A lecture slide of Bone Tumor.pptx for nursing

usefull for bsc Nursing students

1. BONE TUMOR Mr Yogendra Mehta Lecturer, HOD(Adult Health Nursing) BRNC Biratnagar

2. INTRODUCTION Bone tumors develop when cells within a bone divide uncontrollably, forming a lump or mass of abnormal tissue. Affect any bone in the body and develop in any part of the bone — from the surface to the center of the bone, called the bone marrow. Most bone tumors are benign (not cancerous). Benign tumors are usually not life-threatening and, in most cases, will not spread to other parts of the body. Some bone tumors are malignant (cancerous). Malignant bone tumors can metastasize.  

3. INTRODUCTION…   It is either a primary bone cancer or a secondary bone cancer. A primary bone cancer actually begins in bone A secondary bone cancer begins somewhere else in the body and then metastasizes or spreads to bone.

4. INTRODUCTION… Types of cancer that begin elsewhere and commonly spread to bone include: Breast Lung Thyroid Renal (kidney) Prostate

5. Warning Signs of Bone Tumor Pain: pain or Tenderness most of time even in rest. Swelling Problem moving around Fatigue Fever Weakened bone Weight Loss

6. WHO Nomenclature & Classifications 1 Bone forming tumors Benign Osteoid osteoma , osteoma , Osteoblastoma Indeterminate Aggressive osteoblastoma Malignant Osteosarcoma 2 Cartilage forming tumors Benign Osteochondroma , Chondroblastoma , Malignant Chondrosarcoma 3 Gaint cell tumor( Osteoclastoma ) 4 Marrow tumor primary tumor commonest Multiple myeloma 5 Vascular tumor Benign hemangioma Malignant Angiosarcoma

7. Osteoma It is a benign tumor composed of sclerotic, well formed bone protruding from cortical surface of a bone. The bone involved most often are the skull and facial. Generally, the tumor has no clinical significance except that it may produce visible swelling. Sometimes it may bulge into the air sinuses and cause obstruction to the sinus cavity, and leading to pain.

8. Treatment No treatment is generally required except for cosmetic reasons. Simple excision is sufficient.

9. Osteoid osteoma It is the most commonest true benign tumor of the bone. Pathologically, it consists of a nidus of tangled arrays of partially mineralized osteoid trabeculae surrounded by dense sclerotic bone. Tumor is mainly located at diaphysis of long bones. posterior elements of the vertebrae are common site. Clinical Features: Seen commonly between the age of 5-25 yrs bone of the lower extermity are more commonly affected; Tibia nagging pain, worst at night and relieved by salicylates Mild tenderness at the site of the lesions palpable swelling if it is superficial

10. Contd …. Diagnosis: Confirmed by X-Ray: tumor is visible aa a zone of sclerosis surrounding a radiolucent nidus usually less than 1 cm in size. CT scan Treatment: Complete excision of the nidus along with the sclerotic bone is done. Prognosis is good.

11. Osteoblastoma It is a benign tumor consisting of vascular osteoid and new bone. It occurs in the jaw and the spine. If in long bones, it occurs in the diaphysis or metaphysis , but never in the epiphysis. It occurs in patients in their 2 nd decade of life. The patients with aching pain. Radiologically , it is a well-defined radiolucent expansible bone lesion 2-12 cm in size. There is minimal reactive new bone formation. Treatment is by curettage.

12. Chondroblastoma It is a cartilaginous tumor containing characteristic multiple calcium deposit. It occurs in young adults and is located around the epiphyseal plate. Bones around the knee are commonly affected. Radiologically , There is a well- defined lytic lession surrounded by a zone of sclerosis. Are of calcification within the tumor substance give rise to a mottled appearance. Treatment is by curettage and bone grafting.

13. Hemangioma of the bone This is the benign tumor of angiomatous origin commonly affecting the vertebrae and skull. It occurs in young adults. Common presenting symptoms are persistent pain and features of cord compression. Typically, one of the lumbar vertebrae is affected. Radiologically , it appears as loss of horizontal striation and prominence of vertical striation of the affected vertebral body. Treatment is by radiotherapy.

14. Osteoclastoma (GCT) Giant cell tumor is a common bone tumor. The tumor consist of undifferentiated spindle cells, profusely interspersed with multi-nucleate giant cell. The tumor stroma is highly vascular. The tumor is seen commonly in the age group of 20-40 years i.e after epiphyseal fusion. The bone affected commonly are those around the knee and lower end of the radius. Clinical Features:- Swelling & vague pain Pathological fracture

15. Contd …… Examination:- Examination reveals a bony swelling surface of the swelling is smooth limb may be deformed Diagnosis:- Lytic lesion seen in X-ray Soap- bubble appearance seen No calcification seen within the tumor

16. Contd …… Treatment:- - Whenever possible, excision of the tumor is the best treatment. If excision is not possible then radiotherapy is done. Following treatment methods are commonly used: Excision:- It is the treatment of choice when the tumor affects a bone whose removal does not hamper with function e.g., fibula, lower end of ulna

17. Contd …… b. Excision with reconstruction:- When excision of a tumor at some site may result in significant functional impairment & reconstructed by as follows- Arthrodesis by the Turn-O- Plasty procedure Arthrodesis by bridging the gap by double fibula, one taken from same extremity and other from the opposite leg. Arthroplasty - Tumour is excised and attempt is made to reconstruct the joint in some way. It can be carried out using an autograft . c. Curettage with or without supplemetary procedure:- High reoocurance rate Cryotherapy : Liquid nitrogen is used to produce freezing effect and thus kill the residual cells and thermal burning of the cells by using cautrization .

18. Contd …… d. Amputation:- e. Radiotherapy:- It is preferred treatment for GCT affecting the vertebrae Prognosis: - Recurrence is more common.

19. Osteosarcoma It is the second most common and high malignant primary bone tumor. It is defined as a malignant tumor of the mesenchymal cells characterized by formation of osteoid or bone by the tumor cell. It occurs between the age of 15-25 years. lower end of femur , upper end of the tibia and upper end of humerus most common site. It looks like greyish white , hard. Histologically tumors vary in the richness of the osteoid , cartilaginous or vascular components.

20. Contd …… Clinical Features: Pain is usually the first symptoms soon followed by swelling Pain is constant and boring and becomes worse as the swelling increase in size. h/o trauma sometime pathological fracture Examination: Swelling at the metaphysis region. Shinny with prominent vein seen over the skin Margin of swelling are not well defined Regional lymphnodes may be enlarged

21. Contd …… Investigation X-ray shows the irregular destruction in the metaphysis , overshadowed by the new bone formation. Codman’s triangle: A triangle area of subperiosteal new bone is seen at the tumor host cortex junction at the ends of the tumor. Serum Alkaline Phosphatase Biopsy

22. Contd …… Treatment Confirmation of the diagnosis Evaluation of spread of tumor To plan amputation surgery Treatment of the tumor Local Control: surgical ablation, amputation Radiotherapy Chemotherapy Immunotherapy - Portion of the tumor is implanted into a sarcoma survivor and is removed after 14 days.

23. Contd …… Follow up: Checked up every 6-8 wks Any evidence of recurrence of the primary tumor. Prognosis: Without treatment death occurs within 2 yrs, usually within 6 month of detection of metastasis. 5 yrs survival with surgery alone is 20% With surgery and adjuvant therapy, 5 yrs survival is 70%

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