BONE CANCER

Bone cancers are sarcomasthat is, cancers of connective tissue. Primary bone cancers are
relatively uncommon, constituting less than 0.2% of all cancers. Most (60% to 65% tumors of the
bone are secon!ary, or metastatic, ones from other "rimary tumors. #ancers originating in the
osseus, cartilaginous (chron!rogenic, or membrane tissue are classifie! as bone cancer. #ancers
originating from the bone marro$ are usually classifie! as hematologic cancers.
%he most common ty"e of "rimary bone cancer is osteosarcoma. &n osteosarcoma arises from
osteoblasts (bone'forming cells an! osteoclasts (bone'!igesting cells in the interior of the bone( it
occurs most commonly in the femur but also in the tibia an! humerus.
TYPE AGE OF PEAK OF
OCCURENCE
MAJOR LOCATIONS OF
THE BODY
)steogenic sarcoma,
osteosarcoma (*5% of all
cases
+0'*0 Bone of leg, arm an! "elvis
#hon!rosarcoma (26% of
all cases
Pea, in 50'60, but occurs in
ages 25'-5
#artilage of hi", leg an! rib
.$ing/s sarcoma (+6% of
all cases
+0'20 rare in a!ults 0*0
years
1ong bones of legs, arms
an! "elvis
2ibrosarcoma *0'30 Bone of leg, arm an! 4a$
#hor!oma 55'65 5"inal column or s,ull
Parosteal osteosarchoma *0'30 Bone of arm or leg
CAUSES:
)steogenic sarcoma is most common after "uberty, $hich suggests that hormonal fluctuations an!
s"urts of gro$th may be involve!. Bone cancers ten! to be more common in a!ults $ho are affecte!
by Paget/s !isease, hy"er"arathyroi!ism, an! chronic osteomyelitis. %he !evelo"ment of bone cancer
has also been lin,e! to trauma an! sites of ol! bone infarcts or fractures, multi"le e6ostoses
(overgro$th of bone tissue, multi"le osteochon!romas (benign bone tumor, an! bone marro$
trans"lantation.
GENETIC CONSIDERATIONS:
5everal factors can increase the ris, of bone cancer. 2amilies $ith retinoblastoma (an eye cancer
have an increase! ris,, as !o those $ith familial cancer syn!romes li,e 1i 2raumeni syn!rome. %he
genetic con!ition of multi"le here!itary e6ostosis (abnormal bone overgro$ths also increases the
li,elihoo! of bone cancer.
%he focus of the assessment shoul! be on gathering !ata that !ifferentiate bone cancer from arthritic
or traumatic "ain. %he "atient usually re"orts the gra!ual onset of "ain !escribe! as a !ull ache. %he
"atient often notices a s$elling or the inability to move a 4oint as before. & !istinctive trait of bone
cancer "ain is its ten!ency to be $orse at night. 7enerally, it is a locali8e!, aching "ain, but it may
also be referre! from the hi" or s"ine. %he su!!en onset of "ain !oes not rule out bone cancer,
ho$ever, because a "athological fracture may be "resent. 9f the cancer has s"rea!, the "atient may
re"ort $eight loss an! fatigue.
5erum al,aline "hos"hatise, (3.5:+* units;!1, .levate!, .levations occur $ith formation of
ne$ bone by increasing osteoblastic activity
<'rays an! com"ute! tomogra"hy (#%, =isuali8ation of lesions( malignant lesions often have
"oor margination, irregular ne$ bone gro$th, .ach tumor ty"e has its o$n characteristic
"attern( #% sho$s e6tent of soft tissue !amage
MEDICAL:
>a!iation has variable effectiveness in bone cancer. 9t is ?uite effective $ith .$ing/s sarcoma,
mo!erately effective $ith osteosarcoma, an! relatively ineffective in chon!rosarcoma. .ven $hen a
cure is not "ossible, ra!iation is often use! to !ecrease "ain an! slo$ the !isease "rocess. .6ternal
beam ra!iation thera"y, $here the ra!iation is !elivere! from outsi!e of the bo!y, is the ty"e most
often use! to treat bone cancer.
SURGICAL:
5urgery may range from sim"le curettage (removal of necrotic tissue or tumor $ith a curet, $hen
"rimary bone cancer is confine!, to am"utation or e6tensive resection such as a leg am"utation $ith
hemi"elvectomy.. Pain is usually manage! $ith narcotic analgesia in the imme!iate "osto"erative
"erio!. &s the "atient recovers, "rosthetic !evices are often fitte! after am"utations. %he "atient may
have a "rosthesis fitte! imme!iately or a more tra!itional !elaye! fitting. @sually, "hysical thera"y
$or,s $ith the "atient to hel" her or him learn $ays to maintain mobility an! the a""ro"riate use of
a""liances an! a!4uncts.
CHEMOTHERAPY:
Ao6orubicin, cis"latin, methotre6ate $ith calcium leucovorin, ifosfami!e, eto"osi!e
#hemothera"y is often use! "reo"eratively to re!uce the si8e of the tumor, or "osto"eratively to hel"
eliminate the ris, of micrometastasis
OTHERS:
&lthough they can !evelo" in any bone osteosarcomas most commonly arise the vicinity of
,nee (e.g., lo$er femur or u""er tibia or fibula.
%he cause of osteosarcoma is un,no$n. %he tumor has a bimo!al !istribution, $ith -5%
occurring in "ersons younger than 20 years of age
9n younger "ersons, the "rimary tumor most often is locate! at the anatomic sites associate!
$ith ma6imum gro$th velocitythe !istal femur, "ro6imal tibia, an! "ro6imal humerus.
)steosarcomas are aggressive tumors that gro$ ra"i!ly( they often are eccentrically "lace! in
the bone an! move from the meta"hysis of the bone out into the "eriosteal surface, $ith
subse?uent s"rea! to a!4acent soft tissues. %he tumor infre?uently metastasi8es to the lym"h
no!es because the cells are unable to gro$ in the no!e. Bo!al metastases usually occur only
in the late course of !isseminate! !isease.
Most often, the tumor cells e6it the "rimary tumor through the venous en! of the ca"illary, an!
early metastasis to the lung is common.
#linical manifestations inclu!e "ain, s$elling, limite! motion, an! $eight loss ($hich is
consi!ere! an ominous fin!ing. %he bony mass may be "al"able, ten!er, an! fi6e!, $ith an
increase in s,in tem"erature over the mass an! venous !istension
PATHOPHYSIOLOGY:
& tumor in the bone causes the normal bone tissue to react by osteolytic res"onse (bone !estruction
or osteoblastic res"onse (bone formation. Primary tumors cause bone !estruction, $hich $ea,ens
the bone, resulting in bone fractures. &!4acent normal bone res"on!s to the tumor by altering its
normal "attern of remo!eling. %he bone/s surface changes an! the contours enlarge in the tumor
area. Malignant bone tumors inva!e an! !estroy a!4acent bone tissue. Benign bone tumors, in
contrast, have a symmetric, controlle! gro$th "attern an! "lace "ressure on a!4acent bone tissue.
Malignant inva!ing bone tumors $ea,en the structure of the bone until it can no longer $ithstan! the
stress of or!inary use( "athologic fracture commonly results.