Orthopaedic Oncology for Patients with Upper Extremity Tumors of the Hand

Published in Framework - Framework Spring 2019 and Orthopaedic Surgery - Orthopaedic Surgery Spring 2019

A Johns Hopkins orthopaedic surgeon is filling the gap in care for patients with upper extremity tumors of the hand. Sophia Strike specializes in hand oncology and works with a team of experts to provide multidisciplinary care for orthopaedic oncology. New technological developments, advancements in chemotherapy and radiation, and specialized training all empower Strike to offer numerous surgical options.

Now, says Strike, referring physicians don’t have to pick one specialty over another “Should I send my patient to a hand surgeon? Should I send them to an oncologist? You can have both in one.”

After diagnosing a patient, Strike makes recommendations from a multitude of treatment options. “Every patient is just different enough from the last one that it is always a challenge to determine the best plan of care for them.”

New technological developments, such as thinner sutures, and specialized training in “supermicrosurgery” have provided more surgical options, as well. Strike explains that advancements in microsurgery now allow submillimeter vessels to be repaired and to preserve more of the hand. For example, she says, “If I remove a small tumor around a blood vessel, we can reconstruct the blood vessel. The technique has become more and more precise so we can reconstruct smaller vessels than in the past, when we probably would have had to amputate.”

In addition, she says advancements in chemotherapy and radiation have allowed her to save more structures. “Depending on the type of cancer, tumors can be radiated or patients can undergo systemic therapy to help us preserve more of the hand,” says Strike.

Although most upper extremity tumors are benign, including an enchondroma or giant cell tumor of tendon sheath, some malignant tumors can occur in the hand. These include soft-tissue sarcoma, chondrosarcoma, osteosarcoma or Ewing sarcoma. Strike says epithelioid and synovial sarcomas are the most common soft-tissue sarcomas in the adult hand, but squamous cell carcinoma is one of the most common malignant conditions found on the hand.

Diagnosis and treatment can be difficult because every case is unique. “The same thing that makes me excited about what I do is also what makes it challenging. You are not following a clear pathway where you just check a box and go in a set direction,” says Strike. 

Since discovering a passion for oncology during her residency at Johns Hopkins, Strike spent six months focusing on oncology during a hand fellowship with the National University of Singapore School of Medicine. “Because I was able to focus on this almost exclusively, I learned so much,” she says. “It’s extremely rewarding to apply this knowledge to help patients.”