Bone tumor slideshare Especial for nursing students

Bone tumor slideshare
Prepared by: Bindu Gautam
Public Health Nurse

1. BONE TUMOR Bindu Gautam PHN

2. Introduction When cells divide abnormally and uncontrollably, they can form a mass or lump of tissue. This lump is called a tumor. A growing tumor may replace healthy tissue with abnormal tissue. It may weaken the bone, causing it break (Fracture).

3. Cont.. Some tumors are benign, meaning they aren’t cancerous. While benign bone tumors won’t spread to other parts of the body and are unlikely to be fatal, they can still be dangerous and may require treatment. Benign tumors can grow and could compress your healthy bone tissue. Other tumors are malignant, meaning they’re cancerous. Malignant bone tumors can cause cancer to spread throughout the body.

4. Definition Bone tumor refers to a neoplastic growth of tissue in bone (Wikipedia) Bone tumor is an abnormal growth of cells within a bone (Medline Plus) A bone tumor may be cancerous(malignant) or non-cancerous (benign)

5. Incidence Osteochondromas are most common non-cancerous(benign) bone tumors, and occur most often in people between the ages of 10 and 20. Annually about 2700 new cases of bone (and joint) cancer occur in the United States, with an estimated 1200 deaths. Primary bone tumors, both benign and malignant are relatively rare in adults.

6. Classifications Bone tumors are classified into: Primary bone tumors: Benign Bone Tumors Malignant Bone Tumors Secondary bone tumors (Metastasis )

7. Cont.. Types of benign bone tumors: Osteochondroma Osteoclastoma Endochroma Types of malignant bone tumors: Osteogenic Sarcome (Osteosarcoma) Chondrosarcoma Ewing’s sarcoma Chondroma

8. Cont.. BENIGN: 1. Osteochondroma Most common benign bone tumor; frequently located in metaphyseal portion of long bones, particularly the leg, pelvis, or scapula; occurs most often in persons ages 10-25; malignant transformation may occur ( chondrosarcoma ).

9. Osteochondroma

10. Cont.. 2. Osteoclastoma A tumor that arises in the rounded end of the bone and not in the growth plate of the arm and leg bones; about 10% of all osteoclastoma (giant cell tumor) are locally aggressive and may spread to lungs, high rate of local recurrence after surgery and chemotherapy.

11. Osteoclastoma

12. Cont.. 3. Endochroma A n intramedullary cartilage tumor usually found in the cavity of a single hand or foot bone; rare malignant transformation can occur; if tumor becomes painful, a surgical resection is done; peak incidence in persons ages 10-20.

13. Endochroma

14. Cont.. MALIGNANT 1. Osteosarcoma M ost common primary bone cancer; occurs mostly in young males between ages 10-25; most often in bones of the arms, legs or pelvis.

15. Osteogenic sarcoma

16. Cont.. 2. Chondrosarcoma O ccurs in cartilage cells most commonly in the arm, leg and pelvic bones of older adults age 50-70; can also arise from benign bone tumor ( osteochondroma ); wide surgical resection is mostly done as tumor rarely responds to radiation and chemotherapy; survival rate depends on stage, size and grade of tumor.

17. Chondrosarcoma

18. Cont.. 3. Ewing’s sarcoma Develops in medullary cavity of long bones, especially the femur, humerus , pelvis and tibia; usually occurs in children and teenagers; use of wide surgical resection, radiation and chemotherapy has greatly improved the 5 years survival rate to 60%; occurs most often in white people.

19. Ewing’s Sarcoma

20. Cont.. 4. Chordoma R are tumor that occurs in base of the skull and vertebral bones of older adults ages 50-70; wide surgical resection and radiation are difficult because the spinal cord and nerves may also be involved; chemotherapy may be used for late-stage disease; tumor may recur 10 or more years after treatment.

21. Chordoma

22. Cont.. Secondary bone tumors (metastatic bone cancer): Most common type of malignant bone tumor occurs as a result of metastasis from a primary tumor via lymph and blood supply. The term “secondary bone cancer” means that the cancer started somewhere else in the body and then spread to the bone. It usually affects older adults. Common sites for the primary tumor include the breast, prostate, GI tract, lungs, kidney, ovary, and thyroid.

23. Metastatic Bone Disease

24. Risk Factors It's not clear what causes bone cancer but doctors have found certain factors are associated with an increased risk: including: Inherited genetic syndromes: Certain rare genetic syndromes passed through families increase the risk of bone cancer, like hereditary retinoblastoma. Paget's disease of bone: This precancerous condition that causes the bones to become thick and brittle, and to break easily, is considered a bone cancer risk factor affecting older adults, increases the risk of bone cancer.

25. Cont.. Radiation therapy for cancer: Exposure to large doses of radiation, such as those given during radiation therapy for cancer, increases the risk of bone cancer in the future. Bone Marrow Transplantation: Individuals who have undergone a bone marrow transplant for the treatment of another condition may be at an increased risk for developing osteosarcoma. People who are exposed to pesticides in their work Previous history of chemotherapy Being a child or young adult

26. Causes Idiopathic (Unknown ) Heredity Osteosarcoma has been linked to radiation treatment (particularly high doses of radiation ) and other anticancer drugs, especially in children. However, a direct cause hasn’t been identified. People who have had bone fractures repaired with metal implants are also more likely to develop osteosarcoma later . All risk factors

27. Pathophysiology Cancer cells Osteolytic response Osteoblastic response Primary tumor causes Altering its normal bone destruction pattern of remodeling weak change in bone surface and enlargement of affected fracture bone

28. Cont.. Benign bone tumor Malignant tumor have symmetric controlled growth pattern and place invade and weaken the pressure on adjucent bone structure of the bone Alteration in blood supply destruction of bone to particular area fracture Destruction of bone if prolong, Metastatic (other organs) Fracture

29. Clinical Staging It explains the anatomic extent of the malignant disease process by stages: Stage -0: cancer in situ Stage - I: tumor limited to the tissue of origin; localized tumor growth Stage - II: limited local spread Stage - III: extensive local and regional spread Stage - IV: metastasis

30. Clinical Features Some of the following are symptoms that can be associated with cancer. The acronym, C.A.U.T.I.O.N., can remind us of the most common warning signs of cancer. C - Change in bowel or bladder habits A - A sore that does not heal U - Unusual bleeding or discharge T - Thickening or lump in any part of the body I - Indigestion or difficulty swallowing O - Obvious change in a wart or mole N - Nagging cough or hoarseness (From "Cancer Facts", National Cancer Institute, National Institutes of Health)

31. Cont.. Beside these other signs and symptoms are: Bone pain-most common : this may worse at night .However, symptoms my vary depending on the location and size of the tumor Bone cancer can also interfere with normal movements and can weaken the bones , occasionally leading to fractures . The tumor may be diagnosed only after pathologic fracture has occurred. Weight loss, malaise, fever and anemia may be present.

32. Cont.. With spinal metastasis , spinal cord compression may occur (can progress rapidly or slowly) Neurologic deficits (e.g. progressive pain, weakness, gait abnormality, paraplegia, urinary retention, loss of bowel or bladder control) must be identified early and treated with decompressive laminectomy to prevent permanent spinal cord injury.

33. Cont.. Tumors can cause night sweats or fevers . Or you might not have any pain, but you’ll notice a new mass of tissue on some part of your body. People with benign tumors might not have any symptoms, and the tumor might not be detected until an imaging scan reveals it while receiving other medical testing. A benign bone tumor, such as an osteochondroma , may not require treatment unless it starts to interfere with your function and movement.

34. Diagnostic Evaluation History collection and physical examination Blood and Urine Tests A lab will analyze these fluids to detect different proteins that may indicate the presence of a tumor or other medical problems. Serum 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 your blood.

35. Cont.. Imaging tests: X-ray- to determine the size and exact location of the tumor. CT scan- provides series of detailed images of the inside of your body that are taken from several angles. Bone scans- the most widely used radiographical procedure to detect metastatic disease MRI scan- gives detailed pictures of the area in question PET scan ( positron emission tomography)- locate the site of the tumor Biopsies- make a definite determination of the condition

36. Complications Some benign bone tumor may recur even after surgical removal (excision) Muscle wasting Pathological fracture The risk of developing a secondary malignancy Limb salvage surgery and amputation may involve significant body disfigurement and morbidity that may require additional surgery or treatment.

37. Cont.. Temporary burn to the skin and fatigue from radiation therapy Nausea, vomiting, mouth sores, hair loss and lower resistance to infection from chemotherapy Infection of the surgical site and possible blood clotting disturbances from surgery Hypercalcaemia ( symptoms include muscular weakness, incoordination, anorexia, constipation) altered mental states

38. Management Goal :- Primary tumor : To eradicate the tumor completely To promote long term survival Secondary tumor : The treatment of metastatic bone cancer is palliative The therapeutic goal is to relieve the patient’s pain and discomfort while promoting quality of life

39. Cont.. Chemotherapy Radiotherapy Surgery

40. Medical Management Chemotherapy may be delivered intra-arterially for the patients with osteosarcoma ; this mode of delivery is associated with improved limb preservation. Chemotherapeutic agents include: Methotraxate , Doxorubicin, Cisplatin ( Platinol ), Cyclophosphamide (Cytoxan), Bleomycin ( Blenoxane ), Dactinomycin ( Cosmegen ), and Ifosfamide ( Ifex )

41. Cont.. Current use of adjucent chemotherapy following amputation has increased the projected 5 year survival rate to 60% Hypocalcaemia results from breakdown of bone. It needs to be recognized promptly . Treatment includes hydration with IV administration of NS solution ; Diuresis, Mobilization, and medications such as Bisphosphanates and Calcitonin . Inactivity leads to loss of bone mass and increased calcium in the blood, so increase activity and ambulation

42. Cont.. Pain must be assessed accurately and managed with adequate and appropriate opioid, NSAIDs . (key management to administer all analgesics is around the clock(ATC) rather than on an as needed basis). Radiation therapy , if tumor is radio- sensitive . Radiation therapy uses high-energy x-rays to destroy cancer cells. To treat bone cancer, a machine outside the body is used to direct this energy to the treatment area (called external radiation) Radiation is often used in conjunction with surgery. It can also reduce pain and decrease the chance of bone fractures.

43. Non-pharmacological Management Frequent position changes and stimulation of non- tumor areas through heat, cold, or massage may be beneficial. Music therapy Relaxation technique

44. Surgical Management Surgery may be performed to eradicate the disease, either through: Excision of the tumor , a wide zone of surrounding normal tissue or through amputation Limb-sparing (salvage) procedures are used to remove the tumor and adjacent tissue. A customized prosthesis , total joint arthroplasty , or bone tissue from the patient ( autograft ) of from a cadaver donor(allograft) replaces the resected tissue. Soft tissue and blood vessels may need grafting because of the extent of the excision.

45. Cont.. Cryosurgery : 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 to treat bone tumors instead of regular surgery.

46. Nursing Management Goals : To relieve pain and increase the patient’s comfort level Meet the client’s daily living activities Provide emotional support to the patient

47. Nursing Assessment The patient with bone cancer should be assessed for the location and severity of pain. Weakness caused by anemia and decreased mobility may also be noted. Swelling at the involved site and decreased joint function, depending on the tumor site, should also be monitored.

48. Nursing Diagnosis Acute pain related to disease process (increase bone mass, uncontrolled cell multiplication). Impaired physical mobility related to pain, weakness. Disturbed body image related to possible amputation, deformity, effects of chemotherapy. Fear and anxiety related to poor prognosis of the disease..

49. Cont.. Risk for injury related to disease process, possible pathological fracture, inadequate handling or positioning of affected body part. Self care deficit related to pain Knowledge deficit regarding treatment, home care and nutritional plan

50. Acute pain related to disease process Goal : Client will cope with the pain Plan of action : Assess for the site, intensity and duration of pain Establish IPR with the client Monitor vital signs Modify environment Provide comfortable bed Elevate and support the affected part with comfort devices

51. Cont.. Diversional therapies Teach coping strategies or introduce client to other patient of similar disease Administer analgesics if required

52. Disturbed body image related to possible amputation, deformity, effects of chemotherapy . Goal : Demonstrate acceptance of body image changes resulting from chemotherapy, radiation and surgery Plan of action : Promoting a trusting relationship so that the patient feels comfortable expressing concerns and anxieties. Clarifying any misconceptions the patient may have and helps the patient work through modifications needed to adopt to alterations in physical capacity Increased ability to perform self care activities within the limits of the therapeutic regimen

53. Impaired physical mobility related to pain, weakness . Goal: Client will be able to perform his activities of daily living Plan of action: Assessing the limitation of movement of client Instruct and assist client in position changes and transfer Instruct and supervise isometric exercise to the client which strengthens the muscles Encourage for intake of high fibrous and protein diet to prevent weaking . Instruct and supervise safe use of ambulatory devices e.g. wheelchair Elevate and adequately support affected parts with pillows or splints

54. Risk for injury related to disease process Goal : To prevent from injury Plan of action: Careful handling and support of the affected area and log rolling for those client on bed rest Instruct and assist in position changes and transfers Encourage patient to participate in planning

55. Self care deficit related to pain Goal : To care client at home by self or by family Plan of action: Assess home environment of the client Assess availability of physical assistance for ADL, and health care activities Encourage patient to express concerns about care at home Teach caregiver and client the home health care regimen including exercise instructions, medication, diet, safe use of ambulatory devices, follow up and potential problems