A tumor is a mass or swelling formed by uncontrolled dividing body cells and their massive growth within the tissue and/or organ in which they emerged. The cause of most bone tumors is unknown. The growing tumor spreads to healthy tissues over time, causing healthy tissues to be replaced by abnormal tissues and weakening the bone, leading to pathological fractures. If necessary precautions are not taken, aggressive tumors can cause functional failure within the organ system in which they develop and can even be life-threatening by affecting the entire body metabolism.
Most bone tumors are benign. Some may be malignant. Rarely, infection, stress fracture, and other non-tumor conditions may exhibit tumor-like behavior.
Benign tumors are not life-threatening. Malignant ones can also spread throughout the body and form metastases. Metastasis is the spread of cancerous cells outside the tissue where they are located, either directly or via blood/lymph.
Cancer that starts in the bone (primary) is different from cancer that starts in another part of the body and settles in the bone (secondary). Tumor development and destruction depend on the biological behavior of tumor cells. While some bone tumors can only be detected by chance, some tumors can cause many symptoms that are very disturbing to the patient.
Types of Bone Tumors
Tumors that are malignant
Metastatic Bone Tumors: They are malignant tumors that spread to the bone from other organs. Patients often present with complaints of pain that does not go away with rest or pathological fractures. Prostate, lung and breast cancers are the types of cancer that most commonly metastasize to bones.
Multiple Myeloma: Multiple myeloma is the most common primary bone cancer. It is a malignant tumor of the bone marrow. It can kill up to 20 people per million each year. It can affect any bone and is seen in patients between the ages of 50 and 70.
Osteosarcoma: Osteosarcoma is the second most common bone cancer. Osteosarcoma, which often occurs in adolescence and in the knee area, is seen in 2-3 people per million every year. Although less common, it can also be seen in the hip and shoulder area.
Ewing sarcoma: Ewing sarcoma is most common between the ages of 5 and 20; It causes bone destruction along with a large soft tissue mass. It is most commonly seen in the body in the upper and lower extremities, pelvis and rib bones.
Chondrosarcoma: Chondrosarcoma is a type of bone tumor that often occurs between the ages of 40 and 70 with a mass in the hip area, pelvis and shoulder.
The most common ones are;
- Non-ossifying fibroma
- Simple bone cyst
- giant cell tumor
- fibrous dysplasia
What are the symptoms of bone tumor?
The pain experienced in most patients with tumors is usually dull and continuous (persists at rest); It is not related to activity and often worsens at night.
Trauma is not the cause, but pain increases after trauma. Pathological fracture occurs in weakened bone, which increases pain. Some tumors cause fever and night sweats. Sometimes they present with a painless mass. Some tumors may be encountered incidentally in films taken in cases such as ankle trauma.
How to Diagnose Bone Tumor?
If you think you have some of the symptoms and/or complaints mentioned above, it would be appropriate to consult a physician. Medical examinations and evaluations will help you in this regard.
The physician you consult will first take a detailed medical history from you. This history will cover every detail about your medical history, from the medications you take to any illnesses you have had before.
Your doctor will give you a detailed physical examination. During the examination, if there is a tumor and/or tumor suspicion, your physician will investigate the size of the mass, its mobility, whether it is adherent or not, its relationship with the joints, and, if necessary, will also perform examinations of other systems.
Your doctor will request a simple imaging film, which we call “direct” radiography, to evaluate the body part you are complaining about. Bone pathologies of different characteristics, including bone tumors, create different images on plain radiographs. Some will show excessive calcification (bone formation) and some will show bone resorption. Sometimes these two situations may appear mixed together. These radiographs will be evaluated together with a report prepared by the radiology department, your physician’s examination results and, if necessary, laboratory test results.
In some cases, direct radiographs may not be sufficient to elucidate the cause of the problem, and physicians may also benefit from more advanced imaging techniques such as computed tomography, MRI, bone scintigraphy, PET scan and lung tomography. While tomography is used to see bony details, MRI is also used to see whether there is soft tissue spread, tumor extension within the bone, or spread to distant points. Bone scintigraphy gives us information about whether there is metastasis or activation of the tumor.
Complete blood and/or urine analysis may be required. Biopsy is another method of sampling and should be performed by an orthopedic oncologist specialized in this field at the center where the main surgical intervention will be performed. Depending on the tissue to be sampled, biopsy options may be needle biopsy or open biopsy. It is very important that the pathologist be experienced in this field as well as the biopsy to be preferred. The sample to be taken will be sent to the pathology department to be examined at the cellular level and undergo some necessary staining tests.
What is the treatment of bone tumors?
Treatment of Benign Bone Tumors
Although the treatment of benign bone tumors varies depending on the type of tumor and the age of the patient, observation is sufficient in most cases. In some cases, medical treatment relieves the pain. Some disappear on their own over time (especially in children).
Close clinical observation may be required to investigate whether some benign bone tumors change their character (turning into malignant, progressing and spreading to other tissues). In some cases, the doctor recommends removing the tumor (excision), which prevents possible pathological fractures. However, in some tumor types, it may occur again even if the mass is removed (we call this situation recurrence). Giant cell tumor is one of the tumors that are benign but become increasingly aggressive over time. In some cases of osteochondroma with multiple locations, malignancy may occur, that is, cancer.
The most useful way to follow is to be under the control of a physician in order to monitor whether the above different clinical courses occur over time.
Treatment of Malignant Bone Tumors
If you are dealing with a malignant bone tumor, you may always want to seek evaluation from another physician and/or healthcare provider. Treatment of bone cancers is done by a healthcare team working as a team. Among the physicians that make up this team, we can count orthopedic oncologists, medical oncologists, radiologists, radiation oncologists and pathologists. When faced with such situations, the aim of the entire team is to defeat the cancer and protect the associated organ and/or extremity. Following evaluation of the patient’s condition, physicians may use several treatment options together. [örneğin; ilaçla tedavi (kemoterapi), ışın tedavisi (radyoterapi), cerrahi]. The biological behavior (type) and stage of the tumor (the presence of metastasis, also known as “enveloping” tissues other than where the tumor is located) play an important role in the decision on treatment approach.
If your physician thinks that you will benefit from a surgical treatment approach, this treatment may be in the form of evacuating only the tumor focus, or it may be in the form of removing the tumor tissue together with the healthy tissue in a narrow or wide area around it (wide en-bloc resection). The aim here is to make the extremity functional after providing the patient with oncological treatment. While doing this, the latest technical developments in reconstructive surgery, which we can also call “restructuring”, are used. Prosthesis, bone grafts (allograft, which means transplantation from the patient’s own healthy tissue instead of the diseased tissue) and biological reconstruction methods are frequently used today.
Some malignant bone tumors are sensitive to radiation therapy. It can be used alone or in combination with other treatments.
Drug therapy can be therapeutic to varying degrees depending on the biological behavior of the disease. It can usually be applied before or after surgery.
How should follow-up be after treatment?
It is one of the most important issues. It is necessary to follow up the patient first at short intervals and then for the following years. In this way, recurrence of the disease or its spread to other organs is detected early and the necessary treatment is planned. During this period, the patient should also be given psychological support and allowed to return to his social life.
Apart from primary malignant tumors of the bone, tumor formation through metastasis may occur from lung, breast, thyroid and, in men, prostate cancers. Bone pain that occurs in older ages and especially in people with a malignant tumor in one of their organs should be carefully examined.