Difficult operations for the bone tumors are applied succesfully
Date:
28/06/2011
Tumors are defined as masses or swellings that consist of dividing cells out of control, and these tumors can be seen also in bones. Persisting bone pain is thought to be the most important clue of bone tumors. Anadolu Medical Center Orthopaedics and Traumatology specialist Professor Kaan Erler, says that “in most of bone tumors, the cause is not known and sometimes it is genetic. Healthy tissues are replaced by abnormal tissues. Tumor weakens the bone and results in a pathogic fracture. If the preventions needed are not taken, rapidly developing (agressive) tumors move towards the other tissues and cause metastatis.”
Prof. Dr. Erler, says that the most of the bone tumors are benign. And he adds : “Cancer that starts in the bone (primary) differ from the cancer that starts in the other parts of the body and moves to the bone (secondary). Development of tumors and the damage they do in the tissues depend on their biologic behaviours. Some are detected incidentally, some cause significiant conditions. Prof. Dr. Erler, answered our questions about the diagnosis and treatment of bone tumors.
What are the most common bone tumors ?
Most common bone tumors of primary origin are these:
Multiple Myeloma: It is the most common primary bone tumor. It is the malign tumor of bone marrow. Every year it causes 20 people per million. It is seen at the ages of 50-70 and it can effect any bone.
Osteosarcoma: It is secondarily most common primary tumor of bone origin. Frequently seen in adolescents and located at the knee region resulting in death of 2-3 people per million every year. Less commonly seen in hip and shoulder region.
Ewing’s Sarcoma: Mostly seen at the ages between 5-20. It has a wide soft tissue mass and bone damage. It is seen most common in upper and lower extremities, hip bone and chest.
Chondrosarcoma: Most commonly seen in the ages between 40-70. It produce masses at the region of the hip, hip bone and shoulder.
What kind of findings are seen with these tumors ?
There is pain in most of patients with tumor. Pain is generally perceived as continuous discomfort with low intensity called as “blunt” pain. Pain persists although the patient has a rest and it becomes worse at nights. Trauma is not a cause but pain increases after trauma. Pathologic fracture is seen in weakened bones and it increases the pain. Some tumors result in fever and night sweats. Sometimes it is seen as painless masses. Some tumors are detected incidentally by x-ray after traumas of ankle.
What should be done in case of these kind of painful situation ?
If the person thinks that he can have bone tumor, it is necessary for him to see his doctor immediately.
Which steps are taken while diagnosis is made ?
Doctor takes a detailed history of the patient in order to learn the medical history of the patient. History includes all the details from the drugs used and until all the diseases the patient had before.
Size and motility of the tumor, its relation with the joints and whether it is sticked are investigated and examination of the other systems if it is needed. First an X-ray of the patient is taken. Different bone tumors give different images on X-ray. Some show excess calcification and some show resorption of the bone. Sometimes we see both mixed.
Is X-ray enough to detect the tumor, or some imaging method more is needed ?
Some tumor can be seen in X-ray but in order to distinguish the type of the tumor, we use detailed imaging methods like tomography, MRI, scintigraphy, PET scan and tomography of the lung. We use tomography to see the details of bone, and MRI to see the extention of tumor in the bone or to see the spread of the tumor to the distant places. Scintigarphy of the bone give information about the biologic activation of the tumor or whether there is metastatis.
What kind of tests are used for the diagnosis ?
Full blood count or urine sample can be necessary. Biopsy that is used to have a tissue sample is another sampling test, and it has to be done in the center where the surgical intervention will be performed by a specialist in the area of orthopaedic oncology. It can be in the form of needle biopsy or open biopsy. Experience of the pathologist is important as much as the method used.
How is the treatment of the malign bone tumors performed?
If you see a malign bone tumor, then it is beneficial to take a second idea. Treatment of the bone tumors is done in a team work. Main members of this team are orthopaedic oncologist, medical oncologist, radyologist, radyation oncologist, pathologist. Aim of the treatment is to overcome the cancer and protect the extremity.
As medicine develops, what kind of improvements are seen in the treatment of the bone tumors? Is there any change in the surgical methods ?
Formerly, amputations of the extremities were done in order to remove the cancer from the body. But now, there is a surgical approach that protects extremity and remove the tumor. Surgical treatment can be done as removing of the focus of the tumor or as its removal together with narrow or wide part of healthy tissue around it.
Aim is to provide a functioning extremity after the oncologic therapy. Development in reconstructive surgery is beneficial at doing this. Prosthesis, bone grafts that are parts of bone taken from another parts of skeletal system used for healing of the diseased area and methods of biological reconstruction are frequently used.
What are the other methods ?
Some bone tumors are sensitive to the radiotherapy. Radiotherapy has to be done alone or together with other therapies. Chemotherapy can be a cure depending on the biological behaviour of the disease. It can be applied before or after the surgery.
Is there any difference between sexes in the risk of catching this disease ?
We can give information about The USA about this subject. Malign bone tumors are seen in 2500 cases and benign ones are seen in 200.000-300.000 cases in a year. Metastasis to the bone is seen in 250.000 – 300.000 cases in a year. There is no difference between sexes in the risk of having a disease of bone tumor.
What do you want to say about the follow-up of the patients after the treatment ?
Follow-up of the patient is done first in between short time intervals, then it will be done by spreading it to the years. By this method, recurrence of the disease or its spread to the other organs is detected at an early time and a plan of treatment is made. In this term, patient has to take psychological support and turn to his social life. Lung, breast, thyroid and prostate cancer are the leading causes that metastasize from the other organs except primary malign tumor of the bone. Additionally, bone pain that arise at the old ages has to be investigated carefully.
What is amputation ?
Amputation is the removal of the diseased area of the body in order to save the life of the patient in the case that it is impossible to protect the organ. For instance, if it is seen in the leg, the leg has to be taken. But we are now far from this surgical approach by the development in the diagnosis and treatment methods. 90% of patients with cancer in the 80’s were being treated with this method, but now this ratio is under 10%.
What can you say about the benign bone tumors and and their treatment ?
“Most common benign bone tumors are non-ossifying fibroma, simple cyst of the bone, osteochondroma, giant cell tumor, enchondroma and fibrous dysplasia. As well as the treatment of the benign bone tumors depend on the type of the tumor and age of the patient, in most cases it is enough to follow-up the patient. In some cases, medical treatment resolves the pain. In some, especially that are seen in children, can spontaneously disappear in time. Some benign tumors can return into malign tumors and there can occur metastasis. Sometimes doctor recommend the excision of the tumor. This approach prevents the possible pathologic fractures. Some tumors can occur again, although they are excised. Giant cell tumor is the leading benign tumor that can have an agressive course. In some cases of osteochondroma that is located in multiple areas can return into cancer.
BE CAREFUL ABOUT THESE FINDINGS !
Orthopaedics and Traumatology specialist Professor Kaan Erler: If you have pain although you have rest and if you think that you have a tumor in your bones, please visit your doctor immediately. Orthopaedic oncologists will help you in every situation.”