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Bone tumours

  • Most common bone tumours according to age group
    • Childhood
      • Osteosarcoma
      • Ewing sarcoma
      • Benign cysts
      • Fibrous dysplasia
    • Young and middle age
      • Chondrosarcoma
      • Malignant fibrotic histiocytoma
      • Osteoclastoma (giant cell tumour)
    • Elderly
      • Metastasis
      • Myelomas
  • If it’s unclear whether the patient has a bone tumour or not – treat as is they have one!
  • When to think of bone tumours
    • Night pain
    • “Growing pain”
      • What’s known as “growing pain” is not related to growth
    • Patients with history of cancer
    • Atypical symptoms
    • Pathological fracture
    • Lytic or sclerotic bone lesions on x-ray
    • Negative X-ray when patient has symptoms
    • Unexplained weight loss
  • Differentiating between bone tumours and infection can be difficult
    • Most studies can’t differentiate the two
      • Labs
      • X-ray
        • X-rays have low sensitivity and specificity for bone tumours
      • CT
        • CT has high sensitivity but low specificity
        • Not good for diagnosis
        • Good for planning surgery
      • MRI
        • MRI has high sensitivity but low specificity
      • Bone scan
        • Bone scan has high sensitivity but low specificity
    • Only biopsy can give the final answer
      • All suspicious cases should take a biopsy
      • Done under general anaesthesia
        • Local or regional anaesthesia are not used
      • When taking biopsy we go through the muscle to reach the bone
        • This is to prevent spreading of tumour cells while taking biopsy
        • During surgery we go between the muscles
  • Typical image features of malignant bone tumour
    • Positive bone scan
    • Codman triangle
    • Soft tissue expansion
  • Typical image features of benign bone tumour
    • Clear margin between normal tissue and tumour
    • No periosteal reaction
    • No Codman triangle
  • Treatment of bone tumours
    • Recent advances in oncology have increased the 5-year survival rate of malignant tumours from 20 to 80%
      • Advances in cytostatic treatment allows for the treatment of micro-metastases, which allows for the use of
    • Benign tumours are generally treated with just surgery
    • Malignant tumours are generally treated with neoadjuvant chemo, surgery, and adjuvant chemo
    • Amputation
      • Previously amputation used to be the mainstay of treatment of bone tumours
    • Limb-sparing surgery (= limb-salvage surgery)
      • Nowadays, with improved oncological treatment (like neoadjuvant and adjuvant chemo) limb-sparing surgery has become sufficient
      • The tumor is removed, along with bone and tissue around it
      • The bone is replaced by a prosthesis, allograft bone, or both