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Bone tumor
Classification and external resources

Micrograph of an osteosarcoma, a malignant primary bone tumor.
ICD-10 C40.-C41.
MeSH D001859
X-ray of a giant cell bone tumor in the head of the 4th metacarpal of the left hand.
An arm bone tumor

A bone tumor refers to a neoplastic growth of tissue in bone. It can be used for both benign and malignant abnormal growths found in bone, but is most commonly used for primary tumors of bone, such as osteosarcoma. It is may be applied to secondary bone tumors, i.e. metastatic tumors found in bone.

Contents

Classification

Bone tumors may be classified as "primary tumors" which originate in the bone, and "secondary tumors" which originate elsewhere.

Primary tumors

Primary tumors of bone can be divided into benign tumors and cancers. Common benign bone tumors may be neoplastic, developmental, traumatic, infectious, or inflammatory in etiology. Examples of benign bone tumors include osteoma, osteochondroma, aneurysmal bone cyst, and fibrous dysplasia of bone.

Malignant primary bone tumors include osteosarcoma, chondrosarcoma, Ewing's sarcoma, malignant fibrous histiocytoma, fibrosarcoma, and other sarcoma types. Multiple myeloma is a hematologic cancer which also frequently presents as one or more bone tumors.

The tailbone is a common location for a teratoma, known as a sacrococcygeal teratoma, and related germ cell tumors.

Secondary tumors

Secondary bone tumors include metastatic tumors which have spread from other organs, such as the breast, lung, and prostate. Metastatic tumors more frequently involve the axial skeleton than the appendicular skeleton. Tumors which originate in the soft tissues may also secondarily involve bones through direct invasion.

Symptoms

The most common symptom of bone tumors is pain, but many patients will not experience any symptoms, except for a painless mass. Some bone tumors may weaken the structure of the bone, causing pathologic fractures.

Treatment

Treatment of bone tumors is highly dependent on the type of tumor.

Chemotheraphy and radiotheraphy

Chemotherapy and radiotherapy are effective in some tumors (such as Ewing's sarcoma) but less so in others (such as chondrosarcoma).[1]

Medication

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.

Surgical treatment

Main articles

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 is done in two ways (a) bone graft, in which a bone from elsewhere from the body is taken or (b) artificial bone is put in. In upper leg surgeries, limb salvage prostheses are available.

The other surgery is called van-ness rotation or rotationplasty which is a form of amputation, in which the patient's foot is turned upwards in a 180 degree turn and the upturned foot is used as a knee.

Types of amputation:

Leg
  • Below knee
  • Above knee
  • Symes
  • Hip disarticulation
  • Hemipelvectomy or hindquarter, in which the whole leg is removed with one half of the pelvis
Arm
  • Below elbow
  • Above elbow
  • Shoulder disarticulation
  • Forequarter (amputation of the whole arm, along with the shoulder blade and the clavicle)

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 doesn't work or in cases of advanced pelvic/reproductive cancers)

Amputation is not always needed. In some cases, the tumor can be removed without removing the limb.

References

External links

  • UMDNJ Introduces trainees in Pathology to the basic concepts in diagnosis of bone tumors
  • Information for patients and doctors about the symptoms, diagnosis, and treatment of most bone tumors
  • Bone cancer information at Cancer.net







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