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After Tumor: Bone Defects


A tumor is a lump or mass of tissue that forms when cells divide uncontrollably. A growing tumor may replace healthy tissue with abnormal tissue. It may weaken the bone, causing it to break (fracture). Most tumors in the bone are noncancerous (benign). Some are cancerous (malignant). Benign tumors are usually not life-threatening. Malignant tumors can spread cancer cells throughout the body (metastasize). This happens via the blood or lymphatic system.
Most of the time, when people have cancer in the bones, it is caused by cancer that has spread from elsewhere in the body to the bones. It is much less common to have a true bone cancer, a cancer that arises from cells that make up the bone. It is important to determine whether the cancer in the bone is from another site or is from a cancer of the bone cells themselves. The treatments for cancers that have metastasized to the bone are often based on the initial type of cancer.

Bone Cancer Treatment
 

Types of Bone Cancers

Cancer that begins in bone (primary bone cancer) is different from cancer that begins somewhere else in the body and spreads to bone (secondary bone cancer).
The four most common types of primary bone cancer are:

  • Multiple Myeloma: Multiple myeloma is the most common primary bone cancer. It is a malignant tumor of bone marrow. Multiple myeloma affects approximately five to seven people per 100,000 each year. Most cases are seen in patients between the ages of 50 and 70 years old. Any bone can be involved.
  • Osteosarcoma: Osteosarcoma is the second most common bone cancer. It occurs in two or three new people per million people each year. Most cases occur in teenagers. Most tumors occur around the knee. Other common locations include the hip and shoulder.
  • Ewing's Sarcoma: Ewings sarcoma most commonly occurs between 5 and 20 years of age. The most common locations are the upper and lower leg, pelvis, upper arm, and ribs.
  • Chondrosarcoma: Chondrosarcoma occurs most commonly in patients between 40 and 70 years of age. Most cases occur around the hip and pelvis or the shoulder.

There are many types of benign bone cancer tumors. The more common types include:

  • Non-ossifying fibromaunicameral (simple) bone cyst
  • Osteochondroma
  • Giant cell tumor
  • Enchondroma
  • Fibrous dysplasia

Symptoms

Most patients with a bone tumor will experience pain in the area of the tumor. The pain is generally described as dull and achy. The pain may or may not get worse with activity. The pain often awakens the patient at night.
Although tumors are not caused by trauma, occasionally injury can cause a tumor to start hurting. Injury can cause a bone that is already weakened by a tumor to break. This often leads to severe pain. Some tumors can cause fevers and night sweats. Many patients will not have any symptoms, but will instead note a painless mass. Occasionally, benign tumors may be discovered incidentally when X-rays are taken for other reasons, such as a sprained ankle or rotator cuff problem.

Bone Cancer Treatment

Nonsurgical Treatment
Benign Tumors: In many cases, benign tumors just need to be watched. Some can be treated effectively with medication. Some benign tumors will disappear over time. This is particularly true for some benign tumors that occur in children.
Malignant Tumors: If you are diagnosed with a malignant bone tumor, you might want to get a second opinion to confirm it. If you have bone cancer, the treatment team may include several specialists. These may include an orthopaedic oncologist, a medical oncologist, a radiation oncologist, a radiologist, and a pathologist. Treatment goals include curing the cancer and preserving the function of the body.
Doctors often combine several methods to treat malignant bone tumors. Treatment depends upon various factors, including the stage of the cancer (whether the cancer has spread):

  • Localized Stage: Cancer cells are contained to the tumor and surrounding area.
  • Metastatic Stage: Cancers have spread elsewhere in the body. Tumors at this stage are more serious and harder to cure.

Radiation Therapy: Radiation therapy uses high-dose x-rays to kill cancer cells and shrink tumors.
Systemic Treatment (Chemotherapy): This treatment is often used to kill tumor cells when they have spread into the blood stream but cannot yet be detected on tests and scans. Chemotherapy is generally used when cancerous tumors have a very high chance of spreading. Generally, malignant tumors are removed using surgery. Often, radiation therapy and chemotherapy are used in combination with surgery.

Surgical Treatment
Benign Tumors: Certain benign tumors can spread or become cancerous (metastasize). Sometimes the doctor may recommend removing the tumor (excision) or some other treatment techniques to reduce the risk of fracture and disability. Some tumors may come back, even repeatedly, after appropriate treatment.
Malignant Tumors: Limb Salvage Surgery: This surgery removes the cancerous section of bone but keeps nearby muscles, tendons, nerves, and blood vessels. If possible, the surgeon will take out the tumor and a margin of healthy tissue around it. The excised bone is replaced with a metallic implant (prosthesis) or bone transplant.
Amputation: Amputation removes all or part of an arm or leg when the tumor is large and/or nerves and blood vessels are involved.

Recovery

When treatment for a bone tumor is finished, the doctor may take more x-rays and other imaging studies. These can confirm that the tumor is actually gone. Regular doctor visits and tests every few months may be needed. When the tumor disappears, it is important to monitor your body for signs that is may have returned (relapse).

Authored By: Dr. S. V. Santpure

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