Bone tumor

Bone tumor: introduction, causes, clinical manifestations, diagnosis and management

1. BONE TUMOR PRESENTED BY: MRS. HARMEET KAUR NURSING TUTOR UCON, FARIDKOT

2. INTRODUCTION

3. STRUCTURE OF LONG BONE

4. BONE TUMOR (Introduction) A bone Tumor refers to a lump or mass of tissue that forms when cells divide uncontrollably. A growing tumor may replace healthy tissue with abnormal tissue. It may weaken the bone, causing it to break (fracture).

5. definition A bone tumor is an abnormal growth of cells within the bone that may be non cancerous (benign) or cancerous (malignant).

6. Risk factors Genetic disorders Retinoblastoma Paget disease Radiation exposure Bone marrow transplantation Injuries

7. Types of bone tumor Benign Malignant Bone forming/ Osteoblastic Osteoma Osteoid Osteoma Osteoblastoma Osteosarcoma Cartilage Forming Enchondroma Osteocondroma Chondroblastoma Chondrosarcoma Hematopoietic -- Myeloma Lymphoma Unknown Giant Cell tumor Malignant giant cell tumor Ewing’s Sarcoma Notochordal -- Chordoma

8. CLINICAL MANIFESTATIONS Cardinal symptoms: Pain, swelling and general discomfort Limited mobility and spontaneous fracture may also be important feature. Other symptoms: Fever and night sweats Painless mass or obvious bone growth Varying degree of disability, weight loss, malaise.

9. Cont.... With spinal metastasis spinal cord compression may occur. Neurologic deficit: e.g. Progressive pain, weakness, gait abnormality, paresthesia , paraplegia, urinary retntion , loss of bowel and bladder control.

10. pain

11. SWELLING

12. LIMITED MOBILITY

13. PATHOLOGICAL FRACTURE

14. ASSESSMENT AND DIAGNOSIS The differential diagnosis is based on history, physical examination and diagnostic studies. Age: it is useful information before age of 5,a malignant tumor is often metastatic neuroblastoma ; between 5 and 15 years old, osteosarcoma or Ewing sarcoma; and after 40 years, metastasis or myeloma.

15. Diagnostic studies X-rays : can show the location, size and shape of a bone tumor . Chest x-rays are performed to determine presence of lung metastasis.

16. Cont... A Bone Scan : a test in which a small amount of radioactive material is injected into a blood vessel and travels through the bloodstream; it the collects in the bones and is directed by a scanner.

17. Cont... A Computed Tomography : a series of detailed pictures of areas inside the body, taken from different angles, that are created by a computer linked to an x-ray machine .

18. Cont... A Magnetic resonance imaging : which uses a powerful magnet linked to a computer to create detailed pictures of areas inside the body without using x-rays.

19. Cont... A Positron emission tomography : a small amount of radioactive glucose is injected into vein, and a scanner is used to make detailed, computerized pictures of areas inside the body. Because cancer cells often use more glucose more than normal cells, the pictures can be used to find cancer cells in the body .

20. Cont... Biopsy: removal of a tissue sample from the bone tumor . The biopsy is most conclusive test because it confirms tumor is malignant or benign and confirms the cancer stage. Two type of biopsy done based on tumor size and type: Needle biopsy Incisional biopsy

21. Cont... Blood test: Alkaline phosphate Biochemical assay of blood and urine: Elevated serum ALP Calcium levels: Hypercalcemia

22. Tnm classification

23. Cont...

24. Cont...

25. Grading of bone cancer

26. Tnm stage grouping

27. Cont...

28. Cont...

29. Management Chemotherapy Radiation therapy Surgical management Targeted therapy Other treatments Nursing management

30. chemotherapy Use of anticancer drugs to kill cancer cells. Usually received in combination. Most commonly used drugs: Doxorubicin (40-60 mg/m2) Cisplatin (75-100 mg/m2) Carboplatin Ifosfamide (1.2 g/m2) Cyclophosphamide (10-15mg/kg iv; 1-5 mg/kg oral) Methotrexate (oral/iv) Vincristine (1.4mg/m2)

31. Side effects of chemotherapy

32. Radiation therapy Involves use of high energy x-rays to kill tumor cells May be used in combination with surgery Often used if chemotherapy cannot treat the tumor such as chondrosarcoma . May be used in patients those refuse surgery to rduce pain and decrease the chance of bone fracture Side effects: fatigue, loss of appetite, skin changes ranging from redness, hair loss, blistering and peeling may occui due to radiation therapy.

33. Surgical management Removal of entire tumor with negative margins Special surgical techniques may be used to minimize the amount of healthy tissue removed with tumor . It ranges from local exicision to amputation and disarticulation. May include limb salvage and reconstructive surgery.

34. amputation

35. Limb salvage surgery

36. Cont....

37. Reconstructive surgery

38. Tumors in othr areas

39. Other treatments

40. Cont...

41. Nursing management

42. Cont...

43. Acute pain

44. Cont...

45. Diosturbed nutrition:less than body requirements

46. cont.....

47. fatigue

48. Cont...

49. Risk of infection

50. Cont...

51. Risk for fluid volume deficit:

52. Cont...

53. Risk for altered oral mucous membranes

54. Cont....

55. Risk for impaired skin integrity

56. Cont....

57. Cont....

58. Situational low self-esteem

59. Cont....

60. Fear/anxiety

61. Cont....

62. Cont...

63. Thank You