|X-ray of a giant cell bone tumor in the head of the 4th metacarpal of the left hand.|
|Types||Noncancerous (benign) or cancerous (malignant)|
|Diagnostic method||plain X-ray|
Signs and symptoms
There may be a lump, with or without pain. Pain may increase with the growth of the tumor and may be worse at night and at rest. A bone tumor might present with an unexplained broken bone; with little or no trauma. Additional symptoms may include fatigue, fever, weight loss, anemia and nausea. If the tumor presses a nerve, neurological features may be present. Sometimes there are no symptoms and the tumour is found when investigating another problem.
Bone tumors can be noncancerous (benign) or cancerous (malignant). Cancerous bone tumors are commonly secondary; that is they originate from a cancer in another part of the body. Less common are cancers that originate in the bone itself; that is primary tumors.
Noncancerous (benign) bone tumors can be abnormal growths of bone, cartilage, fibrous tissue and blood vessels. The most common is osteochondroma. Others include chondroblastoma, osteoid osteoma, enchondroma, giant cell tumor of bone, unicameral bone cyst, fibroma, eosinophilic granuloma haemangioma, osteoblastoma and aneurysmal bone cyst.
Common benign bone tumors may be neoplastic, developmental, traumatic, infectious, or inflammatory in etiology. Some benign tumors are not true neoplasms, but rather, represent hamartomas, namely the osteochondroma.
The most common site for most noncancerous and cancerous primary tumors is in the long bones of the leg, near the knee.
Cancerous bone tumors are more likely to be due to spread from cancers of other organs. These include cancers of the breast, thyroid, kidney, lung and prostate. Rarely, primary bone cancers such as osteosarcoma may also spread to other bones.
A bone tumor may be felt on examination, following which a plain X-ray is usually carried out. Blood tests might include a complete blood count, inflammatory markers, serum electrophoresis, PSA, kidney function and liver function. Urine may be sent for Bence Jones protein. Other tests that might be requested include a CT scan, MRI, PET scan and bone scintigraphy. For confirmation of diagnosis, a biopsy for histological evaluation might be required, using either a needle or by incision (open biopsy).
Treatment of bone tumors is dependent on the type of tumor. Where available, people with bone tumors are treated at a specialist centre which have surgeons, radiologists, pathologists, oncologists and other support staff. Generally, noncancerous bone tumors may be observed for changes and surgery offered if there is pain or pressure effects on neighbouring body parts. A surgical resection with or without cytotoxic drugs may be considered.
Chemotherapy and radiotherapy
Different regimes of multi-agent adjunct chemotherapy exist and has shown improved survivals with osteosarcoma. Several cycles of neo-adjuvunct chemotherapy may be required to shrink a tumor, such as a Ewing's tumor, prior to surgery. In cases of cancer spread to bone from elsewhere, a broken bone or where surgery is limited due to the margin of the tumor, radiotherapy may help in some types of bone tumor. Although radiotherapy may reduce the extent of surgery, it may cause a greater chance of wound complications.
One of the major concerns is bone density and bone loss. Non-hormonal bisphosphonates increase bone strength and are available as once-a-week prescription pills. 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. Generic Strontium Chloride Sr-89 Injection UPS, manufactured by Bio-Nucleonics Inc., it is the generic version of Metastron.
Treatment for some bone cancers may involve surgery, such as limb amputation, or limb sparing surgery (often in combination with chemotherapy and radiation therapy). Limb sparing surgery, or limb salvage surgery, means the limb is spared from amputation. 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. In upper leg surgeries, limb salvage prostheses are available.
The other surgery is called Van Nes rotation or rotationplasty which is a form of amputation, in which the person's foot is turned upwards in a 180-degree turn and the upturned foot is used as a knee.
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). This operation is done in two stages. First stage is doing the colostomy and the urinary conduit, the second stage is the amputation. 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)
CT guided radiofrequency ablation is a less invasive alternative to surgical removal in the care of benign bone tumors, most notably osteoid osteomas. In this technique, which can be performed under precedural 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. 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. 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.
Thermal ablation techniques are also increasingly being used in the palliative treatment of painful metastatic bone disease. Currently, external beam radiation therapy is the standard of care for patients with localized bone pain due to metastatic disease. 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. 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. 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. 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. 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.
The outlook depends on the type of tumor. The outcome is expected to be good for people with noncancerous (benign) tumors, although some types of benign tumors may eventually become cancerous (malignant). 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.
Secondary bone cancers are estimated to be 50 to 100 times as common as primary bone cancers.
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.
- Maruthainar, Nimalan; Bhumbra, Rej; Cannon, Steve (2018). "7. Orthopaedic oncology". In Ramachandran, Manoj (ed.). Basic Orthopaedic Sciences (2nd ed.). CRC Press. pp. 105–121. ISBN 978-1-4441-2098-1.
- "Bone Tumor - Types and Treatments - OrthoInfo - AAOS". www.orthoinfo.org. Archived from the original on 20 April 2021. Retrieved 20 April 2021.
- "SEER Stat Fact Sheets: Bone and Joint Cancer". NCI. Archived from the original on 20 April 2021. Retrieved 20 April 2021. CS1 maint: discouraged parameter (link)
- "Questions and Answers about Bone Cancer" (PDF). Centers for Disease Control and Prevention. Retrieved 18 April 2012. CS1 maint: discouraged parameter (link)
- "Bone tumours. What are Bone Tumours?. Patient". patient.info. Archived from the original on 24 April 2021. Retrieved 24 April 2021.
- "Osteochondroma". www.hopkinsmedicine.org. Archived from the original on 27 April 2021. Retrieved 27 April 2021.
- Costelloe, Colleen M.; Madewell, John E. (2013). "Radiography in the Initial Diagnosis of Primary Bone Tumors". American Journal of Roentgenology. 200 (1): 3–7. doi:10.2214/AJR.12.8488. ISSN 0361-803X.
- "FDA ANDA Generic Drug Approvals". Food and Drug Administration.
- Rosenthal, D I; Alexander, A; Rosenberg, A E; Springfield, D (1992-04-01). "Ablation of osteoid osteomas with a percutaneously placed electrode: a new procedure". Radiology. 183 (1): 29–33. doi:10.1148/radiology.183.1.1549690. ISSN 0033-8419. PMID 1549690.
- Rimondi, Eugenio; Mavrogenis, Andreas F.; Rossi, Giuseppe; Ciminari, Rosanna; Malaguti, Cristina; Tranfaglia, Cristina; Vanel, Daniel; Ruggieri, Pietro (2011-08-14). "Radiofrequency ablation for non-spinal osteoid osteomas in 557 patients". European Radiology. 22 (1): 181–188. doi:10.1007/s00330-011-2240-1. ISSN 0938-7994. PMID 21842430.
- Rosenthal, Daniel I.; Hornicek, Francis J.; Torriani, Martin; Gebhardt, Mark C.; Mankin, Henry J. (2003-10-01). "Osteoid Osteoma: Percutaneous Treatment with Radiofrequency Energy". Radiology. 229 (1): 171–175. doi:10.1148/radiol.2291021053. ISSN 0033-8419. PMID 12944597.
- Weber, Marc-André; Sprengel, Simon David; Omlor, Georg W.; Lehner, Burkhard; Wiedenhöfer, Bernd; Kauczor, Hans-Ulrich; Rehnitz, Christoph (2015-04-25). "Clinical long-term outcome, technical success, and cost analysis of radiofrequency ablation for the treatment of osteoblastomas and spinal osteoid osteomas in comparison to open surgical resection". Skeletal Radiology. 44 (7): 981–993. doi:10.1007/s00256-015-2139-z. ISSN 0364-2348. PMID 25910709.
- Rosenthal, Daniel I.; Hornicek, Francis J.; Wolfe, Michael W.; Jennings, L. Candace; Gebhardt, Mark C.; Mankin, Henry J. (1998-06-01). "Percutaneous Radiofrequency Coagulation of Osteoid Osteoma Compared with Operative Treatment*". J Bone Joint Surg Am. 80 (6): 815–21. CiteSeerX 10.1.1.1018.5024. doi:10.2106/00004623-199806000-00005. ISSN 0021-9355. PMID 9655099. Archived from the original on 2016-10-06. Retrieved 2016-08-07.
- Tong, Daphne; Gillick, Laurence; Hendrickson, Frank R. (1982-09-01). "The palliation of symptomatic osseous metastases final results of the study by the radiation therapy oncology group". doi:10.1002/1097-0142(19820901)50:5<893::aid-cncr2820500515>3.0.co;2-y. Cite journal requires
- Dupuy, Damian E.; Liu, Dawei; Hartfeil, Donna; Hanna, Lucy; Blume, Jeffrey D.; Ahrar, Kamran; Lopez, Robert; Safran, Howard; DiPetrillo, Thomas (2010-02-15). "Percutaneous radiofrequency ablation of painful osseous metastases". Cancer. 116 (4): 989–997. doi:10.1002/cncr.24837. ISSN 1097-0142. PMC 2819592. PMID 20041484.
- Goetz, Matthew P.; Callstrom, Matthew R.; Charboneau, J. William; Farrell, Michael A.; Maus, Timothy P.; Welch, Timothy J.; Wong, Gilbert Y.; Sloan, Jeff A.; Novotny, Paul J. (2004-01-15). "Percutaneous Image-Guided Radiofrequency Ablation of Painful Metastases Involving Bone: A Multicenter Study". Journal of Clinical Oncology. 22 (2): 300–306. doi:10.1200/JCO.2004.03.097. ISSN 0732-183X. PMID 14722039.
- Callstrom, Matthew R.; Dupuy, Damian E.; Solomon, Stephen B.; Beres, Robert A.; Littrup, Peter J.; Davis, Kirkland W.; Paz-Fumagalli, Ricardo; Hoffman, Cheryl; Atwell, Thomas D. (2013-03-01). "Percutaneous image-guided cryoablation of painful metastases involving bone". Cancer. 119 (5): 1033–1041. doi:10.1002/cncr.27793. ISSN 1097-0142. PMC 5757505. PMID 23065947.