In medical jargon, a swelling refers to the swelling of a tissue, organ or part of the body. This can be linked to inflammation, edema, a post-traumatic hematoma, an abscess or even a tumor. It is a frequent reason for consultation with the doctor. Symptoms vary depending on the nature and location of the swelling. Swelling is a clinical sign, not a symptom. The diagnosis will be evoked according to the context and will be supported by additional examinations (x-rays, ultrasounds, MRI, scanner). The treatment will also depend on the type of swelling, and especially its cause.

If the term “bone swelling” is used little, strictly speaking, in the medical world, some tumors deforming the surface of the bone may be accompanied by an identifiable swelling on palpation. Bone tumor is the development of pathological tissue inside the bone. Most bone tumors are indeed benign (non-cancerous) compared to malignant (cancerous) tumors. The second major distinction is to separate “primary” tumors, most often benign, from secondary (metastatic) always malignant.

A benign (non-cancerous) bone tumor is a lump that does not spread to other parts of the body (not metastasize). The benign tumor is usually not life threatening. Most non-cancerous bone tumors are removed by surgery or curettage, and they usually do not come back (recur).

Primary tumors start in the bone and can be benign or, much less frequently, malignant. No cause or predisposing factor explains why or how they appear. When they exist, the symptoms are most often localized pain on the supporting bone, deep and permanent which, unlike osteoarthritis, does not subside when at rest. More exceptionally, the tumor which weakens the bone tissue is revealed by a “surprising” fracture because it occurs after minimal trauma.

There are many different forms of benign tumor related to the different types of cells that make it up: non-ossifying fibroma, osteoid osteoma, giant cell tumor, osteochondroma, chondroma. They mainly affect adolescents and young adults, but also children. Their benignity is characterized by their slowness of evolution and the absence of distant diffusion. Their most common locations are near the knee, pelvis, and shoulder area.

As a general rule, with the exception of a few tumors (non-ossifying fibroma), it is suggested to remove the tumor to remove the discomfort or pain, to reduce the risk of fracture or, more rarely, to prevent it from transforming. in malignant tumor. The operation consists in performing an excision (ablation) of the affected part of the bone, in compensating the removed area and possibly strengthening the bone with metallic surgical material or osteosynthesis. The removed tumor volume can be filled with bone from the patient (autograft) or bone from another patient (allograft).

Some benign tumors have no signs or pain. It is sometimes a fortuitous radiological discovery. Sometimes it is the pain in the affected bone that requires a complete radiological examination (X-ray, CT scan, even MRI). In most cases, medical imaging makes it possible to precisely and definitively identify the type of tumor, due to its very specific radiographic appearance. In some cases where the definitive diagnosis cannot be made, only a bone biopsy will confirm the diagnosis and rule out any suspicion of a malignant tumor. The bone sample will be examined by a pathologist.

Note the particular case of osteoid osteoma, a small tumor a few millimeters in diameter, often painful, for which the operation is not performed by a surgeon but by a radiologist. The tumor is thermally destroyed by two electrodes introduced into it, under scanner control.

Primary malignant bone tumors are rare and particularly affect adolescents and young adults. The two main types of malignant bone tumor in this age group (90% of bone malignancies) are:

• osteosarcoma, the most common of the bone cancers, 100 to 150 new cases per year, predominantly male;
• Ewing’s sarcoma, a rare tumor affecting 3 in a million people per year in France.

Pain remains the main call sign. It is the repetition and the persistence of these pains, which prevent sleep or unusual, then the appearance of a swelling which leads to request examinations (X-ray, scanner, MRI) which will make suspect the diagnosis. These tumors are rare and must be treated in expert centers.

Surgery is the cornerstone of the curative treatment of sarcomas, when it is possible and the disease is not metastatic. It can be combined with radiotherapy and chemotherapy. The therapeutic choice is made in a concerted manner between specialists from different disciplines (surgery, radiotherapy, oncology, imaging, anatomopathology) and always takes into account the uniqueness of each patient.

The main tumors that can cause bone metastases (secondary tumors) are breast, kidney, prostate, thyroid and lung cancers. The treatment of these metastases aims to improve the patient’s life, by relieving pain and reducing the risk of fracture. It is decided upon and monitored by a multidisciplinary team (oncologist, surgeon, radiotherapist, etc.).