|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||Medical imaging, biopsy|
A bone tumor is an abnormal growth of tissue in bone, traditionally classified as noncancerous (benign) or cancerous (malignant). Noncancerous bone tumors include osteochondroma, osteoid osteoma and giant cell tumor of bone. Cancerous bone tumors usually originate from a cancer in another part of the body such as from lung, breast, thyroid, kidney and prostate. Less common are cancers that originate in the bone itself.
Diagnosis is generally by X-ray and other radiological tests such as CT scan, MRI, PET scan and bone scintigraphy. 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. For confirmation of diagnosis, a biopsy for histological evaluation might be required.
Treatment of bone tumors is dependent on the type of tumor. 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. Average five-year survival in the United States after being diagnosed with bone and joint cancer is 67%.
Bone tumors are traditionally classified as noncancerous (benign) or cancerous (malignant). Several features of bone tumors and soft tissue tumors overlap. Their classification was revised by the World Health Organization (WHO) in 2020. This newer classification categorises bone tumors into chondrogenic tumors, osteogenic tumors, fibrogenic tumors, vascular tumors of bone, osteoclastic giant cell-rich tumors, notochordal tumors, other mesenchymal tumors of bone, and hematopoietic neoplasms of bone.
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, eosinophilic granuloma haemangioma, osteoblastoma and aneurysmal bone cyst. Nonossifying fibromas are a type of noncancerous fibroma growth in bone.
Cancerous bone tumors are commonly secondary; that is they originate from a cancer in another part of the body. They are more likely in long bones, spine and in older people, and are generally due to spread from cancers of other organs. Cancers that spread to bone include cancers of the lung, breast, thyroid, kidney and prostate. In younger people, spread to bone is more likely from cancers involving the nervous system, kidneys and soft tissue. Rarely, primary bone cancers such as osteosarcoma may also spread to other bones.
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.
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.
Bone tumors that originate from bone are very rare and account for around 0.2% of all tumors. Average five-year survival in the United States after being diagnosed with bone and joint cancer is 67%.
Bone tumors are common in dogs.
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