Classification
Bone tumors may be classified as "primary tumors" which originate in the bone, and "Secondary tumors" which originate elsewhere. Primary tumors are more uncommon compared to secondary or metastatic tumors.
Primary tumors
Primary tumors of bone can be divided into benign tumors and cancers. Common benign bone tumors may be neoplastic, developmental, traumatic, infectious, or inflammatory in etiology. Examples of benign bone tumors include osteoma, osteoid osteoma, osteochondroma, osteoblastoma, enchondroma, giant cell tumor of bone, aneurysmal bone cyst, and fibrous dysplasia of bone.
Malignant primary bone tumors include osteosarcoma, chondrosarcoma, Ewing's sarcoma, malignant fibrous histiocytoma,fibrosarcoma, and other sarcoma types. Multiple myeloma is a hematologic cancer which also frequently presents as one or more bone tumors.
The tailbone is a common location for a teratoma, known as a sacrococcygeal teratoma, and related germ cell tumors.
Secondary tumors
Secondary bone tumors include metastatic tumors which have spread from other organs, such as the breast, lung, and prostate.
Symptoms
The most common symptom of bone tumors is pain, which will gradually increase over time. A person may go weeks, months, and sometimes years before they seek help; it depends on the growth of the tumor. Many patients will not experience any symptoms, except for a painless mass. Some bone tumors may weaken the structure of the bone, causing pathologic fractures.
Treatment
Treatment of bone tumors is highly dependent on the type of tumor.
Chemotherapy and radiotherapy
Chemotherapy and radiotherapy are effective in some tumors (such as Ewing's sarcoma) but less so in others (such aschondrosarcoma).
Medication
One of the major concerns is bone density and bone loss. Non-hormonal bisphosphonates increase bone strength and are available as once-a-week prescription pills. Metastron also known as strontium-89 chloride is an intravenous medication given to help with the pain and can be given in three month intervals.
Surgical treatment
Main articles
§ Amputation
Treatment for some bone cancers may involve surgery, such as limb amputation, or limb sparing surgery (often in combination with chemotherapy and radiation therapy). Limb sparing surgery, or limb salvage surgery, means the limb is spared from amputation. Instead of amputation the affected bone is removed and is done in two ways (a) bone graft, in which a bone from elsewhere from the body is taken or (b) artificial bone is put in. In upper leg surgeries, limb salvage prostheses are available.
The other surgery is called van-ness rotation or rotationplasty which is a form of amputation, in which the patient's foot is turned upwards in a 180 degree turn and the upturned foot is used as a knee.
Types of amputation:
Leg
§ Below knee
§ Above knee
§ Symes
§ Hip disarticulation
§ Hemipelvectomy or hindquarter, in which the whole leg is removed with one half of the pelvis
Arm
§ Below elbow
§ Above elbow
§ Shoulder disarticulation
§ Forequarter (amputation of the whole arm, along with the shoulder blade and the clavicle)
The most radical of amputations is hemicorporectomy (translumbar or waist amputation) which removes the legs, the pelvis, urinary system, excretory system and the genital area (penis/testes in males and vagina/vulva in females). This operation is done in two stages. First stage is doing the colostomy and the urinary conduit, the second stage is the amputation. This is a mutilating operation and is only done as a last resort (e.g. when even pelvic exenteration doesn't work or in cases of advanced pelvic/reproductive cancers)
Prognosis
The outlook depends on the type of tumor. The outcome is expected to be good for people with noncancerous (benign) tumors, although some types of benign tumors may eventually become cancerous (malignant). With malignant bone tumors that have not spread, most patients achieve a cure. Because the cure rate depends on the type of cancer, location, size, and other factors.
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