Bone cancer or a bone tumor is a neoplastic growth of tissue in bone. Abnormal growths found in the bone can be either benign (noncancerous) or malignant (cancerous).

A bone lytic lesion (often just lytic lesion) is an area where part of a bone appears to have been dissolved or “eaten away”.

Bone tumors may be classified as “primary tumors”, which originate in bone or from bone-derived cells and tissues, and “secondary tumors” which originate in other sites and spread (metastasize) to the skeleton.

Carcinomas of the prostate, breasts, lungs, thyroid, and kidneys are the carcinomas that most commonly metastasize to bone. Secondary malignant bone tumors are estimated to be 50 to 100 times as common as primary bone cancers.

Primary bone 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. Some benign tumors are not true neoplasms, but rather, represent hamartomas, namely the osteochondroma.

The most common locations for many primary tumors, both benign and malignant include the distal femur and proximal tibia.

Examples of benign bone tumors include osteoma, osteoid osteoma, osteochondroma, osteoblastoma, enchondroma, giant cell tumor of bone, aneurysmal bone cyst, and fibrous dysplasia of bone.

Malignant primary bone tumors include osteosarcoma, chondrosarcoma, Ewing’s sarcoma, fibrosarcoma, and other types.

Multiple myelomas are hematologic cancers, originating in the bone marrow, which also frequently presents as one or more bone lesions.

Germ cell tumors, including teratoma, often present and originate in the midline of the sacrum, coccyx, or both.

These sacrococcygeal teratomas are often relatively amenable to treatment.

Secondary bone tumors

Since, by definition, benign bone tumors do not metastasize, all secondary bone tumors are metastatic lesions that have spread from other organs, most commonly carcinomas of the breast, lung, and prostate.

The most common symptom of bone tumors is a pain, which will gradually increase over time. A person may go weeks, months, and sometimes years before seeking help; the pain increases with the growth of the tumor.

Additional symptoms may include fatigue, fever, weight loss, anemia, and/or unexplained bone fractures. 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 of bone tumors is highly dependent on the type of tumor.

Chemotherapy and radiotherapy are effective in some tumors (such as Ewing’s sarcoma) but less so in others (such as chondrosarcoma). There are a variety of chemotherapy treatment protocols for bone tumors.

The protocol with the best-reported survival in children and adults is an intra-arterial protocol where tumor response is tracked by serial arteriograms. When tumor response has reached >90% necrosis surgical intervention is planned.

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

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. The first stage is doing the colostomy and the urinary conduit, the second stage is the amputation.

This is a mutilating surgery and is only done as a last resort (e.g. when even pelvic interaction doesn’t work or in cases of advanced pelvic/reproductive cancers)

Prognosis

The outlook depends on the type of tumor. The outcome is expected to be good for people with noncancerous (benign) tumors, although some types of benign tumors may eventually become cancerous (malignant).

With malignant bone tumors that have not spread, most patients achieve a cure, but the cure rate depends on the type of cancer, location, size, and other factors.



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