Bone tumor

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Bone tumor_table_infobox_0

Bone cancerBone tumor_header_cell_0_0_0
SpecialtyBone tumor_header_cell_0_1_0 OncologyBone tumor_cell_0_1_1

A bone tumor is a neoplastic growth of tissue in bone. Bone tumor_sentence_0

Abnormal growths found in the bone can be either benign (noncancerous) or malignant (cancerous). Bone tumor_sentence_1

Average five-year survival in the United States after being diagnosed with bone and joint cancer is 67%. Bone tumor_sentence_2

Symptoms Bone tumor_section_0

See also: Cancer pain Bone tumor_sentence_3

The most common symptom of bone tumors is pain, which will gradually increase over time. Bone tumor_sentence_4

A person may go weeks, months, and sometimes years before seeking help; the pain increases with the growth of the tumor. Bone tumor_sentence_5

Additional symptoms may include fatigue, fever, weight loss, anemia, nausea, and unexplained bone fractures. Bone tumor_sentence_6

Many patients will not experience any symptoms, except for a painless mass. Bone tumor_sentence_7

Some bone tumors may weaken the structure of the bone, causing pathologic fractures. Bone tumor_sentence_8

Types Bone tumor_section_1

Bone tumors may be classified as "primary tumors", which originate in bone or from bone-derived cells and tissues, and "secondary tumors" which originate in other sites and spread (metastasize) to the skeleton. Bone tumor_sentence_9

Carcinomas of the prostate, breasts, lungs, thyroid, and kidneys are the carcinomas that most commonly metastasize to bone. Bone tumor_sentence_10

Secondary malignant bone tumors are estimated to be 50 to 100 times as common as primary bone cancers. Bone tumor_sentence_11

Primary bone tumors Bone tumor_section_2

Primary tumors of bone can be divided into benign tumors and cancers. Bone tumor_sentence_12

Common benign bone tumors may be neoplastic, developmental, traumatic, infectious, or inflammatory in etiology. Bone tumor_sentence_13

Some benign tumors are not true neoplasms, but rather, represent hamartomas, namely the osteochondroma. Bone tumor_sentence_14

The most common locations for many primary tumors, both benign and malignant include the distal femur and proximal tibia (around the knee joint). Bone tumor_sentence_15

Examples of benign bone tumors include osteoma, osteoid osteoma, osteochondroma, osteoblastoma, enchondroma, giant cell tumor of bone and aneurysmal bone cyst. Bone tumor_sentence_16

Malignant primary bone tumors include osteosarcoma, chondrosarcoma, Ewing's sarcoma, fibrosarcoma, and other types. Bone tumor_sentence_17

While malignant fibrous histiocytoma (MFH) - now generally called "pleomorphic undifferentiated sarcoma" - primary in bone is known to occur occasionally, current paradigms tend to consider MFH a "wastebasket" diagnosis, and the current trend is toward using specialized studies (i.e. genetic and immunohistochemical tests) to classify these undifferentiated tumors into other tumor classes. Bone tumor_sentence_18

Multiple myeloma is a hematologic cancer, originating in the bone marrow, which also frequently presents as one or more bone lesions. Bone tumor_sentence_19

Germ cell tumors, including teratoma, often present and originate in the midline of the sacrum, coccyx, or both. Bone tumor_sentence_20

These sacrococcygeal teratomas are often relatively amenable to treatment. Bone tumor_sentence_21

Secondary bone tumors Bone tumor_section_3

Secondary bone tumors are metastatic lesions which have spread from other organs, most commonly carcinomas of the breast, lung, and prostate. Bone tumor_sentence_22

Rarely, primary bone malignancies such as osteosarcoma may also spread to other bones. Bone tumor_sentence_23

Reliable and valid statistics on the incidence, prevalence, and mortality of malignant bone tumors are difficult to come by, particularly in the oldest (those over 75 years of age) - because carcinomas that are widely metastatic to bone are rarely ever curable, biopsies to determine the origin of the tumor in cases like this are rarely done. Bone tumor_sentence_24

Diagnosis Bone tumor_section_4

Projectional radiography ("X-ray") is the optimal initial imaging modality for evaluating undiagnosed primary bone tumors. Bone tumor_sentence_25

CT scan, MRI and/or histopathology can aid in reaching a final diagnosis, as well as staging thereof. Bone tumor_sentence_26

Staging Bone tumor_section_5

Bone tumor_unordered_list_0

  • Bone tumor_item_0_0
  • Bone tumor_item_0_1
  • Bone tumor_item_0_2
  • Bone tumor_item_0_3
  • Bone tumor_item_0_4

Treatment Bone tumor_section_6

Treatment of bone tumors is highly dependent on the type of tumor. Bone tumor_sentence_27

Chemotherapy and radiotherapy Bone tumor_section_7

Chemotherapy and radiotherapy are effective in some tumors (such as Ewing's sarcoma) but less so in others (such as chondrosarcoma). Bone tumor_sentence_28

There is a variety of chemotherapy treatment protocols for bone tumors. Bone tumor_sentence_29

The protocol with the best-reported survival in children and adults is an intra-arterial protocol where tumor response is tracked by serial arteriogram. Bone tumor_sentence_30

When tumor response has reached >90% necrosis surgical intervention is planned. Bone tumor_sentence_31

Medication Bone tumor_section_8

One of the major concerns is bone density and bone loss. Bone tumor_sentence_32

Non-hormonal bisphosphonates increase bone strength and are available as once-a-week prescription pills. Bone tumor_sentence_33

Metastron also known as strontium-89 chloride is an intravenous medication given to help with the pain and can be given in three-month intervals. Bone tumor_sentence_34

Generic Strontium Chloride Sr-89 Injection UPS, manufactured by Bio-Nucleonics Inc., it is the generic version of Metastron. Bone tumor_sentence_35

Surgical treatment Bone tumor_section_9

Main article: Amputation Bone tumor_sentence_36

Treatment for some bone cancers may involve surgery, such as limb amputation, or limb sparing surgery (often in combination with chemotherapy and radiation therapy). Bone tumor_sentence_37

Limb sparing surgery, or limb salvage surgery, means the limb is spared from amputation. Bone tumor_sentence_38

Instead of amputation, the affected bone is removed and replaced in one of two ways: (a) bone graft, in which bone is taken from elsewhere on the body or (b) artificial bone is put in. Bone tumor_sentence_39

In upper leg surgeries, limb salvage prostheses are available. Bone tumor_sentence_40

Types of amputation Bone tumor_section_10

Bone tumor_description_list_1

Bone tumor_unordered_list_2

  • Below kneeBone tumor_item_2_5
  • Above kneeBone tumor_item_2_6
  • SymesBone tumor_item_2_7
  • Hip disarticulationBone tumor_item_2_8
  • Hemipelvectomy or hindquarter, in which the whole leg is removed with one half of the pelvisBone tumor_item_2_9

Bone tumor_description_list_3

Bone tumor_unordered_list_4

  • Below elbowBone tumor_item_4_10
  • Above elbowBone tumor_item_4_11
  • Shoulder disarticulationBone tumor_item_4_12
  • Forequarter (amputation of the whole arm, along with the shoulder blade and the clavicle)Bone tumor_item_4_13

The most radical of amputations is hemicorporectomy (translumbar or waist amputation) which removes the legs, the pelvis, urinary system, excretory system and the genital area (penis/testes in males and vagina/vulva in females). Bone tumor_sentence_41

This operation is done in two stages. Bone tumor_sentence_42

First stage is doing the colostomy and the urinary conduit, the second stage is the amputation. Bone tumor_sentence_43

This is a mutilating operation and is only done as a last resort (e.g. when even pelvic exenteration does not work or in cases of advanced pelvic/reproductive cancers). Bone tumor_sentence_44

Another type of surgery is called Van Nes rotation or rotationplasty which is a form of amputation, in which the patient's foot is turned upwards in a 180-degree turn and the upturned foot is used as a knee. Bone tumor_sentence_45

There are other joint preservation surgical reconstruction options, which including allograft, tumor-devitalized autograft, vascularized fibula graft, distraction osteogenesis, and custom-made implants. Bone tumor_sentence_46

An analysis of massive knee replacements after resection of primary bone tumours showed patients did not score as highly on the Musculoskeletal Tumour Society Score and Knee Society Score as patients who had undergone intra-articular resection. Bone tumor_sentence_47

Thermal ablation techniques Bone tumor_section_11

Over the past two decades, CT guided radiofrequency ablation has emerged as a less invasive alternative to surgical resection in the care of benign bone tumors, most notably osteoid osteomas. Bone tumor_sentence_48

In this technique, which can be performed under conscious sedation, a RF probe is introduced into the tumor nidus through a cannulated needle under CT guidance and heat is applied locally to destroy tumor cells. Bone tumor_sentence_49

Since the procedure was first introduced for the treatment of osteoid osteomas in the early 1990s, it has been shown in numerous studies to be less invasive and expensive, to result in less bone destruction and to have equivalent safety and efficacy to surgical techniques, with 66 to 96% of patients reporting freedom from symptoms. Bone tumor_sentence_50

While initial success rates with RFA are high, symptom recurrence after RFA treatment has been reported, with some studies demonstrating a recurrence rate similar to that of surgical treatment. Bone tumor_sentence_51

Thermal ablation techniques are also increasingly being used in the palliative treatment of painful metastatic bone disease. Bone tumor_sentence_52

Currently, external beam radiation therapy is the standard of care for patients with localized bone pain due to metastatic disease. Bone tumor_sentence_53

Although the majority of patients experience complete or partial relief of pain following radiation therapy, the effect is not immediate and has been shown in some studies to be transient in more than half of patients. Bone tumor_sentence_54

For patients who are not eligible or do not respond to traditional therapies ( i.e. radiation therapy, chemotherapy, palliative surgery, bisphosphonates or analgesic medications), thermal ablation techniques have been explored as alternatives for pain reduction. Bone tumor_sentence_55

Several multi-center clinical trials studying the efficacy of RFA in the treatment of moderate to severe pain in patients with metastatic bone disease have shown significant decreases in patient reported pain after treatment. Bone tumor_sentence_56

These studies are limited however to patients with one or two metastatic sites; pain from multiple tumors can be difficult to localize for directed therapy. Bone tumor_sentence_57

More recently, cryoablation has also been explored as a potentially effective alternative as the area of destruction created by this technique can be monitored more effectively by CT than RFA, a potential advantage when treating tumors adjacent to critical structures. Bone tumor_sentence_58

Prognosis Bone tumor_section_12

The outlook depends on the type of tumor. Bone tumor_sentence_59

The outcome is expected to be good for people with noncancerous (benign) tumors, although some types of benign tumors may eventually become cancerous (malignant). Bone tumor_sentence_60

With malignant bone tumors that have not spread, most patients achieve a cure, but the cure rate depends on the type of cancer, location, size, and other factors. Bone tumor_sentence_61

See also Bone tumor_section_13

Bone tumor_unordered_list_5

Credits to the contents of this page go to the authors of the corresponding Wikipedia page: tumor.