A bone tumor is a mass of tissue that forms when the bone-forming cells divide uncontrollably.
A growing mass can replace the healthy tissue with an abnormally weaker tissue.
The bone tumor can cause:
- a fracture of the bone balls (trabeculaeum) that make up the inside of the bone,
- a fracture.
Most bone tumors are benign, but there are also some malignant growths.
Normally, benign tumors are not dangerous.
Malignant tumors can spread (metastasize) cancer cells throughout the body.
This is done via:
- blood circulation,
- the lymphatic system.
The cancer that develops in the bone (primary bone tumor) is different from the cancer that develops in another area of the body and spreads to the bone (secondary bone tumor or bone metastases).
Malignant tumors of soft tissues are called sarcomas. Each type of sarcoma is named according to the body tissues in which it forms.
Ewing’s sarcoma forms in the bone marrow and is the most common sarcoma in children.
Types of bone tumors
The four most common malignant bone tumors are:
1. Multiple myeloma
Multiple myeloma is the most common primary bone cancer.
This is a malignant bone marrow tumor.
Multiple myeloma affects about 9 people out of 100,000 per year.
According to the Italian Society for Cancer Research (Associazione Italiana per la Ricerca sul Cancro, AIRC for short), just over 2,400 new cases of this disease are registered every year.
Patients between the ages of 65 and 70 are particularly affected. Any bone can be affected.
Multiple myeloma often affects or involves the bone, but is not considered the primary tumor of the bone, but of the blood.
Osteosarcoma is the second most common bone tumor.
In Italy, it affects about 0.8-1 persons per 100,000 inhabitants every year.
Most cases occur in adolescents. Most tumors form in the knee area.
Other common places are:
Das Ewing-Sarkom tritt häufiger bei Personen im Alter zwischen 5 und 15 Jahren auf.
Die am stärksten betroffenen Bereiche sind:
- Humerus (Oberarmknochen),
Die Symptome sind:
- starke Knochenschmerzen,
Das Chondrosarkom entsteht im Knorpel und tritt häufiger bei Personen im Alter zwischen 40 und 70 Jahren auf. Betroffen sind vor allem die Bereiche von:
Tumors that originate in bone are called primary bone tumors. Tumors that develop in other areas of the body are called secondary or metastatic bone tumors.
They behave completely differently from primary bone tumors.
- The most common bone cancer is metastatic carcinoma.
- In most cases, these are multiple tumors, but they can also occur individually.
- The metastatic tissue does not originate from the bones, but from other organs.
- The most common primary tumors occur on the breast, prostate, lungs, kidneys and thyroid gland.
- Wilms tumor and neuroblastoma are the forms that most commonly cause bone metastases in childhood.
Benign bone tumors
Benign bone tumors are more common than malignant tumors.
Some types of benign bone tumors include:
- Osteochondroma is the most common benign bone tumor. It usually affects people under the age of 20.
- Fibrous dysplasia. This type of tumor causes excessive growth of bone tissue or fibrous tissue.
- The fibrous metaphyseal defect is also known as non-ossifying fibroma. This asymptomatic roundish bone lesion is caused by excessive growth of fibrous tissue. As the child grows, fibrous tissue is replaced by bone tissue, and the non-ossifying fibroma heals on its own.
- Simple bone cyst. This is a bone cavity filled with fluid.
- The giant cell tumor is a benign neoplasm that usually occurs in the leg (malignant forms of this tumor are rare).
- The osteoid osteoma is a bone tumor that mainly affects the long bones and occurs most frequently in the first 20 years of life.
- Osteoblastoma is a single tumor that forms primarily in adolescents in the lumbar spine and lumbosacral or in the long bones.
- The enchondroma usually occurs in the bones of the hand and foot. Often it does not cause symptoms. It is the most common type of hand tumor.
Bone tumors in children
The causes that cause the development of these tumors in children are not exactly known.
About 2 in 10 children who develop malignant bone tumors have a family history.
The benign bone tumors are not hereditary, except for one type of tumor called multiple exostosis.
Symptoms of bone tumor
In general, benign masses that do not grow are asymptomatic (without symptoms).
The most common symptoms of bone tumor are:
The pain occurs in the place where the tumor mass is located.
For example, if neoplasm sits in the lumbar spine, the patient feels back pain in the central area.
The symptoms vary depending on the location and size of the tumor.
The pain can:
- be constant (in the advanced stages) or occur irregularly,
- become stronger when moving and at night.
The pain can be a symptom of the following disorders:
- Growing neoplasms. This category includes local aggressive abnormal formations (for example, aggressive osteoblastoma) and malignant tumors.
- Pathological fracture as a complication of malignant tumors.
- Significant local reaction of tissues to the tumor.
The following clinical symptoms must be considered, as they can help in differential diagnosis:
- The osteoid osteoma is a small mass, but it greatly irritates the neighboring tissues and usually causes severe pain at night. Symptoms can be alleviated with the help of nonsteroidal anti-inflammatory drugs.
The osteoid osteoma can also occur near the joint surface of a joint. In this case, it causes highly inflammatory synovitis, which often masks the presence of the tumor.
Most often it occurs:
- on the shin,
- on the femur,
- on the spine,
- on the humerus.
- Enchondroma (benign) and chondrosarcoma (malignant) 1st degree: histologically, chondrosarcoma and enchondroma of the 1st degree are very difficult to distinguish because the histological characteristics are similar.
The distinction is based on the behavior of the mass, such as the appearance of pain. Low-grade chondrosarcoma:- is a growing tumor,
– causes pain.The enchondroma tends to be asymptomatic if it is not associated with a pathological fracture.
Causes of bone tumors
The cause of bone tumors is unknown.
They often develop in areas where bones grow rapidly.
Some possible causes include:
- genetically inherited defects in the family;
In most cases, no specific cause can be determined.
According to natural medicine, diet is the cause of bone cancer.
- According to the theory of the blood group diet, milk and dairy products in the diet can provoke this disease.
- Hygienism (from Shelton, Lezaeta, Gerson and Ehret) is a type of naturopathy based on natural lifestyle and nutrition.
According to this theory, the bone tumor is caused by the accumulation of toxins in the blood: these toxins are the result of:
- diet with animal proteins, processed and cooked foods – fruits and vegetables are preferable;
- lack of exercise;
- lack of sun and fresh air;
- Air conditioning in summer, which hinders the excretion of waste products via sweat.
Diagnosis, examinations and tests in a bone tumor
The doctor performs a physical examination. The tests that can be performed are:
- blood test to determine the amount of alkaline phosphatase in the blood;
- bone biopsy;
- bone scintigraphy;
- computed tomography (CT);
- Nuclear magnetic resonance (NMR) of bone and adjacent tissue.
This condition can also affect the results of the following examinations:
- isoenzyme of alkaline phosphatase;
- calcium levels in the blood (with bone metastases);
- the UCS values are elevated, but are a very general indicator, since an increased value can also be caused by:
- rheumatoid arthritis,
- inflammation, etc.
Classification of malignant bone tumors
The results of the tumor examination, the involvement of the lymph nodes and the ability to form metastases give the following stage division:
- Stage 0: Carcinoma in situ, i.e. a low-grade, small tumor in the initial phase that has not yet spread.
- Stage 1A: low-grade tumor less than 8 cm in size, slow growth, confined to bone.
- Stage 1B: low-grade tumor larger than 8 cm, occupying more than one region on the same bone.
- Stage 2A: high-grade tumor with a size of less than 8 cm, which does not involve the lymph nodes and cannot form metastases.
- Stage 2B: high-grade tumor with a size of more than 8 cm, but which does not involve the lymph nodes and does not form metastases.
- Stage 3: high-grade tumor that occupies more than one region on the same bone.
- Stage 4A: Tumor of any size and type that has spread to the lungs.
- Stage 4B: this is the last stage, the tumor can be of any size or degree and has spread to the lymph nodes and/or a part of the body other than the lungs (metastases).
What are the treatment options for a bone tumor?
Treatment depends on:
- the type and stage of the tumour,
- the general state of health,
- personal preferences.
As a rule, the following are planned:
- a combination of these treatments.
The goal of the operation is to remove the entire tumor from the bone. Doctors remove the tumor and a small portion of neighboring healthy tissue. Some of the methods used to treat bone cancer are:
- Amputation of a limb. In the case of extensive bone tumors or those located in a very hard-to-reach place, the limb must be amputated.
This procedure is becoming increasingly rare as other forms of treatment have been developed.
The removed limb is usually replaced with an artificial (or prosthesis) after surgery.
Amputation is more common in children because their bones grow stronger. The patient needs to perform exercises to learn how to use the new limb in everyday life.
- Surgery to remove the tumor without amputation. If a tumor can be separated from the nerves and other tissues, the surgeon is able to remove it and preserve the limb.
Since some bones are removed along with the cancer, the surgeon replaces the missing part with:
- another bone tissue (bone graft),
- a special metal prosthesis; in children, this prosthesis may need to be replaced with a larger one later when the child has grown.
- Surgery to remove the tumor that does not affect the limbs. If the tumor is not located in the arms or legs, the surgeon can remove the bone and adjacent tissue, as in the case of a tumor of:
– rib, – jaw,
In other cases, he may cut out the cancer and try to remove as few bones as possible, for example, if the tumor has affected the spine.
The bone removed during surgery can be replaced with a piece of tissue that:
- has been taken from another part of the body,
- comes from a donor.
Radiation therapy consists of using high-energy ionizing radiation (X-rays) to kill the tumor cells.
In radiation therapy, the patient lies on a couch while a special machine moves around him, sending rays of energy to certain points of the body.
Radiation therapy can be used in people with bone cancer where the tumor cannot be removed by surgery.
Usually, radiation therapy is not particularly effective in treating bone tumors, but it is helpful in reducing the size of the tumor mass before surgery.
Radiotherapy can also be carried out after surgery to kill any remaining tumor cells.
In patients with advanced bone cancer, radiation can help relieve signs and symptoms, such as pain.
Chemotherapy is a pharmacological treatment in which chemical substances are used to kill the tumor cells.
Chemotherapy can be administered as follows:
- in tablet form (oral).
Chemotherapy drugs travel throughout the body (systemic chemotherapy).
This treatment can be done independently or in conjunction with radiation before surgery to compact a bone tumor.
In this way, the surgeon can preserve the limb during the operation.
Chemotherapy can also be used in people with a bone tumor that has spread to other areas of the body.
Prognosis and survival rate of patients with bone tumor
The most important information for forecasting is the presence of any metastases.
Metastases originating in bone usually spread to the lungs.
If the patient has lung metastases, the 5-year survival rate is very low.
If the cancer affects only the bone, then with timely treatment, there is a discreet possibility of recovery.
Based on statistics, the following are the data of the survival rate after 5 years for the main bone tumors:
|Type of tumor||5-year survival rate|
|Ewing’s sarcoma||70-75 %|