{"id":123,"date":"2020-08-26T11:14:40","date_gmt":"2020-08-26T11:14:40","guid":{"rendered":"https:\/\/www.reusceltumor-cumcura.be\/?page_id=123"},"modified":"2020-08-26T11:22:31","modified_gmt":"2020-08-26T11:22:31","slug":"behandeling","status":"publish","type":"page","link":"https:\/\/www.reusceltumor-cumcura.be\/en\/behandeling\/","title":{"rendered":"Treatment"},"content":{"rendered":"

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Treatment and follow-up<\/h1>\n

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How does the treatment proceed?<\/h2>\n

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A\u00a0<\/span><\/b>r<\/span><\/b>eusceltumor<\/span><\/b>\u00a0in the bone<\/span><\/b>\u00a0<\/span>is<\/span>\u00a0preferably treated surgically<\/span>\u00a0By scraping away the tumour (<\/span>curettage<\/span><\/b><\/a>) or\u00a0<\/span>the bone\u00a0<\/span>completely remove<\/span>.\u00a0<\/span>When the localisation of the tumour<\/span>\u00a0surgical treatment\u00a0<\/span>hindering<\/span>,\u00a0<\/span>the doctor will give you<\/span>\u00a0a bone-strengthening medication\u00a0<\/span>proposals<\/span>,\u00a0<\/span>denosumab<\/span><\/b><\/a>\u00a0<\/span>named<\/span>.<\/span>\u00a0<\/span><\/p>\n

At\u00a0<\/span>a<\/span><\/b>\u00a0<\/span>giant cell tumour<\/span><\/b>\u00a0at\u00a0<\/span><\/b>the\u00a0<\/span><\/b>week parts<\/span><\/b>\u00a0treatment is not always necessary. The doctor will suggest you be monitored on a regular basis with ultrasound or MRI.\u00a0<\/span>Only when the growth is giving you symptoms or if it grows too far locally into the surrounding area and\/or bone, then it is better to\u00a0<\/span>the<\/span>\u00a0surgically remove<\/span>\u00a0or initiate systemic treatment.<\/span>\u00a0<\/span>\u00a0<\/span><\/p>\n

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For\u00a0<\/span><\/b>giant cell<\/span><\/b>tumours<\/span><\/b>\u00a0<\/span><\/b>of bone:\u00a0<\/span><\/b>Denosumab<\/span><\/b>\u00a0<\/span><\/p>\n

If the tumour is in a place that is difficult to reach, or if the consequences of completely removing the affected bone are very great, the treatment team will suggest you to\u00a0<\/span>denosumab<\/span><\/b>\u00a0to boot.\u00a0<\/span>Denosumab<\/span>\u00a0is a RANKL inhibitor that interrupts the signals that prompt tumour cells to break down bone. It is administered by subcutaneous injections. The use of this medication strengthens\u00a0<\/span>the bone back on and pain reduction is expected. The effects of treatment are monitored by MRI examinations on a regular basis.\u00a0<\/span>\u00a0<\/span><\/p>\n

The use of\u00a0<\/span>denosumab<\/span><\/b>\u00a0however, has a lot of side effects. Your doctor will discuss this with you.\u00a0<\/span>\u00a0<\/span><\/p>\n

Since the effects of this medication on an unborn child are not known, you should not become pregnant during this treatment.<\/span>\u00a0<\/span><\/p>\n

\u00a0<\/span><\/p>\n

For\u00a0<\/span><\/b>giant cell tumours<\/span><\/b>\u00a0of the weekly parts<\/span><\/b>\u00a0can also\u00a0<\/span>a recent\u00a0<\/span>systemic treatment be initiated, e.g.\u00a0<\/span>Pexidartinib<\/span><\/b>. Your attending physician\u00a0<\/span>can explain more about the indications, side effects and expected effects.<\/span>\u00a0<\/span><\/p>\n

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If your bone is not broken and is not in the vertebral column, the surgeon will try to scrape away the growth (<\/span>curettage<\/span><\/b>): a hatch is first provided in the bone and then the tumour is gradually removed with several sharp spoons. A high-speed router is used to remove all the tumour's outliers from the walls and the cavity in the bone is treated with a substance (liquid nitrogen or phenol).\u00a0<\/span>\u00a0<\/span><\/p>\n

To strengthen the bone, the cavity is refilled. There are two options here: inserting bone cement<\/strong> or from pieces (artificial) bone<\/strong>.\u00a0<\/span>\u00a0<\/span><\/p>\n

Using cement has the advantage that you can almost immediately use and lean on your limb again. It also offers the possibility of a recurring\u00a0<\/span>giant cell tumour<\/span>\u00a0more noticeable because the tumour grows around the cement and not in it.\u00a0<\/span>When filling with (artificial) bone, you have to be patient for several weeks to months before it has grown in. When the tumour grows back, it is more likely to grow into the (artificial) bone which is less visible.<\/span>\u00a0<\/span><\/p>\n

However, cement is not a durable solution. After one to two years, a second operation is needed to remove the cement. Once one is sure that the\u00a0<\/span>giant cell tumour<\/span>\u00a0completely disappeared, the cavity can be filled with pieces of (artificial) bone after which the bone can regenerate again.<\/span>\u00a0<\/span><\/p>\n

[\/et_pb_text][\/et_pb_column_inner][\/et_pb_row_inner][et_pb_row_inner _builder_version=\"4.5.8\u2033 width=\"100%\" width_tablet=\"80%\" width_phone=\"\" width_last_edited=\"on|desktop\" max_width=\"1080px\" custom_margin_tablet=\"|10%||10%||true\" custom_margin_phone=\"\" custom_margin_last_edited=\"on|tablet\" hover_enabled=\"0\u2033 module_alignment_tablet=\"centre\" module_alignment_phone=\"\" module_alignment_last_edited=\"on|desktop\" locked=\"off\" custom_padding=\"|45px||45px|false|true\"][et_pb_column_inner saved_specialty_column_type=\"3_4\u2033 _builder_version=\"3.25\u2033 custom_padding=\"|||\" custom_padding__hover=\"|||\"][et_pb_toggle title=\"If a bot is affected ...\" open_toggle_text_colour=\"#000000\u2033 closed_toggle_text_colour=\"#000000\u2033 icon_colour=\"#ffffff\" module_id=\"toggle2\u2033 _builder_version=\"4.5.8\u2033 title_text_colour=\"#000000\u2033 closed_title_font=\"||||||||\" body_font=\"||||||||\" body_text_colour=\"#000000\u2033 body_font_size=\"15px\" body_line_height=\"2em\" use_background_colour_gradient=\"on\" background_colour_gradient_start=\"rgba(226,156,141,0.39)\" background_color_gradient_end=\"#e29c8d\" background_color_gradient_overlays_image=\"on\" background_image=\"https:\/\/www.reusceltumor-cumcura.be\/wp-content\/uploads\/2020\/08\/REUSCEL_BOLLEN_CMYK-e1598434675594.png\" filter_opacity=\"80%\" hover_enabled=\"0\u2033 border_radii=\"on|10px|10px|10px|10px|10px\" box_shadow_style=\"preset6\u2033 box_shadow_blur=\"8px\" transform_styles__hover_enabled=\"on|hover\" transform_scale__hover_enabled=\"on|hover\" transform_translate__hover_enabled=\"on|desktop\" transform_rotate__hover_enabled=\"on|desktop\" transform_skew__hover_enabled=\"on|desktop\" transform_origin__hover_enabled=\"on|desktop\" transform_translate__hover=\"-3px|-3px\" title_text=\"REUSCEL_BOLLEN_CMYK\"]<\/p>\n

If the bone is too badly affected or broken, or if the surgeon is sure that a\u00a0<\/span>curettage<\/span><\/b><\/a>\u00a0will be insufficient, then it is sometimes better to remove this bone.<\/span>\u00a0<\/span><\/p>\n

Then there are 2 options for surgery: remove the bone without replacing it (for smaller growths in non-bearing bones) or remove it with reconstruction.<\/span>\u00a0<\/span><\/p>\n

Usually, the bone is replaced, either by another bone (biological reconstruction) or by an internal prosthesis.\u00a0<\/span>\u00a0<\/span><\/p>\n

Biological reconstruction is preferred. This can be done by 'recycling' the affected bone: the affected bone is removed and treated by radiation or another sterilisation technique to kill the tumour cells. Afterwards, the treated bone is replaced and screwed back in place. This bone is then transformed by the body into new, living bone, providing a durable solution. An alternative is to use a bone from the tissue bank, sourced from a donor. These bones are extensively tested so that no diseases are transferred from the donor.<\/span>\u00a0<\/span><\/p>\n

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then restoration of the joint is almost only possible with a prosthesis. These prostheses should not be compared to the classic prostheses placed on patients with wear and tear on these joints.<\/span><\/p>\n

Reconstructive prostheses are much larger as a large part of the bone is replaced, not just the worn cartilage. These prostheses have a limited lifespan as they usually involve young, active patients. Prostheses with a biological fixation system are preferred, which reduces the risk of loosening.<\/span>\u00a0<\/span><\/p>\n

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If you have too many symptoms, it is better to surgically remove the tumour. The chances of a\u00a0<\/span>giant cell tumour<\/span>\u00a0of soft tissue recurrence after removal is high, up to 30% for the localised form and up to 50% for the diffuse form. If the tumour is removed open (=with an incision), it is less likely to return than if removed by keyhole surgery.<\/span>\u00a0<\/span><\/p>\n

If it is localised, the surgeon will remove the tumour with a small margin of normal tissue, but without affecting your function. That is, the surgeon will not remove essential tendons, nerves or blood vessels. If it is a diffuse form, the surgeon will remove a slightly larger margin of normal tissue, and if possible also without affecting your function. This is because this shape recurs more quickly because it is less nicely demarcated from its surroundings, and therefore needs to be treated more aggressively. In extreme cases, it is even necessary to after\u00a0<\/span>radiate<\/span><\/b>\u00a0or to\u00a0<\/span>systemic treatment<\/span><\/b>\u00a0start up to get the tumour under control.<\/span>\u00a0<\/span><\/p>\n

[\/et_pb_toggle][\/et_pb_column_inner][\/et_pb_row_inner][et_pb_row_inner module_id=”chirurgie” _builder_version=”3.25.3″ width=”100%” max_width=”1080px” custom_margin=”||0px” custom_padding=”15px|40px|0|70px|false|false” locked=”off”][et_pb_column_inner saved_specialty_column_type=”3_4″ _builder_version=”3.25″ custom_padding=”|||” custom_padding__hover=”|||”][et_pb_blurb use_icon=”on” font_icon=”%%81%%” icon_color=”#e29c8d” icon_placement=”left” content_max_width=”950px” use_icon_font_size=”on” icon_font_size=”40px” _builder_version=”4.5.8″ header_font=”||||||||” body_font=”||||||||” body_font_size=”15px” body_line_height=”2em” max_width=”90%” module_alignment=”center” custom_margin=”15px|0px|-20px|” custom_padding=”|0px||” hover_enabled=”0″]<\/p>\n

A particular concern is that no matter which reconstruction technique is used, the treated bone remains very sensitive to inflammations<\/strong>. Due to limited blood flow around the prosthesis or the\u00a0<\/span><\/span><\/span>botent<\/span><\/span>\u00a0<\/span>the antibiotics may not reach the germs that settled on the prosthesis or bone, or may reach them with difficulty. In case of an uncontrollable infection, additional surgery is required and sometimes amputation is necessary in the second instance. Your doctor may recommend that you take antibiotics at the slightest sign of bacterial infection or dental treatment for the rest of your life.<\/span><\/span>\u00a0<\/span><\/p>\n

 <\/p>\n

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What about your functionality?<\/strong><\/h3>\n

Removing part of the bone or soft tissue usually results in a more or less strong impairment<\/strong> of your job. Your doctor will discuss this well with you beforehand to give you a clear picture of what to expect and to avoid unrealistic expectations. Additional explanations are sometimes needed at a later date, with specialised doctors (e.g. an amputation rehabilitation doctor) or with fellow sufferers. The aim of rehabilitation is to restore your daily activities as much as possible. Sometimes it can be difficult to accept that your normal function will remain limited for life. This limitation affects your psychosocial and economic functioning.<\/span><\/span>\u00a0<\/span><\/p>\n

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text_orientation__hover=”left” text_orientation__hover_enabled=”left” background_layout__hover=”light” background_layout__hover_enabled=”light”]<\/p>\n

How does the follow-up work?<\/h2>\n

[\/et_pb_text][et_pb_divider color=”#e29c8d” divider_weight=”3px” _builder_version=”4.5.8″ max_width=”50px” custom_margin=”||0px” hover_enabled=”0″][\/et_pb_divider][\/et_pb_column_inner][\/et_pb_row_inner][et_pb_row_inner custom_padding_last_edited=”off|desktop” module_id=”wanneergenezen” _builder_version=”3.25.3″ width=”100%” width_tablet=”80%” width_phone=”” width_last_edited=”on|desktop” max_width=”1080px” custom_margin_tablet=”|10%||10%||true” custom_margin_phone=”” custom_margin_last_edited=”on|tablet” custom_padding=”10px|0px|13px|0px|false|false” module_alignment_tablet=”center” module_alignment_phone=”” module_alignment_last_edited=”on|desktop” locked=”off”][et_pb_column_inner saved_specialty_column_type=”3_4″ _builder_version=”3.25″ custom_padding=”|||40px” custom_padding_tablet=”|10%||10%||true” custom_padding__hover=”|||”][et_pb_blurb title=”Wanneer ben je genezen?” use_icon=”on” font_icon=”%%190%%” icon_color=”#e29c8d” icon_placement=”left” content_max_width=”1100px” _builder_version=”4.5.8″ header_font=”Montserrat|500|||||||” header_line_height=”1.8em” text_orientation=”center” module_alignment=”left” custom_margin=”||0px|” hover_enabled=”0″][\/et_pb_blurb][et_pb_text _builder_version=”3.27.4″ text_font=”||||||||” text_font_size=”15px” text_line_height=”2em” header_font=”||||||||” custom_margin=”||30px|||”]<\/p>\n

If the option to wait and see was chosen, the difficult to predict<\/strong> when exactly you will be cured. As long as the\u00a0<\/span>giant cell tumour<\/span>\u00a0grows, you will be followed up further. The higher the growth rate of the tumour is, the more regular examinations will be scheduled.\u00a0<\/span>\u00a0<\/span><\/p>\n

The likelihood of a giant cell tumour<\/strong>\u00a0return after surgical treatment is high<\/strong>. Therefore, you will have to undergo an MRI at regular intervals to see in time whether the\u00a0<\/span>giant cell tumour<\/span>\u00a0develops back.\u00a0<\/span>\u00a0<\/span><\/p>\n

If the\u00a0<\/span>giant cell tumour<\/span>\u00a0has not returned after a lapse of 3 to 5 years<\/strong>, then your doctor will declare you cured.<\/span>\u00a0<\/span><\/p>\n

[\/et_pb_text][\/et_pb_column_inner][\/et_pb_row_inner][et_pb_row_inner custom_padding_last_edited=”off|desktop” module_id=”sarcoomteruggekeerd” _builder_version=”3.27.4″ width=”100%” width_tablet=”80%” width_phone=”” width_last_edited=”on|desktop” max_width=”1080px” module_alignment=”center” custom_margin=”||40px||false|false” custom_margin_tablet=”|10%||10%||true” custom_margin_phone=”” custom_margin_last_edited=”on|tablet” custom_padding=”10px|0px|13px|0px|false|false” module_alignment_tablet=”” module_alignment_phone=”” module_alignment_last_edited=”on|tablet”][et_pb_column_inner saved_specialty_column_type=”3_4″ _builder_version=”3.25.3″ custom_padding=”|||40px”][et_pb_blurb title=”Wat als de reusceltumor is teruggekeerd?” use_icon=”on” font_icon=”%%190%%” icon_color=”#e29c8d” icon_placement=”left” content_max_width=”1100px” _builder_version=”4.5.8″ header_font=”Montserrat|500|||||||” header_line_height=”1.8em” text_orientation=”center” module_alignment=”left” custom_margin=”||0px|” hover_enabled=”0″][\/et_pb_blurb][et_pb_text _builder_version=”3.27.4″ text_font=”||||||||” text_font_size=”15px” text_line_height=”2em” header_font=”||||||||”]<\/p>\n

Your doctor will tell you what treatment options are available to you, after consulting the multidisciplinary team. Basically, the same options remain open, namely wait and see, surgical resection and possible post-surgery, or starting systemic treatment.<\/span><\/span>\u00a0<\/span><\/p>\n

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How is rehabilitation going?<\/h2>\n

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After an operation, you need a period of rehabilitation<\/strong> anticipated. The more severe the surgery, the longer usually the period of rehabilitation. It is important to follow the surgeon's guidelines carefully to avoid complications. A physiotherapist or physiotherapist can certainly guide and support you in the rehabilitation process.<\/span><\/span>\u00a0<\/span><\/p>\n

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Treatment and follow-upHow is treatment? A giant cell tumour in the bone is preferably treated surgically by scraping away the tumour (curettage) or removing the bone completely. When the localisation of the tumour prevents surgical treatment, the doctor will suggest a bone-strengthening medication called denosumab. With a giant cell tumour in the soft tissue, treatment is not always necessary. The doctor will suggest that you follow up on regular [...]<\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":""},"_links":{"self":[{"href":"https:\/\/www.reusceltumor-cumcura.be\/en\/wp-json\/wp\/v2\/pages\/123"}],"collection":[{"href":"https:\/\/www.reusceltumor-cumcura.be\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.reusceltumor-cumcura.be\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.reusceltumor-cumcura.be\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.reusceltumor-cumcura.be\/en\/wp-json\/wp\/v2\/comments?post=123"}],"version-history":[{"count":0,"href":"https:\/\/www.reusceltumor-cumcura.be\/en\/wp-json\/wp\/v2\/pages\/123\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.reusceltumor-cumcura.be\/en\/wp-json\/wp\/v2\/media?parent=123"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}