Are bone tumors a dead end? Is there a way out of it? For many patients, the question is very acute: is the bone tumor curable?
People who ask this question experience fear, perceiving the diagnosis as a death sentence. Despite the fact that bone rarely undergoes tumor transformation, if this happens, for each patient this has already happened and statistics do not matter for him.
Modern bone oncology, with timely diagnosis, allows in almost all cases to completely get rid of this problem. Therefore, it is most important to contact a qualified specialist who is familiar with this issue.
It must be said right away that there are much more benign neoplasms found in the human musculoskeletal system that do not threaten his life, and their treatment, as a rule, is not associated with serious complications and can be resolved through safe surgical intervention.
It should be added that the concept of “bone tumor” includes all oncological pathologies of the musculoskeletal system, including joints, ligaments, muscles, bone marrow and other structures.
1.Bone tumors and benign bone tumors
A bone tumor develops when bone cells begin to divide uncontrollably, forming a mass of tissue. Most bone tumors are benign
those.
This is not cancer and the tumor is not spreading. However, even benign tumors can weaken bones and lead to fractures and other problems. Bone cancer
is even more dangerous - it destroys normal bone tissue and can metastasize, i.e. spread to other parts of the body.
Benign bone tumors
Benign bone tumors are more common than malignant bone tumors. Here are some of the most common types of benign bone tumors:
- Osteochondroma
is the most common bone tumor found, usually in people under the age of 20. - A giant cell tumor
is a benign tumor that usually affects the bones of the legs. The malignant type of this tumor is rare. - Osteoid osteoma
is a tumor that most often begins in the long bones of the skeleton, usually in young people around the age of 20. - Osteoblastoma
is a tumor located in the spine and long bones, mainly in young people. - Cartilaginous tumors
usually appear in the bones of the arms and legs. Often this type of tumor does not produce any characteristic symptoms.
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Treatment of bone tumors
The principle of treatment comes down to radical and ablastic (i.e., within healthy tissues) removal of the tumor and surgical orthopedic correction of the altered bone segment or other structure with the maximum possible functional safety. The main principle of surgical treatment is maximum organ preservation. In the complex of treatment, rehabilitation in the postoperative period is an obligatory element.
Malignant bone tumors require a comprehensive selective approach depending on the nosological affiliation and may include not only surgical intervention, but also chemotherapy and radiation treatment carried out according to special schemes and protocols.
At the SM-Clinic, diagnostics and treatment of all types of benign bone tumors are carried out at the modern level.
2.Metastatic cancer and primary bone sarcoma
Metastatic cancer
If a person has bone cancer, it is due to metastasis of cancer cells from other parts of the body. But even if a person is diagnosed with bone cancer, this disease is not defined as independent, because the area of primary localization of the cancer was different. For example, a person with lung cancer that has metastasized to the bones is diagnosed with lung cancer with metastases to the bones, rather than being diagnosed with lung cancer and bone cancer separately.
There are three main types of cancer that can usually spread to the bone:
- Mammary cancer;
- Prostate cancer;
- Lungs' cancer.
Primary bone sarcoma
Primary bone sarcoma is a tumor that originally formed in the bones. This disease is less common than metastatic cancer. The causes of bone sarcoma are not exactly known, but in this case, a hereditary factor may play a large role. High doses of radiation therapy or anti-cancer drugs may increase the risk of developing this type of cancer. Here are some of the most common types of bone cancer:
- Osteosarcoma
begins in bone cells and is most often located around the knee or shoulder. Most cases are diagnosed during adolescence or young adulthood. In adults, osteosarcoma usually occurs in patients who have previously had a bone disease known as Paget's disease. - Ewing's sarcoma
is also more common in people between 50 and 20 years of age. The affected areas are most often the ribs, pelvic bones, legs and shoulders. Sometimes this type of malignant bone tumor can start in the soft tissue around the bone. - Chondrosarcoma
mainly affects people between 40 and 70 years of age. The bone areas of the hip, pelvis, legs, arms and shoulders are the most common areas for the development of chondrosarcoma, which begins in the cartilage cells. - Multiple myeloma
, although almost always affecting the bone, is not a primary bone cancer. Myeloma is a cancer of the bone marrow, the soft tissue inside the bones.
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Symptoms and diagnosis of bone tumors
Benign bone tumors most often develop without pronounced symptoms and can only in some cases cause pain. That is why they are usually discovered by chance - either by feeling a painful place on the bone, or during an x-ray examination. It happens that a tumor grows undetected to a significant size. In this case it becomes visible. A large bone tumor can cause problems in the functioning of the limb and significant pain, since due to its size it compresses the tendons and nerves.
With some types of benign tumors, increased bone fragility and frequent fractures are possible.
To confirm the diagnosis, the patient undergoes bone x-ray, tomography and angiography (vascular examination). These examinations make it possible to learn about the changes that have occurred in the bone tissue and to analyze the characteristics of the blood supply to the tumor. To definitively confirm the diagnosis and clarify the type of tumor, the patient undergoes a bone biopsy.
3.Symptoms of bone tumor
It often happens that a bone tumor does not manifest itself at all. And the doctor diagnoses it during x-rays when visiting for other reasons. For example, due to sprained ligaments. But a sign of a bone tumor can also be pain felt in the area of the tumor.
It is often described as a dull ache that gets worse during vigorous activity or at night.
Trauma does not cause bone tumors. But due to trauma, a fracture of a bone weakened by the tumor may occur. And this is already causing severe pain.
Other symptoms of a bone tumor may include fever, increased sweating at night, swelling around the bone, and lameness.
If you have any reason to suspect a bone tumor, be sure to consult a good doctor. A medical examination, blood test, and x-ray studies will help identify the disease. To confirm the diagnosis, your doctor may do a biopsy, which is a small sample of tissue taken using a special needle or through an incision. And then examining the resulting sample under a microscope for signs of cancer.
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Diagnosis of bone tumors
The main symptom when a tumor appears is the presence of the tumor itself, often a growing one, and pain in the area of the tumor lesion. Diagnostics comes down to examining the patient by a doctor, performing diagnostic procedures such as X-rays, MRIs, and, if necessary, other more specialized techniques. The crown of the diagnostic trifecta is the morphological examination of the tumor, which involves either the study of biopsy material or the study of the tumor itself, that is, its preparation (surgical material).
4.Treatment of bone tumors
Treatment for bone tumors depends on whether the tumor is benign or malignant. Of course, oncology requires more serious treatment.
Benign bone tumors are treated
with the help of medications or simply go away on their own. If there is a risk of the tumor developing into a malignant one, the doctor may remove it surgically. Sometimes a benign tumor appears again even after successful treatment.
Malignant bone tumors are more difficult to treat.
Cancer treatment is selected individually for each patient and depends on the stage of the disease. Cancer cells located in the area of the bone tumor indicate a localized stage of cancer. Bone cancer that spreads to other areas of the body is the metastatic stage. This disease is more serious and more difficult to treat. Bone cancer is most often removed surgically.
Common treatments for bone cancer may include:
- Surgery of the affected limb
, during which part of the bone containing cancer cells is removed. Nearby muscles, tendons and other tissues are not affected. The part of the bone that was removed is replaced with a metal implant (prosthesis). - Amputation
may be necessary if the tumor is too large or if it has spread to nerves and blood vessels. Limb prosthetics is a method of restoring function after surgery. - Radiation therapy
kills cancer cells and shrinks tumors using a high dose of X-rays. This bone cancer treatment is often used before or after surgery. - Systemic chemotherapy
drugs help kill cancer cells that have spread through the bloodstream. Chemotherapy may also be given before or after surgery.
Bone tumors (Bone neoplasms)
CT scan of the pelvis. Metastatic left iliac carcinoma with bone destruction (red arrow) and extensive soft duct component (green arrow)
Osteogenic sarcoma
A bone tumor arising from bone tissue, prone to rapid development and rapid formation of metastases. Develops mainly between the ages of 10 and 30, men are affected twice as often as women. Usually localized in the metaepiphyses of the bones of the lower extremities, in 50% of cases it affects the femur, followed by the tibia, fibula, humerus, ulna, bones of the shoulder girdle and pelvis. In the initial stages it manifests itself as dull, vague pain. Then the metaepiphyseal end of the bone thickens, the tissues become pasty, a visible venous network is formed, contractures form, the pain intensifies and becomes unbearable.
X-rays of the hip, tibia and other affected bones in the initial stages reveal a focus of osteoporosis with blurred contours. Subsequently, a bone tissue defect is formed, a spindle-shaped swelling of the periosteum and needle-shaped periostitis are determined. Treatment is surgical removal of the tumor. Previously, amputations and disarticulations were used, but now organ-saving operations are more often performed against the background of pre- and postoperative chemotherapy. The bone defect is replaced with an alloprosthesis, an implant made of metal or plastic. Five-year survival rate is approximately 70% for localized tumors.
Chondrosarcoma
A malignant bone tumor arising from cartilage tissue. It is rare, usually in older men. Usually localized in the ribs, bones of the shoulder girdle, pelvic bones and proximal bones of the lower extremities. In 10-15% of cases, the formation of chondrosarcoma is preceded by ecchondromas, enchondromas, osteochondromatosis, solitary osteochondromas, Paget's disease and Ollier's disease.
It manifests itself as intense pain, difficulty moving in the adjacent joint and swelling of the soft tissues. When located in the vertebrae, lumbosacral radiculitis develops. The flow is usually slow. Radiographs reveal a focus of destruction. The cortical layer is destroyed, the periosteal overlays are not clearly expressed, they look like spicules or a visor. To clarify the diagnosis, MRI, CT, osteoscintigraphy, open and penetrating needle biopsy can be prescribed. Treatment is often complex – chemosurgical or radiosurgical.
Ewing's sarcoma
The third most common malignant bone tumor. More often it affects the distal parts of the long tubular bones of the lower extremities, less often detected in the area of the bones of the shoulder girdle, ribs, pelvis and spine. Described in 1921 by James Ewing. Usually diagnosed in teenagers, boys are affected one and a half times more often than girls. It is an extremely aggressive tumor - even at the stage of diagnosis, half of the patients have metastases detected using conventional research methods. The incidence of micrometastasis is even higher.
In the early stages, it manifests itself as vague pain, intensifying at night and not subsiding with rest. Subsequently, the pain syndrome becomes intense, disrupts sleep, interferes with daily activity, and causes restriction of movements. In later stages, pathological fractures are possible. General symptoms are also characteristic: loss of appetite, cachexia, fever, anemia. Upon examination, dilation of the saphenous veins, pasty soft tissue, local hyperthermia and hyperemia are revealed.
To clarify the diagnosis, radiography, CT, MRI, positron emission tomography, angiography, osteoscintigraphy, ultrasound, trephine biopsy, tumor biopsy, molecular genetic and immunohistochemical studies may be prescribed. X-ray images reveal a zone with areas of destruction and osteosclerosis. The cortical layer is indistinct, stratified and disintegrated. Needle-shaped periostitis and a pronounced soft tissue component with a homogeneous structure are revealed.
Treatment is multicomponent chemotherapy, radiation therapy, and, if possible, radical removal of the tumor (including the soft tissue component), while in recent years organ-sparing operations have often been used. If it is impossible to completely remove the tumor, non-radical intervention is performed. All operations are performed against the background of pre- and postoperative radiation and chemotherapy. The five-year survival rate for Ewing's sarcoma is about 50%.
Non-neoplastic bone formations
Not all bone lumps are tumors - benign or malignant. Overgrowths of bone or cartilage tissue can also be of a non-tumor nature. Reaching significant sizes, they can cause significant discomfort by pinching nerve endings and tendons.
Any surgical operations on bone tissue are associated with an increased risk of infectious and other complications, so treatment should be trusted only to qualified specialists. Euroonko carries out a full diagnosis of any formations on the bones, and, if necessary, removal of tumors and exostoses.
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