Introduction
• Bone tumor is neoplastic tissue growth in bone . abnormal growth can benign or malignant.
• Average five year survival in us after diagnose with bone & joint cancer is 70%.
CLASSIFICATION
v Tumor as primary tumors, which originate in bone derive cells & tissue .it may be neoplastic, development, traumatic, infectious & inflammatory etiology.
v Secondary tumor originate in other sites & spread to skeleton.
v Prostate Carcinomas, breasts, lungs, thyroid & kidneys most commonly.
Secondary malignant bone tumor estimated to be 50 to 100 times as primary
TISSUE TYPES | BENIGN | MALIGNANT | SITE | INCIDENCE |
Chondrogenic (cartilage-forming tumors | OSTEOCHONDROMA Chondroma | Pelvis, scapula, ribs Hands, feet, ribs, spine, sternum, or long bones. | Higher in males Age 30 to 50 , higher in males. | |
Chondrosarcoma | femur., pelvis, ribs, epiphysis of long bones | 13% of malignant bone tumors Middle age & older higher in males. | ||
Osteogenic (bone forming tumors) | Osteoid Osteoma | Diaphysis of long bone (femur , tibia) | Age 20 to 30 higher in males | |
Osteosarcoma (most common malignant) | Long bones, knee | 38% of malignant bone tumors, Predominant in adolscents & people age 50 to 60 | ||
Collagenic (collagen forming tumors) | Fibrosarcoma | Femur, tibia | 4% malignant bone tumors, wide but usually 40 to 60, higher in males. | |
Myelogenic (bone marrow tumors) | Giant cell tumor | Diaphysis of long bones | 4 to 5% , higher in males |
q Primary tumor divide in benign & cancers
Common benign bone tumors may neoplastic, developmental, traumatic, infectious or inflammatory etiology.
Example of benign tumours as osteoma, osteoid osteoma, osteochondroma, enchondroma, giant cell tumor, aneurysmal bone cyst, fibrous dyspasia of bone
BENIGNS
1. Osteoma - new piece of bone grows on another piece.
2. Osteoid osteoma- arise from osteoblast cells , size is less than 1.5 cm.
3. Osteochondroma– tumor form of cartilage capped bony projections or outgrowth on bone surface.
4. Osteoblastoma– uncommon osteoid tissue forming , primary neoplasm of bone.
5. Enchondroma- cartilage cyst found in bone marrow.
6.Giant cells tumor – multinucleated
7.ABC- osteolytic bone neoplasma as several sponge like blood or serum filled, generally non- endothelialized spaces of various diameters.
8.Fibrous dysplasia- normal bone & marrow replaced with fibrous tissue.
MALIGNANT
1.Osteosarcoma- cancerous tumor in bone , aggressive malignant neoplasm that arise from primitive transformed cells of mesenchymal origin.
2.Chondrosarcoma- cancer composed of cells derived from transformed cells produce cartilage.
3.Ewing’s sarcoma– malignant small, round, blue cell tumor in bone or soft tissue.
4.Fibrosarcoma- malignant mesenchymal tumor derived from fibrous connective tissue.
SECONDARY BONE TUMORS
Ø All secondary tumor are metastatic lesions.
Ø Have spread from other organ , most commonly carcinomas of breast, lungs & prostate.
PATHOPHYSIOLOGY :-
Due to risk factors & unknown etiology
|
Increase bone activity
| connection
Development of primary bone growth
| FREQUENTLY
Primary bone tumors
| CAUSES
Bone breakdown (osteolysis)
|
Weakens bone results bone fractures
|
Increase pressure of tumor by alterations
|
Altered bone surface & enlarge tumor growth areas
| develop
Malignant tumor invade & destroy adjacent bone tissue
|
Pathological features
CLINICAL MANIFESTATION
ü Bone pain
ü Weakness
ü Slightly tenderness
ü Swelling
ü Sirm lump on bones
ü Fatigue
ü Fever
ü Weight loss
ü Anemia
MANIFESTATION OF NEOPLASMS
TYPES | SITES | MANIFESTATIONS |
bony sarcomas | q Upper, lower extremities or pelvis q Metaphysis of distal femur, proximal tibia, proximal humerus & pelvis | q Worsening deep bony pain, pain at night or during rest may radiate or become severe, muscular weakness or atrophy, q soft tissue mass extends from bone with erythematous or warm skin over tissue mass, q Change in ability to ADLs, fever. |
soft tissue sarcomas | q Upper or lower extremity & pelvis. q Thigh ; shoulder & pelvis q pelvis | q Enlarging firm mass with regular borders, which cause pain in surrounds soft tissue structure. q Erythema, warmth & venous dilation over skin. q Muscular weakness, atrophy limited motion range & change in gait. q Paresthesia with neurologic involvement & distal swelling. q Palpable local lymph nodes. q Altered bowel & bladder habits or pain with intercourse. |
DIAGNOSTIC EVALUATIONS
X –rays
CT scan
MRI
Needle biopsy
LABORATORY TEST –
Alkaline phosphatase (elevate with malignant bone tumor)
Calcium level (increase with massive bone destruction)
TREATMENT
Tumor treated with chemotherapy, radiotherapy & surgery.
Ø Chemotherapy –
Administered to shrink the malignant tumor before.
To control recurrence of tumor growth after surgery.
v Chemotherapeutic agents-
Alkylating agents- ifosfamide, cyclophosphamide
Antibiotics- doxorubicin, bleomycin
Antimetabolites- methotrexate
Plant alkaloids – vincristine
Synthetic agents- cisplatin
MEDICATIONS
o Non hormonal BISPHOSPHONATES / once a week/ pills/ increase bone strength.
o METASTRON (STRONTIUM-89) CHLORIDE / IV medication/ in three month interval/ in pain.
o GENERIC STRONTIUM CHLORIDE Sr- 89 injection
o SURGICAL TREATMENT
o Amputation – limb amputation, limb sparing surgery (combination with chemotherapy & radiation therapy)
o Limb sparing surgery, limb salvage surgery in two ways.
o (a)Bone graft – bone is taken from elsewhere on body.
o (b)Artificial bone – IN surgery of uper leg .
o ratationplasty
o TYPES OF AMPUTATION:-
o LEG- above knee, below knee, symes, hip disarticulation, hemipelvectomy
o ARM:- below elbow, above elbow, shoulder disarticulation forequarter (amputation of whole arm, along with shoulder blade & clavicle)
o
HEMICORPORECTOMY
trans lumbar or waist amputation , which removes legs, pelvis, urinary system, excretory system & genital area.
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