Tumors, cancer of the bones: symptoms, treatment, prognosis, metastases
Among all neoplasms, the proportion of bone tumours account for only about 1% of cases, although «bone cancer» can be heard much more often. The thing is that the rarity of primary tumor pathology, metastases to the bones – a rather typical phenomenon in cancer of various other organs. We will try to figure out what tumors actually originate from bone tissue.
Most malignant neoplasms of human cancers is presented, that is, epithelial neoplasias, while sarcomas (tumors of connective tissue origin) are much rarer. The explanation for this phenomenon is simple: the skin cells lining the surface of the gastrointestinal tract or the respiratory system, the surface layer of the skin, etc. constantly and rapidly updated, so the risk of mutation and malignant transformation in them is disproportionately higher than in the cells of muscles or bones that an adult human is divided, and only perform their functions and is regenerated at the expense of intracellular components.
Not looking for a rare tumor pathology of bones, a problem of their early detection remains quite acute, because timely diagnosis and the type of tumors to determine further tactics of treatment and prognosis and late diagnosis is fraught with the conduct of the crippling and highly traumatic surgical interventions.
Musculoskeletal system grows and is formed during childhood and adolescence, when there is an active development of bone, elongation of bones and to increase their mass.
- With the active growth and cell reproduction in these age periods and associated greater incidence of bone tumors in children and adolescents.
- In adulthood and old age to face such tumors little chance, but the proportion of metastatic lesions of the skeleton with a different pathology from a large elderly population.
Causes of bone tumours is still not formulated. Not to say that everyone knows and has already become «habitual» carcinogens, such as smoke or industrial emissions, cause of bone sarcomas. Not been proven, and the role of injury, although after many years of serious fractures can be diagnosed with a tumor. It is believed that trauma only promotes more frequent visits to the doctor and, consequently, radiographic studies, and can be revealed a tumor, even while not giving any symptoms.
Scientists determined some factors that may increase the likelihood of neoplastic transformation in bone tissue, but their presence was not necessarily indicative of a high risk of cancer. So, the most important are hereditary anomalies:
- For example, Li-Fraumeni syndrome is associated with a high incidence of tumors in General (breast cancer, brain tumor), and bone – in particular (osteosarcoma).
- Paget’s disease that affects the elderly leads to increased bone fragility, which often happen from fractures, and up to 15% of these patients develop osteosarcoma.
Radiation can lead to increased risk of bone tumors, but the dose of radiation must be quite high. Conventional x-ray examination or an annual chest x-rays in this respect, of course, safe, but the radiation therapy for other tumors, especially in childhood, significantly increases the carcinogenic potential of the cells of bone or cartilage. Accumulation in the bones of radionuclides with a long half-life (for example, isotopes of strontium), leading to long-term and chronic local exposure, so, too, can be considered as a carcinogenic factor.
In addition to cancerous, in the bones are growing and benign tumors that do not metastasize and do not damage the surrounding tissue, but can bring a lot of inconvenience. It is believed that benign bone tumors are mostly not prone to malignancy, but can reach considerable size, cause pain attacks and make cosmetic defect (e.g., osteomas in the bones of the skull).
Types of malignant bone tumors
As mentioned above, tumors of the bone are called sarcomas. The source of growth becomes directly the bone tissue and cartilage, which are essential for the normal functioning of the bones, their growth, regeneration and coupling in movable joints. Neoplastic process is more susceptible to the long bones (humerus, femur, tibia) than the ribs, spine or pelvis.
Most malignant bone tumors are prone to rapid growth and early metastasis, and their appearance is often sudden and unpleasant surprise, because there were no signs of trouble. Among patients mostly children, teenagers and young people up to 30 years, men get sick more often women.
Depending on the morphological and clinical features, there are:
In addition to these varieties of bone tumors can be vascular origin (hemangioma, hemangiosarcoma), as well as meet cm, liposarcoma, neuromas (from connective, adipose, nervous tissue).
Identifying the source of growth and histological characteristics of the tumor of the bone allows to predict its clinical course and response to different treatments, so the choice of a particular method of therapy, the dose or name of the chemotherapeutic agent is possible only after a thorough morphological diagnosis.
Osteosarcoma (osteogenic sarcoma)
Among all bone tumors leads in the incidence of osteogenic sarcoma (osteosarcoma), which is the transformation of connective tissue in the tumor bone. Maybe turning into a tumor through the stage of cartilage, as would occur during normal bone growth.
Men develop osteosarcoma in 2 times more often than women, and high morbidity falls on the second decade of life, after adolescence, accompanied by intense lengthening of bones. Young men up to 20 years, the most vulnerable point becomes the metaphysis of long bones is the area located between the diaphysis (middle part) and peripheral part of the bone covered with cartilage facing the joint, which ensures the growth of bones in length.
In the elderly, osteosarcoma can develop as a result of long-existing chronic osteomyelitis, as a complication of Paget’s disease.
Favorite localization of osteogenic sarcoma are the bones of the lower extremities, which are several times more likely than the top. Tumor growth in the femur occurs in about half of all cases of osteosarcomas, the neoplasia is located near the knee joint, but the patella is involved only rarely. The second place on frequency is the defeat of the tibia, also from the knee joint. Children may lose the bones of the skull, which is considered quite rare in adults.
Osteosarcoma is extremely aggressive, growing quickly, damage the soft tissue, quite early metastasizes mainly via blood vessels (hematogenous route), affecting the lungs, liver, brain and other internal organs.
Video: osteosarcoma is the most common tumor of bone
The second place on prevalence after osteogenic sarcoma, chondrosarcoma belongs to the. For this tumor is characterized by the formation of pathologically changed cartilage tissue, however, osteogenesis (bone formation) absent. The disease progresses slowly, metastases appear quite late, and among patients is dominated by people of Mature age. Characteristic is the defeat of the pelvis and extremities, but the tumor involves the ribs, skull, and even the cartilage of the larynx or trachea.
Chondrosarcoma, which develops on intact bones, referred to as the primary, and the neoplastic process arising after traumatic injuries, on the background of the presence of benign or neoplasm – secondary. Secondary chondrosarcoma is diagnosed in young people more often, and the prognosis for them is more favorable.
Ewing’s sarcoma is the third most common place. The disease affects mostly children, adolescents and young people under the age of 30. The tumor affects the long bones of the arms and legs, the pelvis (especially the Ilium), rapidly increases in volume, embedded in surrounding tissue, metastasize quite early on in the internal organs (lungs, liver, brain) and in the lymph nodes.
In contrast to osteosarcoma, bone metaphyses opting for their growth, Ewing’s sarcoma most often found in the diaphysis (middle part) and flat bones (scapula, Ilium) and the vertebrae. Filling the channel of the bone marrow, it quickly goes beyond the original localization to the periphery.
Giant cell tumor of bone
Giant cell tumor of bone in approximately 10% of malignant cases diagnosed in young people in the bones of the hands and feet, in the knee joint. Metastasis in this tumor type is rare, but recurrence after treatment – the phenomenon frequent. Such recurrences may be multiple and each subsequent accompanied by damage to the growing tissue.
Chordoma is a rare tumor growing from remnants of the embryonal cartilaginous tissue (the notochord). Detected in the bones of the skull base, spine. It is not prone to metastasize, but recurrence after non-radical removal of frequent. When the relative purity of current, chordoma dangerous possibility of damage to vital nerve centers and blood vessels, localizes in the area of the base of the brain. In addition, its location often makes it difficult to use of surgical or radiation treatment, and because the consequences can be very dangerous.
Fibrosarcoma, fibrous histiocytoma
Some soft tissue tumors can grow into the bone, for example fibrosarcoma or malignant fibrous histiocytoma (more on combined tumors — primary material sarcomas). Starting its growth in muscle, adipose or connective tissue, ligaments or tendons, these neoplasias are embedded in the bone of the lower or upper extremities, and sometimes of the jaws. Among patients prevail elderly, in contrast to primary tumors of bone.
Tumors of the hematopoietic and lymphoid tissue, such as leukemias, multiple myeloma, lymphoma may also be placed within the bone. Because they originate from elements of the bone marrow is not bone tissue, and relates them to a group of hematological malignancies (tumors of the blood system), although the bone lesions often accompanies these diseases.
Cancer in the bones — metastasis
Metastasis of epithelial tumors (cancers) can often be detected in the bones. These tumors are secondary, appear in the separation of cancer cells by blood flow. The bone metastases in prostate cancer are detected in advanced forms of the disease, the target for them, often become bones of the pelvis, lumbar-sacral spine.
Metastasis of kidney cancer in the bone is diagnosed in approximately 40% of patients, is the most common cause of severe pain syndrome. Most susceptible to metastatic lesions are considered the bones of the pelvis, spine, ribs, hip and shoulder Cells some types of kidney cancer can cause the destruction of bone tissue in the area, so patients prone to frequent fractures. In the vertebrae, metastatic tumor nodules can compress the spinal cord, leading to loss of sensation and motor function of the extremities, malfunction of the pelvic organs (urination, defecation).
Lung cancer is often accompanied by metastasis to the bones – spine, ribs, shoulder and hip etc. the Risk of metastasis is that the first time they are asymptomatic, but at some point the destruction of bone leads to fracture, which is especially dangerous in lesions of the vertebrae. The characteristic feature of bone lesions in carcinoma of the lung can be considered to increase the level of calcium in the blood due to the destruction of bone tissue.
For oncologist is important determining the stage of the cancer, taking into consideration the size of the lesion, the tumor beyond the primary site, the degree of damage of the surrounding tissues, the presence of metastases. The histological type is determined after taking a piece of tumor for morphological studies. The initial stage of the tumor characterized by restricted growth of the tumor, absence of metastases and General symptoms of the tumor. The first three stages of the disease correspond to the tumors without metastasis, while tumor grade (differentiation) may be different. Stage 3 is characterized by the appearance of multiple foci of tumor growth in bone, and in 4 the extent of the disease patients have metastases of sarcoma in the internal organs or lymph nodes, which reflects the neglect of the process.
Video: principles of cancer metastasis (including bone)
Manifestations of tumors of the skeletal system
Manifestations of bone tumors are not a great variety. Specific symptoms of the presence of tumors in the early stages, and yet the pain, especially in elderly patients, often written off to age-related changes. Persons who have suffered injury, should be especially careful, because the consequences of fractures can quite some time to mask tumor growth.
The most characteristic symptoms of malignant bone tumors:
- Swelling, deformation.
- The limitation, claudication in the defeat of the bones in the foot, fractures.
- Common signs of oncological process.
The most characteristic manifestation of the tumor is the pain that becomes constant, is particularly concerned at night, aching or throbbing emanating from deep tissues. Analgesics does not bring the desired result, and the attacks have become only more intense. Physical activity, walking with the defeat of the femur, large or small tibia lead to increased pain, limited mobility in the joints and lameness. Increased load on the bones of the extremities, spine, contributes to the so-called pathological fractures in the area of growth of the tumor.
As you increase the volume of the tumor tissue, appears swelling, increasing the size of the affected bone and deformity. Bone sarcomas are prone to rapid growth, so the swelling can be detected after a few weeks of onset. In some cases it is possible to probe and the tumor itself.
With the progression of the cancer process, there are signs of tumor toxicity as weakness, declining health, weight loss, fever. In some types of tumors are possible local reactions of redness and increase skin temperature (Ewing’s sarcoma).
Bone sarcoma can lead to compression of nerves and large blood vessels, resulting in a pronounced venous vascular pattern, edema of the soft tissues and severe pain in the course of the affected nerves. Compression of the spinal roots is fraught with loss of sensation, paresis and even paralysis of certain muscle groups.
The incidence of sarcoma of the skull bones dangerous damage to brain structures, and the localization of tumors in the temporal lobe can lead to hearing loss. Most often among malignant tumors in the head region revealed osteogenic sarcoma and Ewing’s sarcoma. With the defeat of jaws broken their mobility, so speech and eating can be hampered.
After inspection by a specialist, detailed the nature of complaints and the time of their appearance, the patient is sent for further testing. The main and most available method of detection of the tumor is x-ray. X-ray study should be subjected to whole bone as a whole, and produce images in multiple projections.
Characteristic diagnostic signs of the tumor will be:
In addition to radiography, use other diagnostic methods.
- Computed tomography (with contrast);
- Radioisotope bone scan;
- Biopsy of fragments of the tumor.
An integrated approach to the study of the affected area of the body allows to determine the anatomical correlation of the tumor with the surrounding tissue, its size, stage of the disease. To exclude metastasis in the internal organs necessarily produce x-rays of the lungs (the most frequent localization of metastases) and ultrasound examination of abdominal cavity.
To determine the type of neoplasm, the degree of differentiation necessary to conduct the morphological study. Biopsy (taking a piece of tumor) can be produced using a thick needle or open way during surgery for removal of tumors. If necessary, biopsy is performed under ultrasound or x-ray.
Video: a lecture on the diagnosis and therapy of bone cancer
Treatment of bone sarcomas
The main methods of treatment of malignant bone tumors are considered surgical removal of the tumor, radiation and chemotherapy. Approaches to the choice of a specific technique or their combination depends on the type, localization of the tumor, General condition and age of the patient. The use of modern chemotherapy, neoadjuvant and adjuvant chemotherapy have reduced the number of female genital mutilation by amputation of the limbs and, thus, to increase the effectiveness of treatment in General.
Surgical removal of the tumor is the main and most effective way of dealing with the disease. The tumor must be completely removed within healthy tissue. In case of large tumor size and high risk of metastasis before the operation can be performed neoadjuvant chemotherapy or radiation.
In cases of considerable destruction of the limb bones, may need amputation, although in recent years these operations becomes smaller. After treatment, the patients in need of prosthetics or plastic surgery for the replacement of defects of the musculoskeletal apparatus.
When bone sarcoma of the extremities (femoral, tibial, calcaneal) question the possibility of organ-saving operations is particularly acute, so important is early detection of the disease when the tumor has not germinated soft cloth and began to metastasize.
In the postoperative period, when the likelihood of recurrence or metastasis is large, there are additional courses of chemotherapy (adjuvant chemotherapy).
In advanced stages of tumor growth, when the affected muscles, large vessels and nerves, there are signs of infection of tumor tissue, began an active metastasis of conducting organ-saving operations is dangerous and therefore contraindicated. In such cases, doctors are forced to resort to total removal of the affected area of the skeletal system in parallel with chemotherapy and radiation exposure. If the patient has discovered an isolated lung metastases, they can also be treated surgically.
Radiation therapy is not used as often as in other types of tumors, however, some sarcomas (Ewing’s sarcoma, for example), this method is quite effective and widely used. Radiation can be carried out both before and after surgical treatment, and in severe cases, when the operation is no longer possible, radiation exposure is applied as palliative care designed to alleviate painful symptoms of the tumor.
Chemotherapy is quite effective for most bone sarcomas. Partly thanks to this method and its proper combination with other ways of dealing with the tumor has become possible to keep the patient’s limb. The purpose of chemotherapy before surgery need to reduce the size of the neoplasia, and postoperative chemotherapy helps to prevent recurrence and growth of microscopic metastases.
Since chemotherapy and radiation have an adverse effect on the reproductive system, and among the patients a lot of children and adolescents, when you need this kind of treatment of patients of male doctors may offer to use the services of a sperm Bank.
Bone sarcoma – a serious diagnosis, so it is worth to remind that the self and the use of folk remedies is fraught with complications and progression of the disease due to the loss of such a precious time for cancer patients. No decoctions, lotions or rubbing will not be able to turn cancer growth backwards, so, no matter how heavy have not had treatment by an oncologist, it’s better to pass it.
To avoid re-growth of tumor after treatment, all patients must be under the supervision of an oncologist, to undergo regular preventive examinations and to pay attention to the appearance of disturbing symptoms. The first two years after tumor removal is necessary to visit a doctor every three months, third year every 4 months, then every six months, and after five years – annually. If these intervals of time there will be signs of a return of the disease, worse overall health, we urgently need to see a doctor, without waiting for the next scheduled inspection.
The prognosis of bone sarcomas serious. Even if there are metastases, it is necessary to remember a large relapse rate of many bone tumors, and each return of the disease is heavier than the previous, and affect a larger volume of tissue.
Not looking at the high malignancy of many bony sarcomas, their aggressive course and rapid growth, timely and comprehensive treatment can achieve good results. Thus, in the detection of tumors in I-II stages 5-year survival rate reaches 80%. If the tumor is sensitive to chemotherapy, after removal of 80-90% of patients live five years or more. Late presentation to the doctor, the presence of metastases, massive germination tumor of soft tissues, the prognosis becomes much worse, and survival rate rarely exceeds 40%.
Life expectancy after treatment of sarcoma of the bone depends not only on the stage of the disease and timely treatment, but also from the lifestyle of the patient. It is important to eliminate the harmful effects of Smoking, to observe a rational diet, lead an active lifestyle. The probability of living one year after surgery is increased in patients who are themselves responsible and takes care of their health, and also help the doctor in a timely manner coming to the reception.