Bone tumor

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1. BONE TUMOR JOHNY WILBERT, M.SC[N] LECTURER, APOLLO INSTITUTE OF HOSPITAL MANAGEMENT AND ALLIED SCIENCE

2. DEFINITION A bone  tumor  is an abnormal growth of cells within a bone.

3. TYPES Benign tumours Benign tumours are not cancerous. Do not spread to other parts of the body Benign tumors can grow and could compress the healthy bone tissue.

4. Malignant tumours Malignant tumours are cancerous. Spreads throughout the body.

5. Benign Tumors Types of Benign Bone Tumors Osteochondromas Osteochondromas develop in adolescents and teenagers. The tumors form near the ends of long bones, such as the arm or leg bones. Specifically, these tumors tend to affect the lower end of the thighbone (femur), the upper end of the lower leg bone (tibia) and the upper end of the upper arm bone ( humerus ). Basically, they are usually found at the actively growing ends of long bones.

6. These tumors are formed of a combination of bone and cartilage. The osteochondroma has been considered to be an abnormality of growth. A child may develop a single osteochondroma or many.

7. Non-Ossifying Fibroma Unicameral Non-ossifying fibroma unicameral is a simple solitary bone cyst. It is usually found in the leg and occurs most often in children and adolescents. Giant Cell Tumors Giant cell tumors grow aggressively. They occur in adults and in the rounded end of the bone. These are very rare.

8. Enchondroma An enchondroma is a cartilage cyst that grows inside the bone marrow. When they occur, they begin in children and persist as adults. They tend to be part of syndromes called Ollier’s and Mafucci’s syndrome. Enchondromas occur in the hands and feet as well as the long bones of the arm and thigh. Fibrous Dysplasia Fibrous dysplasia is a gene mutation that makes bones fibrous and vulnerable to fracture.

9. Aneurysmal Bone Cyst An  aneurysmal bone cyst  is an abnormality of blood vessels that begins in the bone marrow. It can grow rapidly and can be particularly destructive because it affects growth plates.

10. Malignant Tumors Types of Malignant Bone Tumors 1.Primary bone cancer  means that the cancer originates in the bones. The three most common forms of primary bone cancers are Osteosarcoma Osteosarcoma , which occurs mostly in children and adolescents, is the second most common type of bone cancer. This usually develops around the hip, shoulder, or knee. This tumor is fast growing and likely to spread to other parts of the body. The most common sites are the areas where the bones are most actively growing (the growth plates), the lower end of the thighbone, and the upper end of the lower leg bone. Osteosarcoma is also sometimes known as osteogenic sarcoma .

11. ESFTs Ewing sarcoma family of tumors (ESFTs) strikes adolescents and young adults, but can sometimes affect children as young as 5 years old. This type of bone cancer usually shows up in the legs (long bones), pelvis, backbone, ribs, and upper arms and in the skull. It begins in the cavities of the bones where the bone marrow is produced (the medullary cavities) In addition to thriving in bone, ESFTs can also grow in soft tissue, such as fat, muscle, and blood vessels. African American children seldom develop Ewings sarcoma. Boys are more likely to be victims than girls. It is a rapidly growing and rapidly spreading tumor.

12. Chondrosarcoma Middle-aged people and seniors are more likely than other age groups to develop chondrosarcoma . The hips, shoulders, and pelvis are the usual areas for this type of bone cancer.

13. 2.Secondary Bone Cancer Secondary bone cancer means that the cancer started somewhere else in the body and then spread to the bone. It usually affects older people. The types of cancer most likely to spread to the bones are: Kidney Breast Prostate Lung (particularly osteosarcoma ) Thyroid gland

14. Multiple Myeloma The most common type of secondary bone cancer is called multiple myeloma. This shows up as tumors in the bone marrow. People between the ages of 50 and 70 are most commonly affected by multiple myeloma.

15. CAUSES The cause of bone tumors is not known. RISK FACTORS Genetics, Radiation treatment, Injuries to the bones. People who have had bone fractures repaired with metal implants are also likelier to later develop osteosarcoma .

16. S/S A dull ache in the affected bone. The pain starts off as occasional and then becomes severe and constant. Pathologic fracture . Swelling at the site of the tumor. Night sweats or fevers. A new mass of tissue on some part of the body.

17. DIAGNOSTIC EVALUATIONS History collection Physical examination to check for tenderness in the bone and range of motion. Blood and Urine Tests

18. To detect different proteins that may indicate the presence of a tumor or other medical problems. An alkaline phosphatase test is one common tool used in diagnosing bone tumors. When the bone tissue is especially active in forming cells, large quantities of this enzyme show up in the blood. This could be because a bone is growing, such as in young people, or it could mean a tumor is producing abnormal bone tissue. This test is more reliable in adults who have stopped growing.

19. Imaging Tests X-rays to determine the size and exact location of the tumor. CT or CAT scan , This test produces a series of detailed images of the insides, taken from several angles. MRI , or magnetic resonance imaging: This test takes detailed pictures of the area in question. PET scan , or positron emission tomography: The doctor injects a little radioactive sugar in the vein. Since cancer cells use more glucose than regular cells, this activity helps to locate the site of the tumor. Angiogram : This is an X-ray of the blood vessels.

20. Biopsy In this test, a sample of the tissue that makes up the tumor will be removed. The sample is examined in a laboratory under a microscope. The main types of biopsies are a needle biopsy and an incisional biopsy. A  needle biopsy  may be done in conjunction with one of the above imaging tests. Local anesthesia will be given to block the pain. The doctor will insert a needle into the bone, using it to remove a small bit of tumor tissue. An  incisional biopsy , also called an open biopsy, is done in an operating room under general anesthesia. The doctor cuts an incision and removes tissue through it.

21. TREATMENT FOR BENIGN BONE TUMORS If the tumor is benign, it may or may not require action. Sometimes doctors just watch benign bone tumors to see if they change. This requires coming back periodically for follow-up X-rays. Bone tumors can grow, stay the same, or eventually disappear. Children have a higher likelihood of having their bone tumors disappear as they mature. Sometimes benign tumors spread or transform into malignant tumors. Since bone tumors can also lead to fractures, the doctor might want to surgically remove even a benign tumor.

22. TREATMENT FOR MALIGNANT BONE TUMORS Surgery Bone cancer is usually treated with surgery. The entire tumor is removed. The surgeon carefully examines the margins of the tumor to make sure no cancer cells are left after surgery. If the bone cancer is in an arm or leg, the doctor may use what is known as limb salvage surgery. This means that while the cancerous cells are removed, the tendons, muscles, blood vessels, and nerves are spared. The surgeon will replace the cancerous bone with a metal implant.

23. Surgical techniques have improved greatly, making it much more likely that doctors can spare the limbs. According to the National Cancer Institute, nine out of 10 people with bone cancer in a limb can have it removed without amputation. However, reconstructive surgery can be done to retain as much limb function as possible.

24. Radiation Therapy Radiation is often used in conjunction with surgery. High-dose X-rays are used to shrink tumors before surgery and kill cancer cells. Radiation can also reduce pain and decrease the chance of bone fractures.

25. Chemotherapy This therapy uses anticancer drugs to kill the rapidly-growing cancer cells. Cryosurgery This treatment involves killing cancer cells by freezing them with liquid nitrogen. A hollow tube is inserted into the tumor, and liquid nitrogen or argon gas is pumped in. In some cases, cryosurgery can be used against bone tumors instead of regular surgery.

26. Complications: Reduced function, depending on the tumor (metastasis)