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bone tumor is a collective term that refers to a group of malignant and benign formations of bone or cartilage tissue. Speaking of bone tumors, specialists most often mean primary neoplasms. They make up about 1% of all human malignant oncopathologies. Most often, bone tumors are diagnosed in the male population at a young or middle age – from 15 to 40 years. As for localization, the tubular bones of the extremities and the pelvic bones suffer mainly.
Some scientists use the phrase “bone tumor” to refer to secondary tumors, that is, those neoplasms that arose as a result of malignancy of exostoses, deforming-type chondromatosis, and other benign pathologies of bone tissue. Also, secondary bone tumors include those that arose as a result of metastasis of malignant neoplasms located in other organs.
The most commonly diagnosed tumors that affect bone tissue are osteosarcomas, chondrosarcomas, and fibrosarcomas. At a young age, patients are predominantly diagnosed with Ewing’s sarcoma. Modern science knows more than 30 types of bone tumors.
Outgrowths can be formed from bone or cartilage tissue, giant cell neoplasms and bone marrow tumors can be detected. Malignant osteoblastoma belongs to the intermediate type.
Causes of bone tumor
The causes of malignant bone tumors are still unclear.
Scientists suggest that the following factors can provoke the development of oncopathology of bone tissue:
Injuries to bones. Despite the absence of a 100% evidence base, most authors agree on the assumption that various injuries play a leading role in the development of primary neoplasms. It has been established that more than 50% of all patients with malignant bone tumors indicate that they have previously received bruises of soft tissues, limbs or joints;
Genetic predisposition. Also, the fact of hereditary predisposition to this oncopathology should not be rejected. The risk of developing the disease in blood relatives is higher if there is already a family history of bone tumors;
Paget’s Disease. Another reason that, according to scientists, can aggravate the risk of developing a malignant tumor in humans is inflammatory bone disease. In particular, we are talking about Paget’s disease. People with this diagnosis have a relatively high likelihood of developing osteosarcoma in adulthood and old age;
Metastasis of primary tumors and malignancy of benign ones. Secondary bone tumors are formed as a result of malignant degeneration of benign neoplasms, or become the result of metastasis of primary tumors from other organs.
Symptoms of a bone tumor
The main symptoms of a bone tumor are represented by the classic triad:
Pain. In the presence of a malignant neoplasm on the bone, a person develops progressive pain of a persistent nature. They tend to intensify at night. It is very difficult to stop such pain with the help of painkillers. If the sensations weaken, then very slightly. It is pain that is the earliest sign of a bone tumor, with the exception being Ewing’s sarcoma. With this pathology, a tumor first appears, and pain manifests itself somewhat later;
The presence of a tumor-like outgrowth on the affected bone. It can be felt already when the neoplasm begins to increase in size. The tumor is most often represented by a dense, painless and immobile conglomerate, prone to constant rapid growth. While benign bone tumors grow much more slowly;
Violation of the functioning of the joint located next to the tumor.
The symptoms of all malignant bone tumors should be considered separately:
Symptoms of Ewing’s sarcoma. An increase in body temperature is characteristic, which is noted by up to 50% of patients. Sometimes it rises to very impressive marks of 39 ° C. The vascular pattern on the skin becomes more pronounced, when a person tries to feel the affected area, pain occurs. The limb increases in volume. Symptoms often increase rapidly, sometimes there is a lightning-fast course of the disease, although periods of remission and exacerbation are not excluded;
Symptoms of osteogenic sarcoma. Statistics indicate that this tumor is the most common and accounts for about 60% of all malignant bone tumors. It manifests itself in progressive pain. Most often affects the long tubular bones above and below the knee joint. Characterized by an increase in the vascular pattern, a local increase in body temperature. Muscles located below the level of the pathological process are prone to atrophy. Joints that are nearby often have limited mobility. For patients with a similar neoplasm, pathological fractures are characteristic;
Symptom chondrosarcoma. Chondrosarcoma usually progresses slowly, developing over 10 years or more. The symptoms of the disease are blurred. Most often, these are pains and the appearance of a tumor-like outgrowth located on the bone. Pain tends to increase with increasing intensity. The skin over the affected area of the bone has a higher temperature, the saphenous veins are dilated. This tumor is most often diagnosed in older men;
Fibrosarcoma symptoms. With fibrosarcoma, pain intensifies at night, progresses slowly and for a long time is not so intense that a person seeks medical help. Most often, more than six months pass from the manifestation of oncopathology to the first visit to the doctor. This period for malignant neoplasms of bone tissue is quite long. As for the outgrowth itself, it often provokes a change in the contour of the joint located next to it. Fibrosarcoma is always motionless relative to the bone;
Histiocytoma symptoms. Malignant fibrous histiocytoma, which is very rare, is characterized by severe pain and the presence of a tumor-like subcutaneous neoplasm that sits tightly on the bone.
Secondary malignant neoplasms of bone or cartilage tissue are most often formed against the background of tumors of the prostate, breast and thyroid glands, as well as kidneys, lungs and uterus. They are characterized by the above triad of symptoms.
Benign bone tumors
Benign bone tumors include osteomas, osteoid osteomas, osteoblastomas, osteochondromas, and chondromas. Most often, benign tumors develop asymptomatically and do not manifest themselves for a long time. Pain, if it occurs, is characterized by low intensity (an exception is osteoblastoma).
Diagnosis of a bone tumor
Diagnosis of a bone tumor almost always begins with an X-ray examination performed in two projections. It is also possible to prescribe additional procedures, such as angiography, tomography, CT.
Bone scintigraphy is a very sensitive method, which makes it possible not only to detect the primary tumor, but also provides information on the prevalence of the oncological process.
To choose the method of treatment for patients with malignant tumors of the bone tissue, an aspiration biopsy, an open biopsy, or a trepanobiopsy are performed. This type of research is decisive in terms of diagnosis.
Bone Tumor Treatment
Treatment of a bone tumor is based on surgical intervention. If the disease was detected at an early stage of development, then preference is given to organ-preserving operations. When the size of the neoplasm is impressive, then amputation or exarticulation of the bone is indicated. Often this method is the only way to save a person’s life.
In addition to surgery, patients are usually prescribed chemotherapy and radiation therapy. When deciding on the choice of one or another method of treatment, the doctor takes into account the sensitivity of the detected type of tumor to various types of exposure. So, cartilage tumors can only be removed with the help of surgery. Ewing’s sarcoma responds well to radiation and chemotherapy, and surgery is an additional method of treatment in this case, which is not possible in every case.
Surgical interventions can be radical and preserving. The first type includes amputation and disarticulation, and the second type is resection. However, in any case, the tumor should be removed along with the musculofascial sheath, and the limb should be transected above the place where there is a damaged segment.
The action plan is drawn up depending on the type of bone tumor:
Treatment of osteogenic sarcoma. The tumor is removed promptly. If in previous years amputation was used, now more and more often they resort to organ-preserving surgery followed by chemotherapy, which is carried out before surgery. The excised bone fragment is replaced with a metal or plastic implant. The prognosis is most often favorable and the five-year survival of patients is about 70% (Read more: osteogenic sarcoma);
Treatment of chondrosarcoma. The approach to this type of tumor is predominantly complex. Chemotherapy is used in combination with a radiosurgical technique for removing the neoplasm. The prognosis after performing a radical operation is most often favorable, the use of only radiation therapy gives a temporary effect, reduces pain and prolongs the life of patients;
Treatment of Ewing’s sarcoma involves multicomponent chemotherapy followed by radiation therapy. If there is such an opportunity, then the bone itself and the soft tissues surrounding it are subject to removal. They refuse radical intervention only when there are contraindications to its implementation. Radiation therapy and chemotherapy are carried out both before and after surgery. As for the prognosis, the five-year survival does not exceed 50% (Read more: Ewing’s sarcoma).
All patients who have been treated for malignant bone tumors are registered with an oncologist. They are actively observed by the doctor during the first five years after the surgery. In subsequent years, it is mandatory to undergo an examination with x-rays performed once every 1 days.