Medicolegal

Unfortunately, in many cases that Tom encounters, there has been a delayed diagnosis leading to either the need for amputation of a limb or even shortened survival. Tom’s day to day practice specialises in treating these kind of orthopaedic oncology problems and so he is in a perfect position to assist the Court in preparation of expert evidence to assist Claimant’s and Defendant’s with their cases.

Tom Cosker provides a rapid service and works closely with instructing parties to ensure that evidence is prepared in a timely manner. He is able to provide a full review of the medical records to include the salient entries for the case and ensure that all aspects of the orthopaedic oncology case are properly covered.

SIGNS & SYMPTOMS

The early signs of osteosarcoma are usually caught on X-rays. A biopsy of suspected osteosarcoma outside of the facial region should be performed by a qualified orthopaedic oncologist such as Mr Cosker. The American Cancer Society states: “Probably in no other cancer is it as important to perform this procedure properly. An improperly performed biopsy may make it difficult to save the affected limb from amputation.” It may also metastasise to the lungs, mainly appearing on the chest X-ray as solitary or multiple round nodules most common at the lower regions.

Tom has significant experience in dealing with such cases from a medicolegal perspective and is able to comment on (un)reasonable delays and timing of surgery.

Family General Practitioners and General Orthopaedic Surgeons rarely see a malignant bone tumour (most bone tumours are benign). The pathway to osteosarcoma diagnosis usually begins with an X-ray, continues with a combination of scans (CT scan, PET scan, bone scan, MRI) and ends with a surgical biopsy.

A feature often seen by an orthopaedic oncology surgeon like Tom Cosker in an X-ray is Codman’s triangle, which is a subperiosteal lesion formed when the periosteum is raised due to the tumour. Films are suggestive, but bone biopsy is the only definitive method to determine whether a tumour is malignant or benign. Tom is experienced in the diagnosis of such malignant bone tumours.

PROGNOSIS

Prognosis of primary bone tumours such as osteosarcoma is separated into three groups.

Stage I osteosarcoma is rare and includes parosteal osteosarcoma or low-grade central osteosarcoma. It has an excellent prognosis (>90%) with wide resection. Stage II prognosis depends on the site of the tumour (proximal tibia, femur, pelvis, etc.), size of the tumor mass, and the degree of necrosis having given neoadjuvant chemotherapy. Tom comments that with a longer length of time (more than 24 months) and few nodules (two or fewer) patients have the best prognosis, with a two-year survival after the metastases of 50%, five-year of 40%, and 10-year of 20%. If metastases are both local and regional, the prognosis is worse. 

Initial prognosis of stage III osteosarcoma with lung metastases depends on the resectability of the primary tumour and lung nodules, degree of necrosis of the primary tumour, and the number of metastases. Overall survival prognosis at five years is about 30%.