Tumours Of The Bone

An abnormal growth of cells within a bone is termed as bone tumour

Introduction :

Bone tumours develop when bone cells divide in an out of control manner, forming a lump or mass of abnormal tissue.

Most bone tumours are benign. Benign tumours are not life threatening, they are not malignant or do not spread to other parts of the body.

Some bone tumours may show signs of malignancy can metastasize or cause cancer cells to spread to the adjoining tissues or organs. In almost all cases treatment for malignant tumours involves a three-fold procedure combination of chemotherapy, radiation, and surgery or specific treatment depending upon the stage the cancer is.

Types of tumours :

Bone tumours can affect any particular bone in the body and develop in any part of the bone from the surface to the centre of the bone, called the bone marrow or marrow of the bone. A growing bone tumour even a benign tumour can destroy healthy tissues and weaken the bones, making them vulnerable to fractures.

When a bone tumour is cancerous or shows signs of being malignant it is either a primary bone cancer or a secondary bone cancer. A primary bone cancer actually begins in the bone itself while a secondary bone cancer begins elsewhere in the body and then metastasizes or spreads to the bone. Secondary bone cancer is termed metastatic bone disease.

Primary bone cancer :

The four most common types of primary bone cancer are :

Multiple myelomas : It is the most common primary bone cancer. This is a malignant type of tumour of which occurs in the bone marrow or the soft tissue in the centre of many bones that produces blood cells. Any particular bone can be affected by this cancer. Most cases are seen in patients between the ages of 50 and 70. Multiple myelomas are systematically treated with chemotherapy, radiation therapy and occasionally surgery if required.

Osteosarcoma : It occurs in two to five people per million with most cases it is found in teenagers and children. Most of the tumours develop around the knee in either the femur or tibia. Other locations mainly include the hip and shoulder. Osteosarcoma is treated with chemotherapy and surgery.

Ewing’s sarcoma : Ewing’s sarcoma usually occurs in people between the ages of 5 and 20. The most common location affected are the upper and lower leg, pelvis, upper arm, and ribs. Ewing’s sarcoma is treated with chemotherapy or either surgery or radiation therapy.

Chondrosarcoma : Chondrosarcoma is malignant tumour composed of cartilage producing cells. It is often seen in patients between the ages of 40 and 70. Most cases occur around the hip, pelvis, or shoulder area. In most cases surgery is the only treatment for chondrosarcoma.

Benign bone tumours

There are certain types of benign bone tumours as well as certain diseases or conditions that resemble bone tumours. Although these conditions are not really bone tumours, in many cases they require the same line of treatment.

Some common types of benign bone tumours and conditions that are commonly grouped with tumours include :

  • Non-ossifying fibroma
  • Unicameral bone cyst
  • Osteochondroma
  • Giant cell tumour
  • Enchondroma
  • Fibrous dysplasia

Causes :

The cause of bone tumours is unknown. They often occur in the area of the bone that grows rapidly. Possible causes include :

  • Genetic defects
  • Radiation after effects
  • Any Injury sustained
  • In most cases.

Benign bone tumours occur most often in children whose skeletons are still growing and people up to age 30. These tumours are often strongly affected by the hormones that cause growth. Many benign tumours stop growing once a child’s bones do. This usually takes place between the age 14 in girls and 16 to 19 in boys.

Symptoms :

  • Pain in the area the tumour is present which worsens with activity
  • Other symptoms of a bone tumour can include fever and night sweats.
  • Certain patients may just notice a mass.
  • An injury may cause the bone with an already existing tumour to break
  • When an x-ray is taken for any another reason, such as a sprained ankle or knee injury the presence of the tumour is detected.

How to diagnose bone tumours :

  • Personal and medical History of the patient is examined
  • Alkaline phosphate blood level test is done to measure the level of alkaline phosphates enzyme in our blood stream.
  • Blood biopsy : A Sample tissue is taken from the tumour to check for malignancy.
  • Bone scan : Radioactive material is injected and scan is done to study the presence if tumours
  • Chest x-ray
  • CT scan of the chest
  • MRI of the bone and surrounding tissue :
  • X-ray of bone and the surrounding tissues
  • Alkaline phosphate is enzyme
  • Blood calcium level
  • Parathyroid hormone
  • Blood phosphorus level

Treatment :

  • Some benign bone tumours dissolve on their own and do not need any specific treatment. They need to be monitored periodically with different tests.
  • Treatment for cancerous bone tumours that are malignant and have reached the surrounding organs from other parts of the body depends on where cancer started. Radiation therapy may be given to prevent fractures or give relief from painful conditions.
  • Tumours that start in the bone are very rare. After the biopsy, a combination of chemotherapy and surgery is usually necessary. Radiation therapy may be needed before or after surgery.

Non-surgical treatment procedures :

Benign tumours :

If the tumour is benign and poses insignificant danger the doctor may recommend just monitoring it closely to see if it changes. During this time, you may need periodic follow-up with x-rays or other tests to be done at regular intervals.

Some benign tumours can be treated effectively with medications only. Some will disappear over time. This is particularly true for certain benign tumours that occur in children, such as Osteoma.

Malignant tumours :

If you are detected with bone cancer, treatment will include a team of doctors from different medical specialities working together to provide care. Super Speciality doctors like radiation oncologist, orthopaedic oncologists, and orthopaedic surgeons team up to give you the best treatment for tumours at KIMS.

Treatment depends on several factors such as your present age, your existing general condition, the size and shape of the tumour and its location when it is detected. Whether it is malignant and the extent of its malignancy.

Doctors often combine several methods to treat malignant bone tumours :

Radiation therapy : radiation therapy uses high-dose x-rays to get rid of cancer cells and shrink tumours. This only treats cancer in the area of the beams projected.

Chemotherapy : Chemotherapy is often used to kill tumour cells that have spread into the bloodstream but cannot be detected on tests and scans. It is generally used when cancerous tumours are malignant in nature. Chemotherapy is usually given intravenously or in a pill or capsule that is swallowed.

Surgical treatment

Benign tumours : Benign tumours can be removed from their place and location.

Malignant tumours :

Limb-salvage surgery : this surgery is done to remove the cancerous section of bone but care is taken to keep nearby muscles tendons, nerves and blood vessels intact where possible. The surgeon will then take out the tumour and a portion of healthy tissue around it. The excised bone is replaced with a metallic implant or bone from elsewhere in your body or bone from a donor whichever is feasible.

Amputation : Amputation of the damaged portion is done, usually if the tumour is big in size and replaced with a prosthetic limb.

Recovery :

Recovery depends upon the prognosis. You must follow the Surgeon’s advice in all respects. Care must be taken to prevent the tumour from recurring.

Outlook (prognosis) :

Many patients have benefited from such treatment. Tumours that are highly malignant may require time to heal. The recovery depends on factors such your age, the size of the tumour and the type of treatment you have received and your response to it.

KIMS is the Best Orthopaedic Hospital in Hyderabad, specialising in the treatment of Bone tumours. Best Orthopaedic Doctors such Dr Srikanth and his team have vast experience in the treatment of bone tumour cases. The orthopaedic department at KIMS is well-equipped to handle any emergency situation.



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