physical therapists and occupational therapists provide critical expertise in all aspects of rehabilitation after surgery, in the hospital as well as following discharge. Some people may benefit from intensive inpatient rehabilitation care at Mayo Clinic after surgery to maximize independence and assist with the transition home.

Pelvic and sacral tumors

Malignant tumors in the pelvis and sacrum are particularly complex to treat surgically and require specialized planning and surgical techniques. Our surgeons are leaders in treating these conditions. Mayo Clinic surgeons have led the way in making these surgeries safe and feasible. They continue to treat many patients each year who require these rare and complex surgeries.

  • Hemipelvectomy. This surgery involves removing a portion of the pelvis that has cancer. Sometimes this also involves removing the hip socket or even the entire leg along with the pelvis.
  • Hip joint reconstruction. Mayo Clinic orthopedic oncologists and hip replacement surgeons can discuss the possibility of a complex hip reconstruction after hemipelvectomy in which the hip has to be removed.
  • 3D printing. The complex bony anatomy of the pelvis and sacrum makes 3D printing a valuable technique to better understand each person's specific tumor and more accurately plan how to remove it. Orthopedic Oncology teams can print patient-specific cutting guides for use during surgery to accurately remove the cancer. Orthopedic Oncology can also manufacture corresponding patient-specific 3D printed hip replacement implants.
  • Sacrectomy. This surgery involves removing a portion of or the entire sacrum, and Mayo Clinic orthopedic oncologists safely perform these complex operations with multidisciplinary surgical teams (vascular surgery, plastic surgery, colorectal surgery and urology).
  • Spinopelvic reconstruction. When a large part of the sacrum has to be removed or when the tumor extends to involve the spine itself, Mayo teams can reconnect the spine to the pelvis with spinal instrumentation and free vascularized fibular bone autografts.

Spinal sarcomas

Bone and soft tissue sarcomas involving the neck (cervical spine), middle back (thoracic spine) or lower back (lumbar spine) are very rare and pose unique treatment challenges.

  • Sarcomas in the spine require specialized planning and surgical techniques. Our surgeons are leaders in treating these rare and complex conditions.
  • Orthopedic oncologists lead multidisciplinary teams to remove these tumors in an en bloc curative fashion (completely removing all of a tumor without rupturing its capsule) when feasible.
  • Radiotherapy is often necessary, and advanced radiation techniques are available at Mayo Clinic, including proton radiotherapy and intraoperative radiotherapy.
  • Reconstruction of the spine after surgery involves modern spinal hardware, including carbon fiber instrumentation and vascularized bone autografting techniques.

Shoulder girdle sarcomas

The complex anatomy of the shoulder and shoulder blade (scapula) so close to nerves (brachial plexus) and arm blood vessels pose unique challenges when sarcomas occur around the shoulder.

  • Orthopedic oncologists evaluate each patient to see if limb salvage is feasible.
  • If so, your care team can turn to a range of techniques pioneered at Mayo Clinic by our Orthopedic Oncology and Shoulder Surgery teams to reconstruct the shoulder.
  • We review the best options for your care with you, to provide the most functional shoulder and arm possible.

Oncoregeneration: Restoring limb function and appearance after cancer surgery

A unique and special collaboration between orthopedic oncologists and plastic surgeons at Mayo Clinic has let these teams push the envelope on not only saving limbs affected by cancer but maximizing the function and appearance of these limbs.

  • Removing cancer from a limb can sometimes leave the limb painful, weak, swollen and disfigured.
  • A variety of surgical techniques (flap coverage, free functional muscle transfer, lymphovenous bypass, targeted muscle reinnervation and others) performed in collaboration with plastic surgeon colleagues brings the salvaged limb both the best function and best cosmetic appearance.

Pediatric tumor care: Specialized expertise for children

Infants, toddlers, children, and teenagers can develop unique types of bone and soft tissue tumors (both benign and malignant). Mayo Clinic's Orthopedic Oncology team has deep experience treating these conditions.

  • Multidisciplinary pediatric sarcoma care. Children with sarcomas are seen and evaluated together with pediatric oncologists to determine the best treatment plan that may involve chemotherapy and surgery. Additional teams with expertise in pediatric sarcoma care are involved as needed, and complex cases are discussed at dedicated pediatric sarcoma tumor boards weekly.
  • Rotationplasty. Mayo Clinic has decades of experience with this unique surgical procedure that can be used to successfully remove cancer around the knee and convert the child's ankle and foot into a functional knee joint.
  • Physeal (growth plate) sparing surgery. When safe from a cancer perspective, orthopedic oncologists can remove cancer around a child's knee or shoulder while maintaining the growth plate. This allows for a curative surgery while allowing the limb to continue growing.
  • Vascularized bone grafting/Capanna technique. Mayo Clinic surgeons pioneered moving bone along with its blood supply from one part of the body to another. This can be a very useful technique for reconstructing bone defects after tumors are removed from a child's bone.
  • Benign bone tumors. Benign bone tumors in children can be painful and destructive. Often surgery is not necessary, but when it is, orthopedic oncologists work closely with pediatric orthopedic surgeons in treating these tumors while preserving normal bone growth. Minimally invasive treatments, including needle ablation for osteoid osteoma, is used whenever possible.
  • Spinal tumors. Benign and malignant bone tumors in the spine in children are rare and require specialized surgical techniques that orthopedic oncologists at Mayo Clinic have experience with. When appropriate, nonsurgical treatment can be employed including needle ablation or specialized radiotherapy techniques.

Metastatic bone disease: Key strengths at Mayo Clinic

Among patients with metastatic cancer, bones may become affected by the cancer. Key features of our approach to metastatic bone disease include:

  • Prompt evaluation for tumors of unknown origin. Bone pain may be the first symptom of cancer even for people with no known cancer history. Our orthopedic oncology team sees people with new bone lesions quickly to start their evaluation, performs testing to figure out where the cancer is coming from and directs them to the appropriate cancer treatment team.
  • Surgery only when needed. Many times, the metastatic bone disease can be treated with radiation, chemotherapy or needle ablation. Surgery is most often recommended when a bone has become weakened by cancer and is at risk for breaking.
  • Pathologic fractures. If bones do become weakened by cancer and break — called a pathologic fracture — it must be treated using highly specialized surgical techniques.
  • Multidisciplinary care. People with metastatic cancer have complex care needs. If we recommend surgery, your orthopedic oncologists collaborate closely with other members of your cancer care team (whether at Mayo Clinic or elsewhere) to make an appropriate surgical plan and decide on the best time for surgery.

Spinal metastases

Cancer that has spread to the bones of the spine can be particularly complex to treat surgically and can require urgent surgery or radiotherapy when cancer is pushing on the spinal cord.

  • Orthopedic oncologists are available for urgent referrals and expedited surgical treatment of those with metastatic spine disease, particularly when there is spinal cord compression or spinal instability with intractable pain.
  • Our surgeons work closely with radiation oncologists, medical oncologists and neuroradiologists to personalize treatment for each patient. Treatment may include modern radiation techniques (stereotactic radiotherapy, intensity modulated radiotherapy, proton beam), minimally invasive or percutaneous surgery, carbon fiber spine hardware, sophisticated needle ablation techniques, and vertebroplasty.

Peri-acetabular metastases

Cancer that has spread to the hip socket (acetabulum) can require complex surgery to reconstruct the bone that has been dissolved by cancer.

  • Most patients can be treated with radiation and chemotherapy, but when surgery is necessary, our orthopedic oncology and hip reconstruction teams have expertise in reconstructing these complex defects.
  • Innovative minimally invasive techniques including needle ablation, cement and minimally invasive screw placement also are options as medically appropriate when a large surgical reconstruction is not the best option.



  • Mayo Clinic Orthopedic Oncology
  • 5779 E Mayo Blvd.
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  • Mayo Clinic Orthopedic Oncology
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  • Mayo Clinic Orthopedic Oncology
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  • Phone: 507-284-2511
Oct. 19, 2023