Tumors of bone
Oncology / / April 27, 2016
Primary malignant bone tumors - tumors originating from the tissues that form bone.They are relatively rare, much more frequently affected bone metastasis of cancer at other sites (breast, lung, kidney, prostate, thyroid, etc.).
Primary malignant bone tumors are most common in the second decade of life and is approximately 3 cases per 100 000 people.Despite this relatively high incidence in the second decade of life, primary bone tumors account for only 3.2% of all cancers in children younger than 15 years.In adults over the age of 30 years, the incidence of approximately 0.2 cases per 100 000 population.
According to various authors, benign bone tumors occur in 2-3 times less than the primary malignant neoplasms of this localization.In contrast to benign tumors that are often equally affect both men and women, malignancies 1.5-2 times more common in men.Typically, bone tumors affect the long bones of the limbs and the bones of the pelvic girdle, but can occur in other parts of the skeleton.
There has been an increased incidence of bone tumors, possibly due to the acceleration of the population.So, it was noted that children under the age of 18 years, osteosarcoma patients, significantly higher growth compared to the children, the sick other forms of cancer.These observations reinforce the evidence that bone tumors occur in areas of rapid growth, and it is possible that the elongation of the timing of growth or over-stimulation of metabolism is important in the origin of bone tumors.In particular, such a phenomenon is observed in bone tumors occurring in adults in tissues metabolically stimulated long existing bone Paget's disease of chronic osteomyelitis, and old bone fractures after ionizing radiation.These diseases, as well as fibrous dysplasia and osteochondral exostoses, in some cases, lead to the development of malignant bone tumors (secondary bone sarcoma).
There are more than 50 classifications of bone tumors, proposed in the last 100 years.Most of them are built on the principle of tissue tumors accessories and the characteristics of their microscopic structure.
It should be noted that some forms of bone tumors are more common, others less, and still others as an anecdotal cases (lipoma, liposarcoma, myxoma, miksosarkoma et al.).The most common are osteosarcoma (30-35%) among all malignant bone tumors, multiple myeloma or multiple myeloma (30-35%), chondrosarcoma (13-15%), Ewing's tumor (7-10%), fibrosarcoma (1-2%).
main classic symptoms of bone tumors is pain, impaired function of the affected limb, the emergence of palpable tumors.Carefully collected history helps to establish the correct diagnosis.The earliest symptom is pain, which, in contrast to the inflammatory process alone does not subside (increased pain at night, when no facilitate immobilization of limbs).As the growth of the tumor begins to suffer a nearby joint function and then developed palpable tumors (late sign).
development of symptoms depends on the rate of tumor growth.Thus, when the fastest growing osteosarcoma tumor is detected early and can quickly occur pathological bone fracture.In other tumors (parostalnaya osteosarcoma, high-grade chondrosarcoma) clinical picture develops slowly over several years.
Bone sarcomas usually metastasize by hematogenous, often very early, most often in the lungs.Lymphatic metastasis is rare, mainly in Ewing tumors and primary bone retikulosarkome.
Diagnostics If you suspect a primary bone tumor of the patient is subject to a full and thorough clinical examination.In the course of the survey is to find out whether benign or malignant tumor, primary or metastatic, and set its nosology.Furthermore, the patient should be investigated in terms of detection of metastases in other organs, primarily in the lungs.Proper and timely response to all these questions determines the choice of rational method of treatment and, ultimately, the fate of the patient.
diagnosis of primary bone tumors made up of clinical data, radiological and morphological studies.This importance are the results of laboratory research.Very often, especially in the early stages of development, the diagnosis of bone tumors cause great difficulties.
When evaluating clinical data should take into account the age of the patients, especially the localization of the lesion in the bone, the nature of pain and the presence of a tumor.For primary tumors of bone is characterized by a young age of the patients, metaphyseal localization, increased pain at night.
X-ray examination is an essential part of the comprehensive examination of the patient and the sum of the X-ray and bone scan.X-ray study of the skeleton produced in at least two projections.
advisable to review radiographs complement sighting shots and tomograms to help identify small structural changes in the bones.Utility, but sometimes it is valuable Angiography (vascular pathological restructuring).
Every form of bone tumors is different radiological semiotics.In the study of most forms of bone tumors detected hearth destruction of the bone with a characteristic lysis or alternatively, abnormal bone formation, various periosteal reaction ( "bulbous" periostitis etc.), The reaction of soft tissues surrounding the bone, pathologic fractures and others.
Knowledge of radiologicalsemiotics can not only establish the presence of the tumor, but also to speak about the possible histological type it.
most important in deciding on the nature of the tumor is a morphological study.Without dwelling on the ongoing efforts in the literature has been for many years the debate about the dangers of biopsy in malignant bone tumors, it may be noted that this danger is greatly exaggerated and based more on theoretical concepts than clinical.Biopsy produced to confirm the diagnosis before the upcoming big and mutilation.Furthermore, in making a biopsy for diagnosis of ambiguous cases (malignant or benign tumor), as well as to refine the histological structure of the tumor in order to select the treatment method.Material from the tumor take either a closed or an open way.It closed methods include needle aspiration, which is produced by puncturing the lesion with a thick needle aspiration of tissue into the syringe and cytology smears.Needle biopsy - to provide "pillar" for histological examination using a special tool.
In case of failure of these methods as a final stage of diagnosis of produce open or operative biopsy.
Laboratory Methods useful only in rare cases, but when they are positive, then, as a rule, considerably help the diagnosis.Thus, the study of alkaline and acid phosphatase helps to differentiate metastatic prostate cancer in the bones (high acid and alkaline phosphatase) from Paget's disease or Kaposi on the basis of Paget's disease (a high level of alkaline phosphatase).The study of serum proteins by electrophoresis or normal ratio of albumin to globulins are reliable methods in multiple myeloma.For other bone tumors, these signs are not as specific, but osteoblastic tumor tend to increase levels of alkaline phosphatase, and sarcomas with great destruction of bone is often characterized by a high level of calcium in the blood serum and high excretion in the urine.In other tumors of bone laboratory methods have high diagnostic value in comparison with the method of X-ray and biopsy.
Basically the choice of treatment depends on the nature of the tumor (benign, malignant, metastatic) and its histological structure, the extent of the tumor process, localization of the tumor and the patient's general condition.
Operative treatment of bone tumors suggested a long time, but so far they are the most important and most frequently used.In the surgical treatment of bone tumors following basic principles should be observed:
1) radical surgery for the smallest possible risk it;
2) ablastics surgery;
3) preservation of the limb on the possibility of that is affected by the tumor, without compromising its function.
patients with benign bone tumors are the main methods of treatment of savings operation - resection of bone and in rare cases, curettage (scraping).The latter method is admissible for special indications with inactive forms osteoblastoklastom.
choice of method of treatment of malignant bone tumors to a certain extent depends on their sensitivity to ionizing radiation.For radioresistant tumors, such as osteosarcoma, chondrosarcoma, fibrosarcoma, parostalnaya sarcoma, malignant osteoblastoklastoma, used surgical interventions such as amputation or disarticulation of limbs.The level of amputation is set depending on the location and extent of the process, the degree of soft tissue and the tasks of the forthcoming prosthetics.Amputation as a rule, should be made outside the affected bone (through a joint).Exceptions to this rule are malignant tumors located in the distal femur.Currently, most surgeons make in such cases subtrochanteric femur amputation.
preferred level of amputation with various localization of bone sarcomas.Driving.
When radiosensitive tumors (Ewing's tumor and primary clasmocytoma) surgical methods currently, as a rule, do not apply.Treatment starts with one main course of radiotherapy.Subsequently carried out the so-called preventive chemotherapy to prevent metastasis.With the help of this method of treatment can not save the affected limb.Radiation therapy for specific indications is used to treat benign tumors, such as angioma and osteoblastoklastoma.
In some cases use a combination treatment of bone sarcomas by a combination of radiation therapy followed by surgery.
Most patients with malignant tumors of the bone die from metastases, mainly in the lungs.Primary tumors can usually eliminate the hearth either surgically or with radiation therapy.In this regard, a great role should belong to chemotherapy.Unfortunately, bone neoplasms represent these types of tumors that are difficult to chemotherapy.
results of treatment and prognosis
treatment results depend on tumor histology supplies, degree of differentiation, location and other factors.Tumours of bones usually have a poor prognosis.According to the summary data of the literature, the five-year survival rate of patients after radical treatment is as follows: when osteogenic sarcoma - 12%, chondrosarcoma - 35%, fibrosarcoma - 20%, Ewing's tumor, 5%, retikulosarkome - 35%, osteoblastoklastome (malignant) - 25%, multiple myeloma - 15%.
The data suggest that after a radical and early treatment can achieve stable cure of a certain group of patients with malignant bone tumors.