It started out as a slight tingling in Janet Ascenzi’s right arm a few years ago. Then the pain became so severe she couldn’t even turn her car radio on.
“It just kept getting worse,” said Ascenzi, 45, of Cohoes. “I couldn’t put my arm in my jacket. I couldn’t swim, and I had a hard time with the computer mouse at work.”
A computer technician for the Department of Transportation and the mother of two young children, Ascenzi saw two sports orthopedists who told her she had avascular necrosis (AVN), a bone disorder in which the affected bones or joints die. She then sought help from a physical therapist, before seeing another orthopedist who sent her to Dr. Matthew DiCaprio.
DiCaprio, who grew up in Scotia, is an orthopedic surgical oncologist at Ellis Hospital — the only physician with this speciality within a 100-mile radius of the Capital Region.
Orthopedic surgical oncology is the treatment of benign and malignant bone and soft tissue tumors.
After doing a physical exam, and several tests, DiCaprio told Ascenzi she had a chondrosarcoma, a type of bone cancer that develops in cartilage cells.
Cartilage is the specialized, gristly connective tissue that is present in adults and the tissue from which most bones develop.
The exact cause of primary bone cancer is unknown. Pain is the most common symptom.
Although rare — less than one in a million — this type of cancer is most commonly seen in people between the ages of 50 and 70. The incidence between males and females is equal. The only treatment is to remove it.
“To cut it out required removing the top third of Janet’s arm bone, called the humerus,” (a long bone in the arm that runs from the shoulder to the elbow) explained DiCaprio. “So it created a massive defect.”
His options were to fill the space with large metal implants or use a cadaver bone (called an allograft) with a more standard shoulder prosthesis.
DiCaprio said he decided to use cadaver bone because it allowed for a more functional outcome.
“About 95 percent of the time we are able to do these limb-salvage type of procedures,” he explained. “So the challenge is to improve the outcome, and using cadaver bone is a way to do that.”
Ascenzi said when she found out her bone tumor was malignant, her first thought was, “OK, what do we do now?”
“At least I finally knew what it was,” she recalled. “Dr. DiCaprio answered all my questions, so it was like, ‘OK let’s deal with it.’ ”
Ascenzi had surgery at Ellis Hospital on Nov. 1, 2005.
“It was painful at first,” Ascenzi admitted. “I had to keep my arm stable in a special sling, so my arm couldn’t move at all for six weeks.”
After six weeks, Ascenzi went to physical therapy for six months.
“Was it painful? I don’t know,” said Ascenzi. “You’re trying to make your arm do something it doesn’t want to do, so you sweat bullets.”
DiCaprio, who returned to Scotia after medical school to be close to his family, said malignant tumors are relatively uncommon.
There are about 3,000 malignant bone tumors per year diagnosed in this country, making up about 1 percent of all tumors, he said.
Because they are so rare, DiCaprio said they are frequently misdiagnosed, or there is a delay in diagnosis.
Benign tumors are approximately 100 times more common than malignant tumors, he added.
Rewarding work
DiCaprio said he finds his job very satisfying.
“Orthopedics in general is rewarding — getting someone back to an activity they couldn’t do because of pain or a fracture,” he said. “But when you start to deal with life-threatening things versus just limb-threatening, it becomes a bit more rewarding, and you get closer to your patients, long term.
Today Ascenzi said she has full range of motion but not 100 percent strength.
“But I’ll keep working on that,” she said. “My biggest thing was that I wanted to be able to swim again. We have a pool and I love to swim, and I am able to swim again. I thank my lucky stars that Dr. DiCaprio was here.”
Unfortunately, it is not always possible to use limb-sparing surgery, and occasionally an amputation may be the only way to treat the cancer, said DiCaprio. This is often the case when the cancer cells have spread from the bone into the nerves and blood vessels around it.
“It’s a tough decision,” he admitted. “But if the tumor has grown all around the nerves, and you have to remove the nerves, and the limb is not going to work properly, it’s science above reason.”
DiCaprio said if he has a patient with a lower leg or ankle cancerous tumor, he will usually lean from a safety standpoint toward amputation because modern leg prostheses are so good.
“It’s much different for an arm,” he said. “There are no real great arm prostheses because it’s much more complex dexterity. So whenever possible, with arms we try limb-sparing surgery.”
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