Bone tumors

• 200 benign types

• 90 malignant conditions
• Relative incidence benign/ malign 200 :1
• USA (2004) – annual incidence : 8600
2400 new cases
• Cancer mortality – 563000 cases/year
- sarcomas are just a small fraction
Etiology of musculuo-skeletal tumors
Tumorigenesis
-complex multiple-step process by which healthy tissue
progressively from a normal phenotype into an abnormal colony of
proliferating cells.
-Cells aquire genetic abnormalities in oncogenesis, tumor supresor
genes and other genes that directly or indirectly control proliferation
-Such a process may progress beyond the controlled state of
benigned deasease to became a dedifferetiated, aggressive and
immortal phenotype by genomic instability
-The instability allows the cell to progress tu fulminant malignancy
 Evaluation and staging of tumors

• History and physical examination

Questions to ask :
1. The patients age
2. Duration of complaint
3. Rate of growth
4. Pain associated with the tumor
5. History of trauma
6.Personal or family history of cancer
7. Sistemic signs or simptoms
Distribution of bone tumors by
age

NEUROBLA
 Aspects of the physical examination
• Skin colour
• Warmth
• Location
• Swelling
• Neurovascular exam.
• Joint range of motion
• Size
• Tenderness
• Firmness
• Lymph nodes
1 G0T0M0 IA G1T1M0

2 G0T1M0 IB G1T2M0

3 G0T1M0-1 II A G2T1M0

II B G2T2M0

III A G1-2 T1M1

III B G1-2 T2M1

CLINICAL SIGNS

• pain
• diformity
• fracture on pathological
bone
Imaging studies
CONVENTIONAL RADIOGRAPHY

• lesion extensions
• lesion aggressivity
• bone distruction (OSTEOLYSIS)
• bone formation (OSTEOCONDENSATION)
• periosteal osteogenesis (periosteal reaction)
RADIOGRAPHY
Periosteal reaction
LAB EXPLORATION
Lung X-Ray
LAB EXPLORATION
Computerised Tomography (CT)
Defines the tumor extension in
the extraosseous soft tissues
LAB EXPLORATION
Magnetic Resonance Imager (MRI)

Defines tumor extension

LAB EXPLORATION
Scintigraphy

Technetium99
Hyperfixation

Early signs
Tumor extension
Tumor evolution
Metastasis
LAB EXPLORATION
Angiography
Normal Femur osteosarcoma
LAB EXPLORATION
Biopsy

SURGICAL Trained team

Atraumatic technique
Between two tourniquets
Using the electrocautery

Roentgen guided
TRANSCUTANEOUS
Useful in metastasis
Histologic classification

TYPE

BONE
SURGICAL CLASSIFICATION
G tumor degree
G0 benign histologic tumor Enneking (1980)
G1 low malignancy tumor
G2 high malignancy tumor

T tumor topography
T0 intracapsular and/or intracompartmenal tumour
T1 extracapsular BUT intracompartmenal tumour
T2 extracompartmental tumour

M Metastasis
M0 lack of metastasis
M presence of metastasis
TUMOR TREATMENT
Principles

Treatment starts ONLY AFTER tumor histologic

classification

Treatment is realized by a TEAM formed by

• radiologist
• anatomopathologist
• oncologist
• surgeon
TUMOR TREATMENT
Surgical principles
EXCISION AMPUTATION

TOTAL
TOTAL

EXTENDED
EXTENDED

INTRALESIONAL
MARGINAL
(LIMITED)
TUMOR TREATMENT
Filling bone defect

Plaster
Graft
Cement
Osteosynthesis
Reconstruction
TUMOR TREATMENT Pseudarthrosis
Filling articular defect Arthrodesis
Arthroplasty
TUMOR TREATMENT
Radiotherapy
Ewing sarcoma (child)
Curative action Plasmocytoma (adult)

Symptomatic action
(antalgic) Scatter metastasis

Indications
Stage 3 benign tumors High penetrability/
Stage I malignant tumors Reduced treatment duration
Stage II malignant tumors
TUMOR TREATMENT
Chemiotherapy

Cytotoxicity at DNA level

Intraarterial selective administration
Drug mixture

Treatment result evaluation

Indications
(histologic)
Stage 3 benign tumors
I = necrotic cells < 50%
Stage I malignant tumors
II = necrotic cells 50-90%
Stage II malignant tumors
III = necrotic cells > 90%
(preoperatively)
IV = necrotic cells 100%
TUMOR TREATMENT
Extracorporeal irradiation
Pathological bone fracture
- Osteosarcoma of humerus -
Osteosarcoma of humerus
Osteosarcoma of humerus
Ulcerated maligant tumor
Management of carcinoma
metastasized to bone
SPITALUL CLINIC DE
URGENŢE IAŞI
SPITALUL CLINIC DE
URGENŢE IAŞI
Management of carcinoma
metastasized to bone
day after tomorrow.wmv