BONE TUMORS

Bone tumors develop when bone cells divide uncontrollably, forming a lump or abnormal mass of tissue. Bone tumors can be benign, malignant, or metastatic. The cause of bone tumors is unknown. Genetic factors and external environmental factors are assumed to play a role.

Tumors vary depending on the cells in which they occur:

• tumors originating from bone tissue (osteogenic tumors) – osteoma, osteoid osteoma, osteosarcoma
• tumors originating from cartilage tissue (chondrogenic tumors) – chondroma, chondroblastoma, chondrosarcoma
• tumors originating from connective tissue – fibroma, fibrosarcoma, and others.

Bone tumors can affect any bone in the body and can develop in any part of the bone – from the surface to the center of the bone, called the bone marrow. A growing bone tumor – even a benign one – destroys healthy tissue and weakens the bones, making them more vulnerable to fractures.

When a bone tumor is cancerous, it is classified as primary bone cancer or secondary bone cancer. Primary bone cancer actually starts in the bones, whereas secondary bone cancer starts elsewhere in the body and then metastasizes or spreads to the bones. Secondary bone cancer is also called metastatic bone disease.

Types of cancer that start elsewhere and commonly spread to the bones include:

• Breast cancer;
• Lung cancer;
• Thyroid cancer;
• Kidney cancer;
• Prostate cancer;

TYPES OF BONE CANCER

Osteoma

Osteoma is a benign bone tumor that appears in childhood and has a very slow growth. It mainly affects flat skull bones (Figure 1). You can feel it as a solid oval elevation of a small bone. In most cases, osteoma causes no complaints and does not require treatment. However, osteoma under the thumbnail causes pain and nail deformity, and surgical treatment is performed.

Figure 1

 

Chondroma (enchondroma)

Enchondroma is one of the most common benign bone tumors. It is composed of immature cartilage cells. Most often, the short tubular bones of the hands are affected (Figure 2), but it can also affect other bones such as the femur, humerus, or tibia. This occurs at any age. Symptoms are absent for a long time. Gradually, a spindle-shaped swelling forms in older individuals, and pathological fractures may also occur. Surgical treatment of enchondromas is performed.

 

Figure 2

Osteoid Osteoma

Osteoid osteoma is a benign bone tumor that most commonly affects the femur (Figure 3) and tibial bone. Usually, young people between the ages of 20 and 30 are affected. A characteristic sign of the disease is the onset of pain that intensifies at night. The pain is relieved by painkillers.

Figure 3

Movements in adjacent joints are limited. The treatment of osteoid osteoma is surgical.

 

Osteosarcoma

Osteosarcoma is the most common malignant tumor of the bones. It usually occurs between the ages of 10 and 25. Osteosarcoma (Figure 4) is most commonly localized in the femur, humerus, and tibia. Symptoms in osteosarcoma depend on its localization. The characteristic presentation is pain and swelling. The skin over the tumor is stretched and warm to the touch; if the lower limb is affected, limping may occur.

Figure 4

Chondrosarcoma

Chondrosarcoma can be primary (first appearing in the bone) or secondary (developing from a pre-existing cartilage tumor, such as an enchondroma). Primary chondrosarcoma grows rapidly, while secondary chondrosarcoma develops slowly and appears after the age of 35. Most often, chondrosarcoma is localized in the lower part of the femur (Figure 5) and the upper part of the humerus. The first symptom of chondrosarcoma is pain that intensifies at night. The tumor extends beyond the bone, and a painful mass becomes visible. Treatment is surgical.

Figure 5

Ewing’s Sarcoma

Ewing’s sarcoma arises from the base tissue of the bone marrow. It is more common in male children and adolescents. Most often, the long bones of the arms and legs, ribs, and pelvis are affected (Figure 6).

The clinical presentation of Ewing’s sarcoma resembles osteomyelitis. There is fever, pain, and swelling in the affected area, and the skin is red and edematous.

Combined treatment with chemotherapy, radiation, and surgical treatment is performed.

 

Figure 6

Multiple Myeloma

Multiple myeloma is the most common primary bone cancer. It is a malignant tumor of the bone marrow – a soft tissue in the center of many bones that produces blood cells. Any bone can be affected by this cancer (Figure 7). Multiple myeloma affects about six out of every 100,000 people each year. According to the National Cancer Institute, approximately 90,000 people are diagnosed with this disease each year. Most cases are observed in patients between 50 and 70 years of age. Multiple myeloma is usually treated with chemotherapy, radiation therapy, and sometimes surgical intervention.

Figure 7

Metastatic Bone Tumors

Bone metastases are the most common malignant tumors of the bones. Many tumors that develop in other organs metastasize to the bone through the blood, lymphatic pathways, or by direct infiltration from adjacent areas. Usually, the first sign of bone metastases is the occurrence of a pathological fracture.

The tumors that metastasize to bones most frequently are: breast cancer, prostate cancer, lung carcinoma, renal hypernephroma, and thyroid cancer.

Bone cancer is a rare disease. It can start its development from any bone in the human body. Most often, the long bones of the arms and legs are affected. There are several types of bone cancer. Some types are characteristic only for children, while others are found only in adults.

The term bone cancer also refers to a cancer process that starts its development in another part of the body and spreads to the bones. Then, we speak of a metastatic process.

The exact cause of bone cancer has not yet been explained. Scientists believe that these types of cancer are caused by errors in cell DNA. This error causes uncontrolled and abnormal cell growth. These cells live longer than normal cells and form a tumor mass.

 

BENIGN BONE TUMORS

 

In addition to benign bone tumors, there are also some diseases and conditions that resemble bone tumors. Although these conditions are not true bone tumors, in most cases, they require the same treatment.

Some common types of benign bone tumors and conditions often grouped with tumors include:

• Aseptic fibroma;
• Bone cyst;
• Osteochondroma;
• Giant cell tumor;
• Fibrous dysplasia;
• Chondroma;
• Aneurysmal bone cyst;
• Osteoid osteoma

 

SYMPTOMS

Bone Pain

Most often, patients complain of significant pain in the affected bones, which causes restriction of their movements. In the early stages of the disease, the pain is mild and occurs only under heavier loads, especially affecting running activities. In some cases, frequent bone pain can cause sleep problems and make correct diagnosis difficult. Although bone pain is a characteristic symptom of bone cancer, some patients do not experience bone pain for years after the onset of the disease.

Edema / Swelling

Another characteristic sign of bone cancer is swelling caused by the cancer process. This symptom is not always accompanied by bone pain. In some cases, it takes several weeks and months for swelling to form at the tumor site, which can then be seen by patients.

 

Palpation of the Tumor Mass

Like other cancer processes, a growing bone tumor can be palpated. Usually, the tumor is the size of a pea. In the area where the tumor mass is palpated, patients complain of pain and limitation of the range of motion.

 

More Frequent Bone Fractures

As the cancer progresses, deformation of the affected bone occurs, making it more susceptible to fractures. In such patients, even the mildest impacts can cause a bone fracture, which subsequently heals more slowly.

In addition, in the later stages of the disease, cancer cells begin to release calcium salts, which can be detected in the bloodstream by blood tests. Increased calcium levels in the blood can cause vomiting, fatigue, and abdominal pain.

Some non-specific symptoms such as unwanted weight loss, nausea, chills, mild fatigue, and anemia may indicate a diagnosis of bone cancer.

DIAGNOSIS

Infections, stress fractures, and other abnormal conditions can resemble tumors. To ensure you have a bone tumor, our professor will perform a comprehensive evaluation and order several tests.

Medical History

As part of the evaluation, the Professor will take a complete medical history. He will ask you about your general health, medications you take, current symptoms, and any family history of tumors or cancer.

Physical Examination

The Professor will perform a comprehensive physical examination, focusing on the tumor mass, and check for:

• Swelling or tumor tenderness;
• Skin changes;
• Any impact on nearby joints, which may include swelling;

X-ray

X-rays provide images of dense structures like bone. In most cases, an X-ray is performed to diagnose a bone tumor. Different types of tumors can look different on X-rays. Some dissolve the bone or create a hole in the bone. Others cause additional bone formation. Some can do both.

BONE BIOPSY

A bone biopsy is a diagnostic procedure in which a tissue sample is taken from the bone and examined under a microscope for the presence of pathological changes. A needle biopsy or surgical (open) biopsy is performed. It differs from a bone marrow biopsy, which investigates and diagnoses diseases affecting the outer layers of the bone and the bone marrow.

A biopsy can usually be performed on any bone in the body after detecting deviations in X-ray examinations or scans. This helps in making an accurate diagnosis and preparing a treatment plan.

Indications for Biopsy:

• To clarify the pathogen of an infection;
• To confirm or rule out benign or malignant bone formations (cysts, bone cancer);
• Diagnosis of a number of bone diseases (Paget’s disease and others);

Investigation is recommended in the following cases:

• In the presence of unexplained long-term sensitivity or pain in one or more bones.
• When deviations from the normal bone image are detected on X-ray or scans.

CONTRAINDICATIONS: A bone biopsy carries a risk of complications and is not recommended in the following cases:

* When it is impossible for the patient to remain motionless for a long time.

* In immunodeficient conditions, where the risk of infection is increased.

* In cases of bleeding disorders or intake of medications affecting hemostasis (aspirin, anticoagulants) due to the risk of bleeding.

Method: Depending on the type of bone biopsy, it is performed under local anesthesia (for needle biopsy) or general anesthesia (for surgical biopsy).

Before the procedure, an IV line is placed in the arm (using an angiocath/IV cannula) to allow the administration of necessary medications.

Closed (Needle) Biopsy

• The patient lies on their back;
• The puncture site is treated with an antiseptic;
• A small incision is made in the skin through which a hollow needle is inserted;
• The needle is slowly advanced into the bone until it reaches the bone lesion. Usually, video control (fluoroscopy) is used to guide the needle position;
• Through the lumen of the first hollow needle, a second smaller needle is inserted to obtain a small piece of bone;
• The procedure ends after stopping the bleeding and applying a sterile bandage;

Open (Surgical) Biopsy

• Performed under spinal or general anesthesia.
• Used when a larger tissue sample is needed from the pathologically altered area.
• Sutures and a sterile bandage are applied after the procedure. Sutures are removed 2 weeks after the biopsy.

Bone Biopsy Results:

Healthy – normal bone structure

• Made of compact, mineral deposits called lamellae, which are very strong and dense.
• Spongy bone, which has a porous structure, has lower mineralization and contains the central bone marrow.

Benign bone formations include:

• Cysts
• Fibroma
• Osteoblastoma
• Osteoid osteoma

Malignant bone tumors can be:

• Ewing’s Sarcoma
• Multiple myeloma
• Osteosarcoma / Chondrosarcoma

Pathological findings may also include:

• Infections such as histoplasmosis, tuberculosis
• Osteomyelitis
• Osteomalacia
• Osteitis fibrosa.

Complications:

• Dull pain and discomfort of a temporary nature after the investigation
• Infection (osteomyelitis) if sterility is compromised
• Bleeding
• Allergic reaction to anesthesia.

TREATMENT

* Non-Surgical Treatment

Benign Tumors

If your tumor is benign, the Professor may recommend careful monitoring to see if it changes. During this period, periodic monitoring with X-rays or other diagnostic tests may be necessary.

Some benign tumors can be treated effectively with medications. Some disappear over time. This is especially true for some benign tumors seen in children, such as osteoid osteoma.

Malignant Tumors

If you have bone cancer, treatment involves a team of doctors from various medical specialties working together to provide care. Some will be oncologists specializing in cancer treatment. Your team may include an orthopedic surgeon, medical oncologist, radiation oncologist, radiologist, and pathologist. The goal of treatment is to cure the cancer and preserve function in the affected body part as much as possible.

Treatment depends on several factors, including the stage of the cancer. If the cancer is localized, the cancer cells are limited to the tumor and its immediate surroundings. When cancer reaches a metastatic stage, it spreads to other parts of the body and can be more serious and difficult to treat.

The Professor usually combines several treatments for malignant bone tumors:

* Radiation therapy. Radiation therapy uses high doses of X-rays to kill cancer cells and shrink tumors. This treats cancer only in the radiation area. It does not treat cancer elsewhere in the body.

* Chemotherapy (systemic treatment). Chemotherapy is usually used to destroy tumor cells when they have spread into the bloodstream, even if they cannot be detected during tests and scans. It is generally used when cancer tumors have a high risk of spreading. Chemotherapy is usually administered intravenously (injection into a vein) or taken orally as a tablet or capsule.

As a rule, malignant tumors are removed surgically. Usually, radiation therapy and chemotherapy are used in combination with surgery.

Surgical Treatment

 

Benign Tumors

In some cases, the Professor may recommend removal of the tumor (excision) or other surgical techniques to reduce the risk of fracture and damage. Some tumors may recur after appropriate treatment. Rarely, some benign tumors can spread or become cancerous (malignant).

Malignant Tumors

Limb-sparing surgery. This procedure removes the bone cancer while keeping nearby muscles, tendons, nerves, and blood vessels intact as much as possible. The surgeon removes the tumor and a surrounding margin of healthy tissue. The removed bone is replaced with a metal implant (prosthesis), bone from another part of your body, or donor bone.

Amputation. Amputation is a procedure to remove all or part of an arm or leg. It is usually used when the tumor is large and/or involves nerves and blood vessels. A prosthetic limb can help you function after amputation.

 

RECOVERY PERIOD

The duration and complexity of your recovery will depend on the type of tumor and the type of procedure performed.

When treatment is complete, the Professor will order further X-rays and other imaging studies to confirm that the tumor is indeed gone.

After treatment, you will continue to visit us for regular check-ups and follow-up examinations every few months. Although the tumor is gone, it is important to monitor your body for signs of recurrence. Recurring tumors can cause serious problems, so it is important to find them early.