Bone Tumors

Bone Tumors:  Most bone tumors are secondary, caused by seeding from a primary site.  Primary tumors are more common in males, usually children and adolescents, although some types do occur in persons between ages 35 and 60.  They may originate in osseous or nonosseous tissue.  Osseous tumors arise from the bony structure itself; they include Chondrosarcoma, Malignant giant cell tumor, Osteogenic sarcoma (most common), and Parosteal osteogenic sarcoma.  Nonosseous tumors arise from hematopoietic, vascular, and neural tissues; they include Chordoma, Ewing's sarcoma, and Fibrosarcoma.  In children, the most common type of bone tumors are Osteogenic and Ewings's sarcomas.

Cause:  The exact cause of bone tumors are unknown, but theories point to heredity, trauma, and excessive radiotherapy.  Possible cause also, maybe rapid growth, since children and young adults with such tumors seem to be much taller than average.

Symptoms:

Bone pain  (may occur with or without movement and more intense at night)
Weakness
May experience dull and usually localized pain
May include a mass or tumor, which may be tender and may swell
Pathologic fractures
Cachexia (general ill health and malnutrition)
Fever
Impaired mobility (which may occur during late stages)

Treatment:

Surgery and radiation
Chemotherapy and biotherapy
Sometimes radical surgery is necessary, such as hemipelvectomy or interscapulothoracic amputation (however, surgical resection of the tumor and bone transplants -often with preoperative radiation and postoperative chemotherapy have saved limbs from amputation.

Classifying primary malignant bone tumors:

Osseous origin:

Osteogenic sarcoma:  Usually in males ages 10 to 30.  Occurs most often in femur, but also tibia and humerus; occasionally, in fibula, ileum, vertebra, or mandible.

Tumor arises from bone-foming osteoblast and bone-digesting osteoclast.  Osteoid tumor present in specimen.

Treatment:  Surgery (tumor resection, high thigh amputation, hemipelvectomy, interscapulothoracic surgery).   Radiation and or Chemotherapy (or combination of all)

Parosteal osteogenic sarcoma:  Usually in females ages 30 to 40.  Occurs most often in distal femur, may also be tin the humerus, tibia, and ulna.  Develops on surface of bone instead of interior and progresses slowly.

Treatment:  May be a combination of:  Surgery (tumor resection, possible amputation, interscapulothoracic surgery, hemipelvectomy). Chemotherapy

Chondrosarcoma:  Usually in males ages 30 to 50.  Occurs most often in pelvis, proximal femur, ribs, and shoulder girdle.  Develops from cartilage, and grows slowly.  Usually painless; locally recurrent and invasive.

Treatment:  Hemipelvectomy, surgical resection (ribs).  Radiation, and or Chemotherapy.

Malignant giant cell tumor:  Usually in females ages 18 to 50.  Arises from benign giant cell tumor.  Found most often in long bones, more so in the knee area.

Treatment:  Curettage; Total excision: Radiation.

Nonosseous Origin:

Ewing's sarcoma:  Usually in males ages 10 to 20.  Originates in bone marrow and invades shafts of long and flat bones.  usually affects lower extremities, most often in the femur, innominate bones, ribs, tibia, humerus, vertebra, and fibula.  (may metastasize to lungs).  Pain increasingly severe and persistent.

Treatment:  High-voltage radiation (tumor is very radiosensitive); Chemotherapy to slow growth; Amputation only if there's no evidence of metastases.

Fibrosarcoma:  Usually in males ages 30 to 40.  Originates in fibrous tissues of the bone.  Invades long or flat bones such as femur, tibia, and mandible.  It also involves periosteum and overlying muscle.

Treatment:  Amputation; Radiation; Chemotherapy; Bone grafts (with low-grade fibrosarcoma).

Chordoma:  Usually in males ages 50 to 60.  Derived from embryonic remnants of notochord; progresses slowly.  Usually found at the end of spinal column and in spheno-occipital, sacrococcygeal, and vertebral areas.  Characterized by constipation and visual disturbances.

Treatment:  Surgical resection (usually resulting in neural defects);  Radiation (palliative, or when surgery not applicable, as in occipital area)

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