Bone tumors

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.