Orthopedic Oncology
What is a Bone Tumor?
Skeleton System Tumors or Bone tumors are the structures that occur as a result of the uncontrolled abnormal growth of cells in the bone tissue and make the normal bone tissue weaker and more fragile. Tumors can occur in any bone in the human body and in any part of the bone.
The term “bone tumor” is a broad definition and includes many diseases whose course and treatment are very different from each other. Areas of origin from bones and joints, which tend to grow and cause destruction where they are located, are called “benign tumors”. Beyond growing and spreading where they are, those that are life-threatening with a tendency to spread to distant parts of the body are called “malignant tumors (bone cancer / bone sarcoma)”. Those that spread from other organs in the body (internal organs, blood elements, skin, etc.) to bones and joints are called “Metastatic tumors”. Apart from these, there are other bone disorders that are not actually tumors but cause tumor-like destruction of bones and joints.
Benign tumors aren’t cancerous. Treatment is decided according to the type of tumor and follow-up is usually recommended.
Malignant tumors are cancerous. Bone cancers are divided into primary and secondary bone cancers. Primary bone cancers are cancer types that originate from the bone itself. A secondary bone cancer (also called metastatic bone disease) begins somewhere else in the body and then metastasizes or spreads to bone. Chemotherapy, radiation or both may be recommended for the treatment of malignant tumors (Bone Cancers). Some bone cancers may also require surgery.
What are the Symptoms of Bone Tumor?
A common symptom of bone tumor is pain that increases with activity and may worsen at night. This pain is felt at the tumor site and is often described as dull and aching. Pain from bone tumors can sometimes be mistaken for arthritis or growing pains.
Bone cancer may present with a noticeable lump over a bone, fever (38C (100.4F) or above), excessive sweating (especially at night), and unexplained weight loss, in addition to pain.
Benign tumors do not cause any symptoms in some people. Luckily, a tumor may be detected as a result of medical tests performed for another reason. Sometimes, a minor injury can break bone that has been weakened by an undiscovered bone tumor. This is called a pathological fracture, so the tumor can be detected for the first time.
Fractures, infections, and other conditions can resemble tumors. Various tests may be ordered to detect a bone tumor.
What are the Types of Malignant Bone Tumors?
Tumors that originate from bone tissue and tend to grow in situ and spread to distant parts of the body are called bone cancers. If bone cancers actually begin in bone, it is classified as primary bone cancer, and if it occurs due to metastasis from another cancerous tissue in the body, it is classified as secondary bone cancer.
Primary bone cancer accounts for less than 1 percent of all types of cancer and most often develops in the long bones of the legs or upper arms.
Treatment of malignant tumors includes a combination of chemotherapy, radiation and surgery, depending on the type and stage of the cancer.
The most common forms of primary bone cancers are Osteosarcoma, Ewing sarcoma, Chondrosarcoma and Multiple Myeloma.
Osteosarcoma
Osteosarcoma is the most common primary bone cancer. It is mostly seen in young people and children under the age of 20. The cause is not known. In some cases, osteosarcoma runs in families. Most tumors develop around the knee in the femur (thigh bone) or tibia (shin bone). It can also be detected on the hips and shoulders.
Ewing’s Sarcoma
Ewing sarcoma usually occurs in patients aged 5 to 20 years. The most common places affected are the upper and lower legs, pelvis, upper arm and ribs. Ewing’s Sarcoma often metastasizes.
Chondrosarcoma
Chondrosarcoma occurs in middle-aged people. It usually develops in the shoulders and pelvis. Depending on the location and stage of the chondrosarcoma, which treatment will be applied is decided.
Multiple Myeloma
Multiple myeloma is a bone marrow-derived cancer that often presents as one or more bone lesions and most commonly affects older adults.
What are the Types of Benign Bone Tumors?
Benign tumors are more common than malignant ones. Benign tumors are not cancerous but are still abnormal cells and may require treatment. Benign tumors can grow and compress healthy bone tissue and cause problems with bone structure in the future.
Osteochondromas
The most common type of benign bone tumor is an osteochondroma and develops in adolescents and teenagers. These tumors are made of bone and cartilage and form near the actively growing ends of long bones, such as the bones of the arm or leg. Specifically, these tumors tend to affect the lower end of the thighbone, the upper end of the lower leg bone, and the upper end of the upper arm bone. Osteochondromas have been considered a growth abnormality. Osteochondromas can develop as a single tumor or as many tumors.
Enchondroma
An enchondroma is a cyst detected in the bone marrow. They begin in childhood and continue into adulthood. Enchondromas occur in the hands and feet, long bones of the arm and thigh.
Osteoid Osteoma
An osteoid osteoma is a bone tumor that usually develops in the long bones of the body, such as the thighbone and shinbone. Osteoid osteomas can cause pain and discomfort. Osteoid osteomas can affect people of all ages, but are more common in children and young adults.
Chondroblastoma
Chondroblastoma is a rare benign tumor of the joints of the body’s long bones. Most often, tumors develop at the ends of the thighbone, shinbone, or upper arm bone. If left untreated, chondroblastomas can enlarge and destroy the surrounding bone, making it painful to move the nearby joint.
Nonossifying fibroma
It is a simple bone cyst. It is usually found in the leg and is most common in children and adolescents. It is often discovered incidentally when a patient needs an X-ray for another reason. They do not become cancerous and they do not spread to other parts of the body. In most cases, no treatment is necessary. It typically goes away on its own when a child is fully grown.
Giant Cell Tumors
A giant cell bone tumor grows at the ends of the body’s long bones. They most often occur near the knee joint, at the lower end of the thighbone or at the upper end of the shinbone. Giant cell tumors are very rare and are usually detected in young adults. Although giant cell tumors are not cancerous, they are aggressive and can destroy surrounding bone. The treatment for a giant cell tumor is to surgically remove the tumor.
Fibrous Dysplasia
Fibrous dysplasia is the development of abnormal fibrous tissue instead of normal bone. This fibrous tissue weakens the bone and can cause it to break or deform. Some patients with fibrous dysplasia show no symptoms at all. More than one bone may be affected. In these patients, it may be necessary to surgically remove the affected areas of bone.
Aneurysmal Bone Cyst
It is an abnormality of blood vessels that begins in the bone marrow. If they grow quickly, they can be devastating.
How is a bone tumor diagnosed?
The doctor listens to the patient’s complaints and asks a number of questions to learn about their health history. Performs a physical examination of the area causing the complaint. Evaluates swelling, pain, tenderness and movement restrictions in this area and makes necessary tests.
Routine blood tests help determine whether existing symptoms are due to non-cancerous causes. Alkaline Phosphatase (ALP) is a marker of bone activation. For patients who have completed bone development, it may indicate an abnormality in bone structure.
In case of suspicion of bone cancer, imaging methods are also used. X-Ray can detect abnormal structure in bone tissue. Magnetic resonance imaging (MRI) scan or computerized tomography (CT) scan may be requested for more detailed examinations.
In order to definitively assess whether the abnormal structure detected in the bone is cancer or not, a biopsy should be taken from this structure and evaluated with a microscope by a pathologist. The cell structure in the sample is examined and the presence of abnormal cells is evaluated. Depending on the existence of the cells that have changed and how they change, the diagnosis of cancer are revealed.
What Are the Stages of a Bone Tumor?
In addition to diagnosing bone cancer, the first thing to do after this diagnosis is to determine the stage of the cancer. Staging is a term for the spread of cancer throughout the body. Whether it has spread and how far it has spread is important for staging. Staging helps determine how serious the cancer is and how best to treat it.
Staging is a very complex process and is done by evaluating many conditions, such as the spread of cancer, involvement of lymph nodes, and metastasis. Basically, we can talk about 3 phases.
Stage I – Cases where low-risk cancer foci are found in the bone. Lymph nodes are clean and there are no metastases.
Stage II – Conditions where there are high-risk cancer foci in the bone.
Stage III – Conditions where the cancer has spread to other tissues.
What are the Causes of Bone Tumors?
The causes of bone tumors are not fully known. Genetic predisposition, radiation exposure and bone injuries are held responsible for bone tumors.
Rare genetic conditions such as Li-Fraumeni syndrome have been shown to cause cancer. Exposure to high doses of radiation in people who have previously received radiotherapy can cause cancerous changes in bone cells. In particular, a condition called Paget’s disease of the bone has been predicted to increase the risk of bone cancer in people between the ages of 50 and 60.
Specific reasons for some types of bone cancer have been suggested. For example, Osteosarcoma has been associated with radiation therapy (especially high-dose radiation) and other anticancer drugs, especially in children. However, no direct cause has been identified. People who had a rare type of eye cancer called retinoblastoma as a child may be more likely to develop bone cancer, because the same inherited faulty gene can be responsible for both conditions. It has also been found that people with bone fractures repaired with metal implants are also more likely to develop osteosarcoma later on.
How are Bone Tumors Treated?
Benign Tumor Treatment
In most benign bone tumors, the tumor is checked at regular intervals to determine whether it is growing or not. If it is painful, medical drugs may be recommended. Some benign bone tumors may require surgical removal in case there is a weakness in the bone. Except for this possibility, surgery is not prescribed for benign bone tumors. Follow up is enough.
Malignant Tumor Treatment
In cases where malignant bone cancers are detected, treatment should be performed by a team of doctors experienced in cancer treatment in different specialties.
The goal of treatment is to cure the cancer while maintaining the best possible function in the part of the body affected by the tumor. Treatment depends on several factors, including the stage of the cancer.
In some bone cancers, chemotherapy or radiotherapy or both can be used noninvasively. In some patients, the cancerous tissue may need to be surgically removed. During these surgeries, organs such as arms or legs can be partially or completely removed or limb salvage surgery can be applied.
Recovery from Bone Tumor Treatment
Recovery time varies depending on the type of tumor and what type of treatment is used. After the treatment, the patient is kept under follow-up for a while to confirm that the tumor is completely gone. In the meantime, X-Ray, CT or MRI may be requested at certain intervals for the presence of tumor.
It is important that regular follow-ups are not interrupted so that there will always be a possibility of recurrence and these recurrences can be diagnosed early and intervened immediately. Returning tumors can cause serious problems, so early detection is important.
