Date:
Patient:
MRN:
Clincian: (Orthopedic Oncologist, Radiologist)
Reason for Visit:
Follow-up for giant cell tumor of bone (GCT)
Evaluation of symptoms (pain, swelling, limitations in movement)
Review of imaging studies
Discussion of treatment plan and potential complications
History of Present Illness:
Briefly describe the patient’s current status:
Location of the GCT (common sites: distal femur, proximal tibia, distal radius)
Duration and severity of symptoms (pain, swelling, decreased range of motion)
Any functional limitations due to the tumor
Response to previous treatment approaches (surgery, embolization)
Past Medical History:
Underlying medical conditions relevant to treatment considerations (bone health, allergies)
Social History:
Not typically relevant for GCT unless occupation involves strenuous activity on the affected bone.
Physical Exam:
Musculoskeletal exam:
Localized tenderness, swelling, and warmth over the affected bone.
Assess range of motion and any functional limitations of the affected joint.
Neurovascular exam to assess for any nerve or blood vessel compression by the tumor.
Labs:
Routine blood tests (CBC, electrolytes) may be ordered pre-operatively.
Consider mentioning other labs ordered as needed (tumor markers may be helpful in some cases to differentiate GCT from other tumors).
Imaging:
X-ray: Initial imaging study to show a lytic (bone destruction) lesion with characteristic margins.
MRI: Provides detailed information about the size, extent, and soft tissue involvement of the tumor.
CT scan: May be used for preoperative planning and assessment of potential lung metastases (rare).
Assessment:
Summarize the diagnosis and disease stage:
Confirmation of GCT diagnosis based on clinical presentation, imaging studies, and potential biopsy results.
Stage of the GCT based on the Enneking system (considering size, location, and extension to surrounding tissues).
Plan:
Outline the treatment plan based on the assessment:
Surgical intervention: The mainstay of treatment is surgical resection of the tumor with clear margins. Reconstruction techniques (bone grafts, implants) may be needed depending on the size and location of the resected bone.
Minimally invasive techniques: Consider mentioning the possibility of using minimally invasive surgical techniques (arthroscopy) for small, accessible tumors.
Adjuvant therapy: Radiation therapy may be considered in some cases to decrease the risk of recurrence, especially for high-risk tumors or incomplete surgical resection.
Physical therapy: Rehabilitation is crucial to regain strength, range of motion, and function in the affected limb.
Prognosis:
Briefly discuss the prognosis. GCT is generally a benign tumor, but it has a risk of recurrence. The prognosis depends on the stage of the tumor, completeness of resection, and response to treatment.
Emphasize the importance of ongoing follow-up to monitor for potential recurrence.
Education:
Document any education provided to the patient regarding:
The nature of GCT, its symptoms, and potential complications
The details of the planned surgical procedure or other treatment options
The importance of physical therapy and rehabilitation
Warning signs and symptoms of recurrence (worsening pain, swelling)
The importance of following up with regular appointments
Notes:
Include any additional relevant information not covered above, such as the patient’s understanding of the diagnosis and treatment plan, and any concerns they may have about surgery, recovery, potential complications, or long-term prognosis.
Consider mentioning the potential for future fractures in the affected bone, especially with extensive surgical resections.
Disclaimer: This is a template and should be adapted to the specific needs of each patient. It is important to consult with an orthopedic oncologist or radiologist for diagnosis, treatment recommendations, and prognosis.