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Patients with recurrent, diffuse, or difficult-to-treat TGCT may benefit from a multidisciplinary team–based approach to care.1,5 Providing collaborative care may help improve outcomes, especially for patients with diffuse disease given its high risk of recurrence.1 Find your care-team role below to read about how you may contribute to this team-based approach.*

* This information is not intended to serve as guidelines or a tool for diagnosis and treatment. Rather, it is meant to raise awareness of TGCT in disciplines
that may be involved in caring for patients who have it.

Advanced practitioners

Nurse practitioners and physician assistants who specialize in oncology or orthopedics may have the expertise to provide treatment and long-term care to patients with recurrent, diffuse, or difficult-to-treat TGCT. These advanced practitioners may perform physical examinations, order and evaluate laboratory tests, and provide pre- and posttreatment education.6-8

Oncologists

As medical professionals experienced in treating and managing tumors, oncologists may provide a valued contribution to the long-term management of patients with recurrent, diffuse, or difficult-to-treat TGCT. In addition to surgical resection—the standard of care for TGCT—oncologists may provide options beyond surgery to treat and help manage the disease.9

Discussion guides

Download the appropriate guide to aid in your dialogue with new patients who
have TGCT.

Orthopedic surgeons

As physicians with expertise in the management of joint problems, orthopedic surgeons can play an important role in the
long-term management of patients with recurrent, diffuse, or difficult-to-treat TGCT.10-12 Surgical resection in an open or arthroscopic procedure is the standard of care for TGCT where possible. Diffuse TGCT is often more complex than the localized form and may require multiple surgeries to help manage the disease.13

Discussion guide

Download this guide to aid in your dialogue with new patients who have TGCT.

Pain management specialists

Pain management specialists may use palliative measures to help with the long-term management of patients with recurrent, diffuse, or difficult-to-treat TGCT. Such measures may include pain relievers, anti-inflammatory drugs, or steroids.14

Physical therapists and rehabilitation specialists

Physical therapists and rehabilitation specialists can play an important role in the long-term management of patients with recurrent, diffuse, or difficult-to-treat TGCT. Following surgery, patients may benefit from physical therapy and rehabilitation, including stretching and strength-training exercises. These activities can help patients return to their usual daily and
work-related activities.2,3

Radiologists and pathologists

Radiologists and pathologists can use imaging and histological assessment to help guide the long-term management of patients with recurrent, diffuse, or difficult-to-treat TGCT.1 Magnetic resonance imaging is the best approach to diagnosing TGCT and planning for follow-up care.13,15-17

You need a holistic approacha “PVNS is not something that’s going to be handled by a single doctor. You need a more holistic approach to guide you to putting together the appropriate team.” —Woman with recurrent, diffuse TGCT in ankle

a The impact of TGCT is different for everyone; this information is not meant to be reflective of all patients with TGCT.

Consider a sarcoma center for your patients

The specialized expertise of healthcare professionals in sarcoma centers can help support the potential long-term management needs of patients
with TGCT.1,4,12

National Comprehensive Cancer Network® Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Soft Tissue Sarcoma recommend that patients with diffuse TGCT be evaluated and managed by a multidisciplinary team that has experience and expertise in sarcoma.5

Find a sarcoma center in the United States

Sarcoma Alliance identifies medical centers and hospitals specializing in sarcoma in the United States.

References

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  1. van der Heijden L, Gibbons CLMH, Dijkstra PDS, et al. The management of diffuse-type giant cell tumour (pigmented villonodular synovitis) and giant cell tumour of tendon sheath (nodular tenosynovitis). J Bone Joint Surg Br. 2012;94(7):882-888. doi:10.1302/0301-620X.94B7.28927
  2. Hegedus EJ, Theresa K. Postoperative management of pigmented villonodular synovitis in a single subject. J Orthop Sports Phys Ther. 2008;38(12):790-797. doi:10.2519/jospt.2008.2934
  3. Siegel GW, Biermann JS, Chugh R, et al. The multidisciplinary management of bone and soft tissue sarcoma: an essential organizational framework. J Multidiscip Healthc. 2015;8:109-115. doi:10.2147/JMDH.S49805
  4. Verspoor FGM, van der Geest ICM, Vegt E, Veth RPH, van der Graaf WT, Schreuder HWB. Pigmented villonodular synovitis: current concepts about diagnosis and management. Future Oncol. 2013;9(10):1515-1531. doi:10.2217/fon.13.124
  5. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Soft Tissue Sarcoma V.1.2021. © National Comprehensive Cancer Network, Inc. 2020. All rights reserved. Accessed November 9, 2020. To view the most recent and complete version of the guideline, go online to NCCN.org. NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way.
  6. Spence BG, Ricci J, McCuaig F. Nurse practitioners in orthopaedic surgical settings: a review of the literature. Orthop Nurs. 2019;38(1):17-24. doi:10.1097/NOR.0000000000000514
  7. Vogel WH. Oncology advanced practitioners bring advanced community oncology care. Am Soc Clin Oncol Educ Book. 2016;35:e97-e100. doi:10.1200/EDBK_158751
  8. Cawley JF, Hooker RS. Physician assistants in American medicine: the half-century mark. Am J Manag Care. 2013;19(10):e333-e341.
  9. Types of oncologists. Cancer.Net. Accessed September 1, 2020. https://www.cancer.net/navigating-cancer-care/cancer-basics/cancer-care-team/types-oncologists
  10. Orthopedic services. MedlinePlus. Updated June 2, 2020. Accessed September 3, 2020. https://medlineplus.gov/ency/article/007455.htm
  11. Lucas DR. Tenosynovial giant cell tumor: case report and review. Arch Pathol Lab Med. 2012;136(8):901-906. doi:10.5858/arpa.2012-0165-CR
  12. Mastboom MJL, Verspoor FGM, Verschoor AJ, et al; TGCT study group. Higher incidence rates than previously known in tenosynovial giant cell tumors: a nationwide study in The Netherlands. Acta Orthop. 2017;88(6):688-694. doi:10.1080/17453674.2017.1361126
  13. Brahmi M, Vinceneux A, Cassier PA. Current systemic treatment options for tenosynovial giant cell tumor/pigmented villonodular synovitis: targeting the CSF1/CSF1R axis. Curr Treat Options Oncol. Published online January 28, 2016. 2016;17(2):10. doi:10.1007/s11864-015-0385-x
  14. Gelhorn HL, Tong S, McQuarrie K, et al. Patient-reported symptoms of tenosynovial giant cell tumors. Clin Ther. Published online April 1, 2016. 2016;38(4):778-793. doi:10.1016/j.clinthera.2016.03.008
  15. Camillieri G, Di Sanzo V, Ferretti M, Calderaro C, Calvisi V. Intra-articular tenosynovial giant cell tumor arising from the posterior cruciate ligament. Orthopedics. Published online July 1, 2012. 2012;35(7):e1116-e11168. doi:10.3928/01477447-20120621-34
  16. Bedir R, Balik MS, Sehitoglu I, Güçer H, Yurdakul C. Giant cell tumour of the tendon sheath: analysis of 35 cases and their Ki-67 proliferation indexes. J Clin Diagn Res. 2014;8(12):FC12-FC15. doi:10.7860/JCDR/2014/10553.5311
  17. Mastboom MJL, Verspoor FGM, Hanff DF, et al. Severity classification of tenosynovial giant cell tumours on MR imaging. Surg Oncol. 2018;27(3):544-550. doi:10.1016/j.suronc.2018.07.002