Bone Tumors

– Abnormal cell growth in bone tissue

– defined as:
a. Benign – noncancerous and not life-threatening
b. Malignant – cancerous and can spread cancer cells throughout the body (metastasize). This
happens via the blood or lymphatic system
– Classified as:
1. Primary Tumors – originate in the bone
2. Secondary – originate elsewhere and spread from other organs such as:
a. Breast
b. Lung
c. Kidney
d. Prostate
e. Colon
f. Thyroid
– Causes - unknown.
They often arise in areas of rapid growth. Possible causes include:
1. Inherited genetic mutations
2. Radiation
3. Trauma
But in most cases no specific cause is found
– Signs and Symptoms
1. pain in the area of the tumor
2. Some bone tumors may weaken the structure of the bone, causing pathologic .
3. Occasionally a mass and swelling can be felt at the tumor site
4. Fever
5. night sweats
6. weight loss

*Many patients will not experience any symptoms, except for a painless mass.
- The Most Common Bone Tumors
a. Benign Bone Tumor
1. Osteoid Osteoma - found most frequently in the femur and in males.
- Symptoms include pain, mostly at night.
- Diagnosis is by X-ray.
- Most cases do not require invasive treatment, just the use of aspirin or non-aspirin
analgesics for pain.
2. Osteoblastoma – are small, and are seen most frequently in children or young
adults.
- Symptoms include pain and bone mass reduction. Treatment is primarily by
surgery.
- Chemotherapy and radiation have also been used to treat osteoblastoma but are
controversial.
3. Osteochondroma - an abnormal, solitary, benign growth of bone and cartilage,
typically at the end of a long bone.
- are usually discovered in persons 15 to 25 years of age.
- They are typically detected when the area is injured, or when they become large. It
can be a hereditary condition, in which case it may be called hereditary multiple
exostoses (HMS).
4. Enchondroma - a cartilage cyst found in the bone marrow
5. Chondromyxoid fibroma – rare and most often found in the long tubular bones,
especially the tibia and femur near the knee joint
6. Giant Cell tumor - characterized by massive destruction of the end (epiphysis) of a
long bone which has the potential to become malignant.

a. Malignant Bone Tumor

 1. Osteosarcoma
– is the most common primary malignant bone cancer.
– most commonly affects males between 10 and 25 years old, but can less commonly affect older
adults.
– often occurs in the long bones of the arms and legs at areas of rapid growth around the knees
and shoulders of children.
– This type of cancer is often very aggressive with risk of spread to the lungs.
– The five-year survival rate is about 65%.
1. Ewing's sarcoma
– the most aggressive bone tumor
– affects younger people between 4-15 years of age.
– more common in males and is very rare in people over 30 years old
– most commonly occurs in the middle of the long bones of the arms and legs
– The three-year survival rate is about 65%, but this rate is much lower if there has been spread to
the lungs or other tissues of the body.
1. Chondrosarcoma
– the second most common bone tumor
– accounts for about 25% of all malignant bone tumors
– These tumors arise from the cartilage cells and can either be very aggressive or relatively slow-
growing.
– Unlike many other bone tumors, chondrosarcoma is most common in people over 40 years old.
– slightly more common in males and can potentially spread to the lungs and lymph nodes
– most commonly affects the bones of the pelvis and hips
– The five-year survival for the aggressive form is about 30%, but the survival rate for slow-growing
tumors is 90%.
1. Malignant fibrous histiocytoma (MFH)
– affects the soft tissues including muscle, ligaments, tendons, and fat
– the most common soft-tissue malignancy in later adult life, usually occurring in people 50-60
years of age
– most commonly affects the extremities
– about twice as common in males as females.
– MFH also has a wide range of severity.
– The overall five-year survival rate is about 35%-60%.
1. Fibrosarcoma
– much more rare than the other bone tumors
– most common in people 35-55 years of age
– most commonly affects the soft tissues of the leg behind the knee
– slightly more common in males than females

1. Chordoma
– a very rare tumor with an average survival of about six years after diagnosis
– occurs in adults over 30 years of age
– about twice as common in males as females
– most commonly affects either the lower or upper end of the spinal column

There are two other relatively common types of cancer than develop in the bones:
1. Lymphoma - a cancer arising from the cells of the immune system, usually begins in the lymph
nodes but can begin in the bone.
2. Multiple myeloma - begins in the bones, but it is not usually considered a bone tumor because it
is a tumor of the bone marrow cells and not of the bone cells.

– Possible Complication
1. Pain
2. Reduced function, depending on the extent of the tumor
3. Side effects of chemotherapy (depending on the type of chemotherapy)
4. Spread of the cancer to other nearby tissues (metastasis)

– Diagnosis
 A. Complete Medical History
- any previous tumors or cancers that you or your family members may have had
- symptoms you are experiencing
- medication taken
B. Physical Examination
- The focus is on the tumor mass, tenderness in bone, and any impact on joints and/or range of
motion. In some cases, the doctor may want to examine other parts of your body to rule out
cancers that can spread to bone.
C. Diagnostic and Laboratory Exams
1. X-Ray
– can show the location, size, and shape of a bone tumor
– different types of tumors have different characteristics on X-ray
1. Bone Biopsy
- only definitive method to determine whether a tumor is malignant or benign
2. Blood test
+ to determine the level of Alkaline phosphatase
- normal range is 20 to 140 IU/L
- elevated ALP indicates that there could be active bone deposition
3. Bone scan
- visually detect bone abnormalities
- detects cancers that have spread (metastasized) to the bone
4. MRI (Magnetic Resonance Imaging)
- visualize detailed internal structure of the bone
6. CT Scan
- for further examination
- tell if your bone cancer has spread into your lungs, liver, or other organs. These scans also
show the lymph nodes and distant organs where metastatic cancer might be present.

- Management
+ Treatment options depend on the type, size, location, and stage of the cancer, as well as the
person’s age and general health.

A. Surgery
– the usual treatment for bone cancer
– removes the entire tumor with negative margins (no cancer cells are found at the edge or border
of the tissue removed during surgery)
– also use special surgical techniques to minimize the amount of healthy tissue removed with the
tumor.
– Dramatic improvements in surgical techniques and preoperative tumor treatment have made it
possible for most patients with bone cancer in an arm or leg to avoid radical surgical procedures
(removal of the entire limb). However, most patients who undergo limb-sparing surgery need
reconstructive surgery to maximize limb function.
A. Cryosurgery
– use of liquid nitrogen to freeze and kill cancer cells
– can sometimes be used instead of conventional surgery to destroy the tumor
A. Chemotherapy
– use of anticancer drugs to kill cancer cells.
– Patients who have bone cancer usually receive a combination of anticancer drugs. However,
chemotherapy is not currently used to treat chondrosarcoma.

A. Radiation therapy
 – also called radiotherapy, involves the use of high-energy x-rays to kill cancer cells.
– may be used in combination with surgery
– often used to treat chondrosarcoma, which cannot be treated with chemotherapy, as well as
ESFTs.
– may also be used for patients who refuse surgery
A. Hormone therapy
– either the removal of the organs which produce hormones which can promote the growth of
certain types of cancer (such as testosterone in males and estrogen in females), or drug therapy
to keep the hormones from promoting cancer growth.
A. Medication
Biphosphonates
– used to reduce bone pain and slow down bone damage in people who have
cancer that has spread to their bones.

A. Diet
1. Foods rich in Calcium
-Make sure your diet has plenty of dairy products such as milk, yogurt and cheese.
2. Foods rich in Phosporus
- avoid sodas and cut back on meat and poultry intake
- Having too much phosphorus means that your body will draw calcium from your bones to
balance it out, and that is exactly what you don't want happening with fragile bones
3. Diet should include fish, poultry, legumes, low-fat yogurt, fruits and vegetables and whole grains
and cereals. Green tea has antioxidants making it more effective than vitamin E and C in fighting fre
-radicals. Garlic contains allyl sulfides that inhibit cancer-causing chemicals. Tomatoes contain the
antioxidant lycopene. You want to concentrate on eating a healthy diet that will be rich in nutrients
needed as your body tries to heal itself
4. Vegetable Juice
- Try combinations of carrots, parsley, celery, cucumber, spinach, kale, garlic, onion, broccoli,
green pepper and tomato to create a recipe you like.

A. Supplements
- Vitamin and mineral supplements can help provide essential nutrients that may be lacking in
your diet, and offer a boost where bone cancer may have depleted nutrients in your body. The
CTCA vitamin and mineral supplementation plan includes nutrients designed to help support your
immune system and reduce toxic side effects of conventional bone cancer treatment.

B. Have appropriate exercise program

How Are Bone Cancers Staged?

Staging is a process that tells the doctor how widespreadacancer may be. It will show whether the cancer has spread and how far. The
treatment and prognosis (outlook) for bone cancers depend, to a large extent, on the patient's stage at diagnosis.
AJCC Staging System
One system that is used to stage all bone cancer is the American Joint Commission on Cancer (AJCC) system. T stands for features of
tumor (its size), N stands for spread to lymph nodes, M is for metastasis (spread) to distant organs, and G is for the grade of the tumor. This
information about the tumor, lymph nodes, metastasis, and grade is combined in a process called stage grouping. The stage is then
described in Roman numerals from I to IV (1-4).
T stages of bone cancer
TX: Primary tumor can't be measured
T0: No evidence of the tumor
T1: Tumor is 8 cm (around 3 inches) or less
T2: Tumor is larger than 8 cm
T3: Tumor is in more than one place on the same bone
N stages of bone cancer
N0: The cancer has not spread to the lymph nodes near the tumor
N1: The cancer has spread to nearby lymph nodes
M stages of bone cancer
M0: The cancer has not spread anywhere outside of the bone or nearby lymph nodes
M1: Distant metastasis (the cancer has spread)
M1a: The cancer has spread only to the lung
M1b: The cancer has spread to other sites (like the brain, the liver, etc)
Grades of bone cancer
G1-G2: Low grade
G3-G4: High grade
TNM stage grouping
After the T, N, and M stages and the grade of the bone cancer have been determined, the information is combined and expressed as an
overall stage. The process of assigning a stage number is called stage grouping. To determine the grouped stage of a cancer using the
AJCC system, find the stage number below that contains the T, N, and M stages, and the proper grade.
Stage I
All stage I tumors are low grade and have not yet spread outside of the bone.
Stage IA: T1, N0, M0, G1-G2: The tumor is less than 8 cm.
Stage IB: T2 or T3, N0, M0, G1-G2: The tumor is either larger than 8 cm or it is in more than one place on the same bone.
Stage II
Stage II tumors have not spread outside the bone (like stage I) but are high grade.
Stage IIA: T1, N0, M0, G3-G4: The tumor is less than 8 cm.
Stage IIB: T2, N0, M0, G3-G4: The tumor is larger than 8 cm.
Stage III
T3, N0, M0, G3-G4: Stage III tumors have not spread outside the bone but are in more than one place on the same bone. They are high grade.
Stage IV
Stage IV tumors have spread outside of the bone they started in. They can be any grade.
Stage IVA: Any T, N0, M1a, G1-G4: The tumor has spread to the lung.
Stage IVB: Any T, N1, any M, G1-G4 OR Any T, any N, M1b, G1-G4: The tumor has spread to nearby lymph nodes or to distant sites
other than the lung (or both).
Even though the AJCC staging system is widely accepted and used for most cancers, bone cancer specialists tend to simplify the stages
into localized and metastatic. Localized includes stages I, II, and III, while metastatic is the same as stage IV.

Osteoid osteoma diagnosis was incorrect For stage 3 lesions, wide

and the initial lesion was resection is recommended
- Pain may be relieved by an osteosarcoma, since because of the need to
aspirin or histologic differentiation of remove all tumor-bearing
other nonsteroidal these two entities can be tissue. Wide excision is
antiinflammatory drugs. very difficult. defined here as the
Ablation (removal) is also The alternative means of excision of tumor and a
performed in some cases treatment consists of circumferential cuff of
surgical therapy. The normal tissue around the
Osteoblastoma treatment goal is complete entity. This type of
surgical excision of the complete excision is
Treatment lesion.[6] The type of usually curative for
The first route of treatment excision depends on the osteoblastoma.
in Osteoblastoma is via location of the tumor. In most
medical means. Although For stage 1 and 2 lesions, patients, radiographic findi
necessary, radiation the recommended ngs are not diagnostic of
therapy (or chemotherapy) treatment is extensive osteoblastoma; therefore,
is controversial in the intralesional excision, using further imaging is
treatment of a high-speed burr. warranted. CT examination
osteoblastoma. Cases of Extensive intralesional performed with the
postirradiation sarcoma ha resections ideally consist of intravenous administration
ve been reported after use removal of gross and of contrast agent poses a
of these modalities. microscopic tumor and a risk of an allergic
However, it is possible that margin of normal tissue. reaction to contrast
the original histologic material.
The lengthy duration of examination, or if the technology to produce
an MRI examination and a presence of the tumor cross-sectional images
history of claustrophobia in leads to a fracture. In (often called slices), both
some patients are limiting addition to a complete horizontally and vertically,
the use of MRI. Although medical history and of the body. A CT scan
osteoblastoma physical examination, shows detailed images of
demonstrates increased diagnostic procedures for any part of the body,
radiotracer accumulation, enchondroma may include including the bones,
its appearance is the following: muscles, fat, and organs.
nonspecific, and x-ray - On plain film, an CT scans are more detailed
differentiating these enchondroma may be than general x-rays.
lesions from those due to found in any bone formed
other etiologies involving from cartilage. They are ]Treatment
increased radiotracer lytic lesions that usually Specific treatment for
accumulation in the bone is contain calcified chondroid enchondroma is
difficult. Therefore, bone matrix, except in the determined by a physician
scans are useful only in phalanges. They may be based on the age, overall
conjunction with other central, eccentric, health, and medical history
radiologic studies and are expansile or nonexpansile. of the patient. Other
not best used alone. Differentiating an considerations include:
enchondroma from a bone extent of the disease
Osteochondroma infarct on plain film may be tolerance for specific
difficult. Generally, an medications, procedures,
Treatment enchondroma commonly or therapies
Osteochondromas are causes endosteal expectations for the course
most often, upon scalloping while an infarct of the disease
diagnosis, simply will not. An infarct usually opinion or preference of
monitored through has a well defined, the patient
periodic x-rays. Those sclerotic serpiginous Treatment may include:
tumors that grow large border, while an surgery (in some cases,
enough to irritate enchondroma will not. when bone weakening is
surrounding muscles, tend When differentiating an present or fractures occur)
ons, or tissues are usually enchondroma from a bone grafting - a surgical
removed by surgery. chondrosarcoma, the procedure in which healthy
Enchondroma radiographic image may be bone is transplanted from
equivocal; however, another part of the
Symptoms periostitis is not usually patient's body into the
Individuals with an seen with an affected area.
enchondroma often have uncomplicated If there is no sign of bone
no symptoms at all. The enchondroma. weakening or growth of the
following are the most radionuclide bone scan - a tumor, observation only
common symptoms of an nuclear imaging method to may be suggested.
enchondroma. However, evaluate any degenerative However, follow-up with
each individual may and/or arthritic changes in repeat x-rays may be
experience symptoms the joints; to detect bone necessary. Some types of
differently. Symptoms may diseases and tumors; to enchondromas can develop
include: determine the cause of into malignant, or
Hand pain that may occur bone pain or inflammation. cancerous, bone tumors
if the tumor is very large, This test is to rule out any later. Careful follow-up with
or if the affected bone has infection or fractures. a physician may be
weakened causing a hand magnetic resonance recommended.
fracture imaging (MRI)[1] - a Chondromyxoid Fibroma
Enlargement of the diagnostic procedure that
affected finger uses a combination of Treatment:
Slow bone growth in the large magnets, -curettage is indicated
affected area radiofrequencies, and a for well
The symptoms of computer to produce encapsulated stage 2
enchondroma may detailed images of organs lesions;
resemble other medical and structures within the - stage 3 lesions, most
conditions or problems. body. This test is done to often seen in the pelvis,
Always consult your rule out any associated require wide excision to
physician for a diagnosis. abnormalities of the spinal prevent recurrance;
cord and nerves.
Diagnosis computed tomography Giant cell tumor of bone
Because an individual with scan (Also called a CT or
an enchondroma has few CAT scan.) - a diagnostic Clinical characteristics
symptoms, diagnosis is imaging procedure that Patients usually present
sometimes made during a uses a combination of x- with pain and limited range
routine physical rays and computer of motion caused by
tumor's proximity to the bones and may fracture surgery when possible (or
joint space. There may be with minor trauma (a amputation in some cases)
swelling as well, if the pathological fracture). and a combination of high
tumor has been growing dose methotrexate with leu
for a long time. Some Diagnosis covorin rescue, intra-
patients may be Family physicians and orth arterial cisplatin, adriamyci
asymptomatic until they opedists rarely see n, ifosfamide with mesna,
develop a pathologic a malignant bone tumor BCD, etoposide, muramyl
fracture at the site of the (most bone tumors tri-peptite(MTP).
tumor. are benign). Thus, many Rotationplasty is also
Patients may also patients are initially another surgical technique
experience nerve pain misdiagnosed with cysts or that may be used.
which feels like an electric muscle problems, and Ifosfamide can be used as
shock. some are sent straight an adjuvant treatment if
[edit]Imaging to physical therapy without the necrosis rate is low.
On x-ray, giant cell tumors an x-ray. Despite the success of
(GCTs) are lytic/lucent The route chemotherapy for
lesions that have a to osteosarcoma diagnosis osteosarcoma, it has one
metaepiphyseal location usually begins with an x- of the lowest survival rates
and grow to the articular ray, continues with a for pediatric cancer. The
surface of the involved combination of scans (CT best reported 10-year
bone. [3] Radiologically the scan, PET scan, bone survival rate is 92%; the
tumors show characteristic scan,MRI) and ends with a protocol used is an
'soap bubble' appearance. surgical biopsy. Films are aggressive intra-arterial
They are distinguishable suggestive, but regimen that individualizes
from other bony tumors in bone biopsy is the only therapy based on
that GCTs usually have a definitive method to ateriographic response.
non-sclerotic and sharply determine whether a tumor [4]
Three-year event free
defined border. 5% of giant ismalignant or benign. survival ranges from 50%
cell tumors metastasize, The biopsy of to 75%, and five-year
usually to lung, which may suspected osteosarcoma s survival ranges from 60%
be benign metastasis, hould be performed by a to 85+% in some studies.
[4]
when the diagnosis of qualified orthopedic Overall, 65-70% patients
giant cell tumor is oncologist. The American treated five years ago will
suspected, a chest x-ray Cancer Society states: be alive today [5]. These
or CT may be needed. MRI "Probably in no survival rates are overall
can be used to assess other cancer is it as averages and vary greatly
intramedullary and soft important to perform this depending on the
tissue extension. procedure properly. An individual necrosis rate.
[edit]Treatment improperly Fluids are given
Surgery is the treatment of performed biopsy may for hydration, while drugs
choice if the tumor is make it difficult to save the like Kytril and Zofran help
determined to be affected limb with nausea and vomiting.
resectable. Curettage is a from amputation." Neupogen, Neulasta help
commonly used technique. [edit]Treatment with white blood cellcounts
[5]
Patients with osteosarcoma and neutrophil counts.
Patients with tumors that are best managed by Blood transfusions and
are not amenable to a medical oncologist and [(epogen)] help
surgery are treated with an orthopedic with anemia.
radiation therapy.[6] The oncologist experienced in [edit]Prognosis
situation is complicated in managing sarcomas. Prognosis is separated into
a patient with a Current standard three groups.
pathological fracture. It treatment is to Stage I osteosarcoma is
may be best to immobilize use neoadjuvant chemothe rare and includes parosteal
the affected limb and wait rapy (chemotherapy given osteosarcoma or low-grade
for the fracture to heal before surgery) followed by central osteosarcoma. It
before performing surgery. surgical resection. The has an excellent prognosis
percentage of tumor (>90%) with wide
Osteosarcoma cell necrosis (cell death) resection.
seen in the tumor after Stage IIb prognosis
Symptoms surgery gives an idea of depends on the site of the
Many patients first the prognosis and also lets tumor (proximal tibia,
complain of pain that may the oncologist know if femur, pelvis, etc.) size of
be worse at night, and may the chemotherapy regime the tumor mass (in cm.),
have been occurring for should be altered after and the degree of necrosis
some time. If the tumor is surgery. from neoadjuvant
large, it can appear as a Standard therapy is a chemotherapy
swelling. The affected bone combination of limb- (chemotherapy prior to
is not as strong as normal salvage orthopedic surgery). Other
pathological factors such
as the degree of p-
glycoprotein, whether the
tumor is cxcr4-positive [6],
or Her2-positive are also
important, as these are
associated with distant
metastases to the lung.
The prognosis for patients
with metastatic
osteosarcoma improves
with longer times to
metastases, (more than 12
months-24 months), a noncontrast
smaller number of
metastases (and their
resectability). It is better to
have fewer metastases
than longer time to
metastases. Those with a
longer length of
time(>24months) and few
nodules (2 or fewer) have
the best prognosis with a
2-year survival after the
metastases of 50% 5-year
of 40% and 10 year 20%. If
metastases are both local
and regional, the prognosis
is worse.
Initial presentation of stage
III osteosarcoma with lung
metastates depends on the
resectability of the primary
tumor and lung nodules,
degree of necrosis of the
primary tumor, and maybe
the number of metastases.
Overall prognosis is about
30% [7].
Ewing's sarcoma
Magnetic resonance
imaging slice showing
Ewing's sarcoma of the left
hip (white area shown
right).
On
conventional radiographs,
the most common osseous
presentation is
permeative lytic lesion
with periosteal reaction.
The classic description of
lamellated or "onion skin"
type periosteal reaction is
often associated with this
lesion. Plain films add
valuable information in the
initial evaluation or
screening. The wide zone
of transition (e.g.
permeative) is the most
useful plain film
characteristic in
differentiation of benign
versus aggressive or the prevalence of diagnosis
malignant lytic lesions. during teenage years,
MRI should be routinely there may possibly be a
used in the work-up of link between the onset of
malignant tumors. MRI will puberty and the early
show the full bony and soft stages of this disease,
tissue extent and relate although no research is
the tumor to other nearby currently being conducted
anatomic structures (e.g. to confirm this theory.
vessels).Gadolinium contra [edit]Treatment
st is not necessary as it Because almost all patients
does not give additional with apparently localized
information over disease at diagnosis have
studies, occult metastatic disease,
though some current multidrug chemotherapy (o
researchers argue that ften
dynamic, contrast including ifosfamide and et
enhanced MRI may help oposide)[11] as well as local
determine the amount of disease control with
necrosis within the tumor, surgery and/or radiation is
thus help in determining indicated in the treatment
response to treatment of all patients[12].
prior to surgery. Treatment often consists of
CT can also be used to neo-adjuvant chemotherap
define the extraosseous y generally followed by
extent of the tumor, a limb salvage or
especially in the skull, an amputation and may
spine, ribs and pelvis. Both also includeradiotherapy.
CT and MRI can be used to Complete excision at the
follow response to time of biopsy may be
radiation performed if malignancy is
and/or chemotherapy. confirmed at the time it is
Bone scintigraphy can also examined. Treatment
be used to follow tumor lengths vary depending on
response to therapy. location and stage of the
[edit]Differential diagnosis disease at diagnosis.
Other entities that may Radical chemotherapy may
have a similar clinical be as short as 6 treatments
presentation at 3 week cycles, however
include osteomyelitis, oste most patients will undergo
osarcoma (especially chemotherapy for 6–12
telangiectatic months and radiation
osteosarcoma) and therapy for 5–8 weeks.
eosinophilic granuloma. Antisense
Soft tissue neoplasms such oligodeoxynucleotides hav
as malignant fibrous e been proposed as
histiocytoma that erode possible treatment by
into adjacent bone may down-regulating the
also have a similar expression of the
appearance. oncogenic fusion protein
[edit]Epidemiology associated with the
The frequency in the development of Ewing
a United States depends on sarcoma resulting from the
the patient's age, with a EWS-ETS gene
rate of 0.3 case per translocation.[13][14] In
1,000,000 children in those addition, the synthetic
younger than 3 years of retinoid derivative
age to as high as 4.6 cases fenretinide (4-
per 1,000,000 in hydroxy(phenyl)retinamide
adolescents aged 15–19 ) has been reported to
years. Internationally the induce high levels of cell
annual incidence rate death in Ewing sarcoma
averages less than 2 cases cell lines in vitro and to
per 1,000,000 children. delay growth of Ewing
[10]
In the United Kingdom sarcoma xenografts in
an average of six children vivo mouse models. [15][16]
per year are diagnosed, [edit]Prognosis
mainly males in early Staging attempts to
stages of puberty. Due to distinguish patients with
localized from those the aggressiveness of the
with metastatic disease.[17] tumors.[3] Because Diagnosis
Most chondrosarcomas are rare, It can be detected
commonly, metastases occ they are treated at by magnetic resonance
ur in the chest, bone specialist hospitals with imaging (MRI), but a biopsy
and/or bone marrow. Less Sarcoma Centers. is required for definitive
common sites include Surgery is the main form of diagnosis. MRI usually
the central nervous treatment for shows a well-circumscribed
system and lymph nodes. chondrosarcoma. mass that is dark on T1-
Five-year survival for Musculoskeletal tumor weighted imaging, bright
localized disease is 70% to specialists or orthopedic on T2. Central necrosis is
80% when treated oncologists are usually often evident, especially on
with chemotherapy.[18] Lon chosen to treat larger masses.
g term survival chondrosarcoma, unless it [edit]Treatment
for metastatic disease can is located in the skull, Treatment consists of
be less than 10% but some spine, or chest cavity, in surgical excision (the
sources state it is 25-30% which case, a extent of which ranges
neurosurgeon or thoracic from tumor excision to
Chondrosarcoma surgeon experienced with limb amputation
sarcomas is chosen. Often, depending on the tumor)
Diagnosis a limb-sparing operation and in some cases
Like all other bone tumors can be performed, however radiation. Chemotherapy re
and disease processes, in some cases amputation mains controversial in
diagnosis is made primarily is unavoidable. Amputation MFH. The usual site of
by imaging. There are no of the arm, leg, jaw, or half metastatic disease is the
blood tests to determine a of the pelvis (called lungs, and metastases
diagnosis of a hemipelvectomy) may be should be resected if
chondrosarcoma. The most necessary in some cases. possible.
characteristic imaging Chemotherapy or [edit]Prognosis
findings are on CT, where traditional radiotherapy are Prognosis depends on the
detection of a chondroid not very effective for most primary tumor, grade
matrix is present. chondrosarcomas, (aggressiveness), size,
Nearly all chondrosarcoma although proton therapy is depth, and presence of
patients appear to be in showing promise with local metastases. 5-year survival
good health. This form of tumor control at over 80%. ranges from 35-60%.
cancer generally doesn't [5]
[edit]Human-human
affect the whole body. Complete surgical ablation transmission
Often, patients are not is the most effective A malignant fibrous
aware of the growing treatment, but sometimes histiocytoma was
tumor until there is a this is difficult. Proton contracted from a patient
noticeable lump or pain. therapy Radiation can be by a surgeon when he
Earlier diagnosis is useful in awkward locations injured his hand during an
generally accidental, when to make surgery more operation.[
a patient undergoes effective.
testing for another problem [edit]Prognosis Chordomas
and physicians discover Prognosis depends on how
the cancer. Occasionally early the cancer is are relatively
the first symptom will be a discovered and treated. For radioresistant, requiring
broken bone at the the least aggressive grade, high doses of radiation to
cancerous site. Any broken about 90% of patients be controlled. The
bone that occurs from mild survive more than five proximity of chordomas to
trauma warrants further years after diagnosis. vital neurological
investigation, although People usually have a good structures such as the
there are many conditions survival rate at the low brain stem and nerves
that can lead to weak grade volume of cancer. limits the dose of radiation
bones, and this form of [2]
For the most aggressive that can safely be
cancer is not a common grade, more than a quarter delivered. Therefore, highly
cause of such breaks.[4] of patients live more than focused radiation such
five years. as proton therapy and
Causes Tumors may recur in the carbon ion therapy are
The cause is unknown. future. Follow up scans are more effective than
Patients may have a extremely important for conventional x-ray
history chondrosarcoma to make radiation.[15]
of enchondroma or osteoch sure there has been no There are no drugs
ondroma. recurrence or metastasis, currently approved to treat
Treatment which usually occurs in the chordoma, however a
lungs. clinical trial conducted in
Treatment depends on the Malignant fibrous Italy using
location of the disease and histiocytoma the PDGFR inhibitor Imatini
bdemonstrated a modest sometimes combined with and lenalidomide–
response in some radiotherapy. See the dexamethasone. [13] Autolo
chordoma patients.[16] The article on the gous stem cell
same group in Italy found corresponding form of transplantation, the
that the combination of lymphoma for further transplantation of a
imatinib information. patient’s own stem cells
and sirolimuscaused a after chemotherapy, is the
response in several Multiple myeloma most common type of stem
patients whose tumors cell transplantation for
progressed on imatinib Treatment multiple myeloma. It is not
alone. Treatment for multiple curative, but does prolong
myeloma is focused on overall survival. Allogeneic
Lymphoma disease containment and stem cell transplantation,
suppression. If the disease the transplantation of a
Diagnosis, etiology, is completely healthy person’s stem cells
staging, prognosis, and asymptomatic (i.e. there is into the affected patient,
treatment a paraprotein and an has the potential for a
Depends on the specific abnormal bone marrow cure, but is only available
form of lymphoma. For low- population but no end- to a small percentage of
grade lymphoma, watchful organ damage), treatment patients. [2] Furthermore,
waiting is often the initial may be deferred. there is a 5-10%
course of action. If a low- In addition to direct treatment-associated
grade lymphoma is treatment of the plasma mortality rate. Patients
becoming symptomatic, cell over age 65 and patients
radiotherapy or proliferation, bisphosphona with significant concurrent
chemotherapy are the tes (e.g. pamidronate or zo illness often cannot
treatments of choice, as ledronic acid) are routinely tolerate stem cell
while they do not cure the administered to prevent transplantation. For these
lymphoma, they can fractures patients, the standard of
palliate symptoms, and erythropoietin to treat care has been
particulary anemia. chemotherapy
painful lymphadenopathy. with melphalan and
Patients with low-grade Initial therapy prednisone. Recent studies
lymphoma can live near- Initial treatment of multiple among this
normal lifespans, but the myeloma depends on the population[14] suggest
disease is incurable. patient’s age and improved outcomes with
Treatment of high-grade comorbidities. In recent new chemotherapy
lymphoma can result in a years, high-dose regimens. Treatment with
cure in the majority of chemotherapy with bortezomib, melphalan and
cases, however, the hematopoietic stem-cell prednisone had an
prognosis for patients with transplantation has estimated overall survival
a poor response to therapy become the preferred of 83% at 30 months,
is worse. Treatment for treatment for patients lenalidomide plus low-dose
high-grade lymphoma under the age of 65. Prior dexamethasone an 82%
typically consists of to stem-cell survival at 2 years and
aggressive chemotherapy, transplantation, these melphalan, prednisone and
including patients receive an initial lenalidomide had a 90%
the CHOPregimen. Hodgkin course of induction survival at 2 years. Head-
lymphoma typically is chemotherapy. The most to-head studies comparing
treated with radiotherapy common induction these regimens have not
alone, as long as it is regimens used today been performed.
localized. Advanced arethalidomide–
Hodgkins disease requires dexamethasone, bortezomi
systemic chemotherapy, b based regimens,