Bone tumours
comprise of benign (non-cancer) and malignant tumours. They afflict people in the
prime of their life, and since they usually involve the limbs, they are a
source of morbidity, loss of livelihood and social ostracisation.
Great strides
have been made in the early diagnosis and management of bone sarcomas
especially in the field of limb preservation, so much so, that malignant bone
tumours are no longer the dreaded cancers that they once were.
Signs and symptoms
* Pain in the
bones
* Swelling
* Restriction of
joint movement
* Erythema
(redness and raised temperature over swelling)
Evaluation
A preliminary
work up by way of a clinical examination and X-ray of the local part reveals it
to be a bony lesion. Thereafter, taking into consideration the age of the
patient and radiological characteristics of the tumour, the lesion can be
characterized as benign or malignant with greater than 90 per cent accuracy. Suspected
malignant lesions require further evaluation to know the histology and stage of
the tumour. Bone biopsy by a bone needle done as a day-care procedure is the
preferred method. It produces minimal trauma and soft tissue contamination by
tumour as compared to an open biopsy, which should be used only as a last
resort.
CT scan and MRI
scan identify local spread of the disease and neurovascular (blood vessels and nerves)
involvement.
Staging
Bone scan and
PET scan identify metastatic disease i.e. spread of disease to other parts.
Management
Benign bone
tumours, which are asymptomatic, can be observed whereas the larger lesions and
symptomatic (bone pain etc.) require surgery:
* Bone curettage
with bone cementing or grafting
* Wide local
excision with bone cementing and bone grafting
Malignant bone tumours
The principles
of treatment are local control of the disease and prevention of metastases. The
chemo sensitive bone sarcomas like osteosarcoma and Ewing's tumour undergo two
to three cycles of neoadjuvant chemotherapy (i .e. drugs that kill cancer cells
given by way of intravenous infusion) to downstage and downsize the tumour. The
next stage of the treatment is surgery.
Prior to the
1990s, nearly all extremity sarcomas were treated by amputation of the affected
limb which still did not lead to high cure rates. In the last decade, with
better understanding of the biology of the disease, and achievement of specialised
expertise procedures like limb salvage surgery, today limb conservation is
possible in more than 70 per cent of patients. Limb salvage surgery is a
complex two stage limb preservation procedure.
* Stage I -
Meticulous neurovascular dissection is done to separate nerves and vessels from
the tumour bearing bone. The entire
liability and functionality of the limb is dependent on this step.
* Stage 11-
Prosthetic (Titanium) implantation in the gap produced by removal of the bone
enzymes preserves integrity of the limb. Thus at the end of the procedure the
diseased portion of the limb has been removed with preservation of a functional
limb.
Children and
adults no longer have to face ostracisation and pity due to amputation, and
with the help of limb salvage surgery can continue to lead productive lives on their
own feet. Early detection of bone sarcomas and appropriate treatment leads to
high cure rates.
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