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
- Childhood
- 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
- Most studies can’t differentiate the two
- 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
- Recent advances in oncology have increased the 5-year survival rate of malignant tumours from 20 to 80%