Orthopedic Oncology

A tumor is a growth or mass that may be benign (not cancerous) or malignant (cancerous). Orthopedic oncology is a sub-specialty of orthopedic surgery focused on the management of benign and malignant tumors of soft tissues and bones. Soft tissue tumors may arise in the skin, subcutaneous fat, fascia (lining over the muscles), muscles, nerves, or vessels. Bone tumors may arise directly from the bone itself (primary bone tumor) or spread to bone (metastatic bone tumor) or arise from the bone marrow (e.g. myeloma). A primary malignant soft tissue or bone tumor (cancer of muscles or bones) is often referred to as a sarcoma (e.g. soft tissue sarcoma, osteosarcoma, chondrosarcoma etc.) depending on the cell of origin.

The treatment of bone and soft tissue tumors varies considerably depending on the nature of the tumor (benign or malignant), tumor histology or grade (the appearance of the cancerous cells under the microscope, cell of origin), location (superficial vs. deep, extremities vs. pelvis or shoulder blade or spine), and the size of the tumor. These factors, generally speaking, may determine the prognosis and potential for long-term cure of the tumor if it is malignant. 

Dr. Deheshi has 14 years of post-fellowship experience in the diagnosis and management of orthopedic oncology patients. He was one of only 15 orthopedic oncology surgeons across Canada and is one of very few orthopedic oncology surgeons in DFW. He receives referrals from oncologists and orthopedic surgeons in Tarrant County and surrounding regions with bone and soft tissue tumors that may be benign or malignant such as sarcoma and bone metastases.

Dr. Deheshi performs an extensive evaluation of a patient referred with a bone or soft tissue tumor to determine if it is benign or malignant. The evaluation includes a detailed history, physical examination, and investigations. Investigations may include but are not limited to X-rays, CT scan, MRI scan, bone scan, PET scan, and/or laboratory tests (blood work) as necessary. If a malignant tumor is suspected, then a biopsy is performed. Majority of biopsies are performed under image guidance such as ultrasound or CT guided with a core needle, often performed by a radiologist with local anesthetic and/or sedation.

Sometimes, a core needle biopsy is non-diagnostic and an open (surgical) biopsy may be necessary to confirm the diagnosis and guide management. Dr. Deheshi will then review the biopsy results with the pathologist and meet with the patient and/or family members in person to discuss the results and potential treatment options.

Sarcomas

Sarcomas are very rare tumors and the management of sarcomas is performed in a multi-disciplinary fashion. Cases with diagnosis of sarcoma are often discussed in a multi-disciplinary setting with the presence of radiologists, pathologists, medical and radiation oncologists, and oncology surgeons, with input from all members of the treatment team.

This allows the multi-disciplinary treatment team to coordinate the best care, personalized to the patient’s condition and tumor, considering the latest evidence and clinical trials available. Dr. Deheshi will then discuss the multi-disciplinary team recommendations with the patient and educate and guide the patient and family through the next steps in treatment. The patient is often referred to medical and radiation oncologists as indicated who will personally meet with the patient and counsel and assist them through the treatment as we all work toward eradicating the tumor and a long-term cure.

Benign Lumps, Bumps & Bone Lesions

Majority of soft tissue and bone lesions are benign (not cancerous). This can often be determined by a detailed history and physical evaluation and review of imaging such as X-rays, CT or MRI. If the lesion has a typical benign appearance, then a biopsy may not be necessary.

Dr. Deheshi would then arrange for regular follow up evaluation and imaging as indicated to confirm that the lesion is not showing any concerning signs such as growth or change in imaging characteristics over time, that would warrant a biopsy.

Metastatic Bone Disease

Metastatic bone disease is a condition where the cancer has originated from another site (e.g. breast, prostate, lung, kidney, thyroid) to the bones. As the tumor weakens the bone, it can lead to pain, limited mobility and pathologic fracture (broken bone). The role of the orthopedic oncology surgeon is to determine the risk of an impending pathologic fracture or manage the fracture if it occurs. Metastatic bone disease can be managed with a number of treatment options including radiation, chemotherapy, anti-hormonal therapy, medications to prevent further bone damage (e.g. bisphosphonates or Denosumab).

Surgical management of bone metastases includes stabilization or fixation of the bone with an intramedullary rod or plates and screws, or replacement of the bone such as a hip, knee or shoulder replacement. The goal of surgical management is to control the pain, return the patient back to their normal function, and most important, improve the patient’s quality of life.

Dr. Deheshi has treated hundreds of patients with metastatic bone disease and has a specialty research interest in the management of bone metastases. He was a local expert in management of bone metastases at McMaster University, center for evidence-based orthopedics and was involved in clinical research with a focus on improving function and quality of life for patients afflicted with this condition. Dr. Deheshi has presented his research on bone metastases at local and international meetings and is a recognized expert in this field.

What People Say About Us.

Excellent staff, and Dr. Deheshi is a very caring Dr. Great bedside manners, and take his time explaining everything about your condition. He just did a revition on my right knee in Sept 18/19 and four days after I got home I dint used the walker anymore. Great advance on my knee. He love what he does and is very sure of it as well . I recommend Dr. Deheshi ! 👍

- A. Tolleson

Dr. Deheshi is an excellent surgeon. Who listens and takes care of his patients. He did an outstanding job on my total knee replacement. He kept me informed on every stage. His staff did a great job too. I would recommend him to anyone .great job doc👍.

- D. Gibson

Dr. Deheshi and his entire staff have been a Godsend to our family! My Father had to have an amputation that we never saw coming, and a total knee replacement on his other leg.... They took care of him! At 78, he has recovered perfectly from both and is starting to walk again with a prosthesis. I do not believe we would have had the same outcome with any other Surgeon and Staff! I recommend them to EVERYONE!

- MM Teague

Thank you Dr. Ben Deheshi and nurses for taking such great care of my father. It has been a journey. So wonderful to have you and your staff help him get well again. 💖

- S. Fetzko