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Wikipedia

Bone tumor

January 13, 2023

A bone tumor is an abnormal growth of tissue in bone, traditionally classified as noncancerous (benign) or cancerous (malignant).[1][4] Cancerous bone tumors usually originate from a cancer in another part of the body such as from lung, breast, thyroid, kidney and prostate.[1] There may be a lump, pain, or neurological signs from pressure.[1] A bone tumor might present with a pathologic fracture.[1] Other symptoms may include fatigue, fever, weight loss, anemia and nausea.[2][3] Sometimes there are no symptoms and the tumour is found when investigating another problem.[2][3]

Diagnosis is generally by X-ray and other radiological tests such as CT scan, MRI, PET scan and bone scintigraphy.[1] Blood tests might include a complete blood count, inflammatory markers, serum electrophoresis, PSA, kidney function and liver function.[1] Urine may be tested for Bence Jones protein.[1] For confirmation of diagnosis, a biopsy for histological evaluation might be required.[1]

The most common bone tumor is a non-ossifying fibroma.[4] Average five-year survival in the United States after being diagnosed with bone and joint cancer is 67%.[5] The earliest known bone tumor was an osteosarcoma in a foot bone discovered in South Africa, between 1.6 and 1.8 million years ago.[6]

Classification

 
X-ray of a giant cell bone tumor in the head of the 4th metacarpal of the left hand.
 
An arm bone tumor

Bone tumors are traditionally classified as noncancerous (benign) or cancerous (malignant).[1] Several features of bone tumors and soft tissue tumors overlap.[7] Their classification was revised by the World Health Organization (WHO) in 2020.[8] This newer classification categorises bone tumors into cartilage tumors, osteogenic tumors, fibrogenic tumors, vascular tumors of bone, osteoclastic giant cell-rich tumors, notochordal tumors, other mesenchymal tumors of bone, and hematopoietic neoplasms of bone.[4][7]

Bone tumors may be classified as "primary tumors", which originate in bone or from bone-derived cells and tissues, and "secondary tumors" which originate in other sites and spread (metastasize) to the skeleton. Carcinomas of the prostate, breasts, lungs, thyroid, and kidneys are the carcinomas that most commonly metastasize to bone. Secondary malignant bone tumors are estimated to be 50 to 100 times as common as primary bone cancers.[citation needed]

Primary bone 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. Some benign tumors are not true neoplasms, but rather, represent hamartomas, namely the osteochondroma. The most common locations for many primary tumors, both benign and malignant include the distal femur and proximal tibia (around the knee joint). Examples of benign bone tumors include osteoma, osteoid osteoma, osteochondroma, osteoblastoma, enchondroma, giant cell tumor of bone and aneurysmal bone cyst.[citation needed]

Malignant primary bone tumors include osteosarcoma, chondrosarcoma, Ewing's sarcoma, fibrosarcoma, and other types. While malignant fibrous histiocytoma (MFH) - now generally called "pleomorphic undifferentiated sarcoma" - primary in bone is known to occur occasionally,[9] current paradigms tend to consider MFH a wastebasket diagnosis, and the current trend is toward using specialized studies (i.e. genetic and immunohistochemical tests) to classify these undifferentiated tumors into other tumor classes. Multiple myeloma is a hematologic cancer, originating in the bone marrow, which also frequently presents as one or more bone lesions.[10]

Germ cell tumors, including teratoma, often present and originate in the midline of the sacrum, coccyx, or both. These sacrococcygeal teratomas are often relatively amenable to treatment.[11]

Secondary bone tumors

Secondary bone tumors are metastatic lesions which have spread from other organs, most commonly carcinomas of the breast, lung, and prostate. Rarely, primary bone malignancies such as osteosarcoma may also spread to other bones.[12] Reliable and valid statistics on the incidence, prevalence, and mortality of malignant bone tumours are difficult to come by, particularly in older adults (those over 75 years of age) - because carcinomas that are widely metastatic to bone are rarely ever curable. Biopsies to determine the origin of the tumour in cases like this are rarely done.[citation needed]

Signs and symptoms

See also: Cancer pain

Clinical features of a bone tumor depend on the type of tumor and which part of which bone is affected.[2][13] Symptoms and signs usually result from the pressure effect of the tumor.[1]

There may be a lump, with or without pain.[1] Pain may increase with the growth of the tumor and may be worse at night and at rest.[1][3] A bone tumor might present with an unexplained broken bone; with little or no trauma.[2] Additional symptoms may include fatigue, fever, weight loss, anemia and nausea.[2][3] If the tumor presses a nerve, neurological signs may be present.[1] Sometimes there are no symptoms and the tumour is found when investigating another problem.[2][3]

Diagnosis

A bone tumour may be felt on examination, following which a plain X-ray is usually carried out.[1][14] Blood tests might include a complete blood count, inflammatory markers, serum electrophoresis, PSA, kidney function and liver function.[1] Urine may be sent for Bence Jones protein.[1] Other tests that might be requested include a CT scan, MRI, PET scan and bone scintigraphy. For confirmation of diagnosis, a biopsy for histological evaluation might be required, using either a needle or by incision (open biopsy).[1][2]

Staging

  •  

    Stage 1A bone cancer

  •  

    Stage 1B bone cancer

  •  

    Stage 2A bone cancer

  •  

    Stage 2B bone cancer

  •  

    Stage 3 bone cancer

Treatment

Treatment of bone tumors is dependent on the type of tumor.[2] Where available, people with bone tumors are treated at a specialist centre which have surgeons, radiologists, pathologists, oncologists and other support staff.[1] Generally, noncancerous bone tumors may be observed for changes and surgery offered if there is pain or pressure effects on neighbouring body parts. Surgical resection with or without cytotoxic drugs may be considered.[1]

Chemotherapy and radiotherapy

Chemotherapy and radiotherapy are effective in some tumors (such as Ewing's sarcoma) but less so in others (such as chondrosarcoma).[15] There is a variety of chemotherapy treatment protocols for bone tumors. The protocol with the best-reported survival in children and adults is an intra-arterial protocol where tumor response is tracked by serial arteriogram. When tumor response has reached >90% necrosis surgical intervention is planned.[16][17]

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. Generic Strontium Chloride Sr-89 Injection UPS, manufactured by Bio-Nucleonics Inc., it is the generic version of Metastron.[18]

Surgical treatment

Main article: 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 replaced in one of two ways: (a) bone graft, in which bone is taken from elsewhere on the body or (b) artificial bone is put in. In upper leg surgeries, limb salvage prostheses are available.[citation needed]

There are other joint preservation surgical reconstruction options, which including allograft, tumor-devitalized autograft, vascularized fibula graft, distraction osteogenesis, and custom-made implants.[19] An analysis of massive knee replacements after resection of primary bone tumours showed patients did not score as highly on the Musculoskeletal Tumour Society Score and Knee Society Score as patients who had undergone intra-articular resection.[20]

Thermal ablation techniques

Over the past two decades, CT guided radiofrequency ablation has emerged as a less invasive alternative to surgical resection in the care of benign bone tumors, most notably osteoid osteomas. In this technique, which can be performed under conscious sedation, a RF probe is introduced into the tumor nidus through a cannulated needle under CT guidance and heat is applied locally to destroy tumor cells. Since the procedure was first introduced for the treatment of osteoid osteomas in the early 1990s,[21] it has been shown in numerous studies to be less invasive and expensive, to result in less bone destruction and to have equivalent safety and efficacy to surgical techniques, with 66 to 96% of patients reporting freedom from symptoms.[22][23][24] While initial success rates with RFA are high, symptom recurrence after RFA treatment has been reported, with some studies demonstrating a recurrence rate similar to that of surgical treatment.[25]

Thermal ablation techniques are also increasingly being used in the palliative treatment of painful metastatic bone disease. Currently, external beam radiation therapy is the standard of care for patients with localized bone pain due to metastatic disease. Although the majority of patients experience complete or partial relief of pain following radiation therapy, the effect is not immediate and has been shown in some studies to be transient in more than half of patients.[26] For patients who are not eligible or do not respond to traditional therapies ( i.e. radiation therapy, chemotherapy, palliative surgery, bisphosphonates or analgesic medications), thermal ablation techniques have been explored as alternatives for pain reduction. Several multi-center clinical trials studying the efficacy of RFA in the treatment of moderate to severe pain in patients with metastatic bone disease have shown significant decreases in patient reported pain after treatment.[27][28] These studies are limited however to patients with one or two metastatic sites; pain from multiple tumors can be difficult to localize for directed therapy. More recently, cryoablation has also been explored as a potentially effective alternative as the area of destruction created by this technique can be monitored more effectively by CT than RFA, a potential advantage when treating tumors adjacent to critical structures.[29]

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, but the cure rate depends on the type of cancer, location, size, and other factors.[citation needed]

Epidemiology

Bone tumors that originate from bone are very rare and account for around 0.2% of all tumors.[7] Average five-year survival in the United States after being diagnosed with bone and joint cancer is 67%.[5]

History

The earliest known bone tumor was an osteosarcoma in a foot bone belonging to a person who died in Swartkrans Cave, South Africa, between 1.6 and 1.8 million years ago.[6]

Other animals

Bones are a common site for tumors in cats and dogs.[30]

References

  1. ^ a b c d e f g h i j k l m n o p q r s t u v Maruthainar N, Bhumbra R, Cannon S (2018). "7. Orthopaedic oncology". In Ramachandran M (ed.). Basic Orthopaedic Sciences (2nd ed.). CRC Press. pp. 105–121. ISBN 978-1-4441-2098-1.
  2. ^ a b c d e f g h i j k "Bone Tumor - Types and Treatments - OrthoInfo - AAOS". www.orthoinfo.org. Retrieved 27 June 2021.
  3. ^ a b c d e f g "Questions and Answers about Bone Cancer" (PDF). Centers for Disease Control and Prevention. Retrieved 27 June 2021.
  4. ^ a b c d e Soft Tissue and Bone Tumours: WHO Classification of Tumours. International Agency for Research on Cancer. 2020. pp. 338–344. ISBN 978-92-832-4502-5.
  5. ^ a b "SEER Stat Fact Sheets: Bone and Joint Cancer". NCI. Retrieved 18 June 2014.
  6. ^ a b Strauss, Mark (28 July 2016). "Earliest Human Cancer Found in 1.7-Million-Year-Old Bone". Culture. Retrieved 27 June 2021.
  7. ^ a b c Choi JH, Ro JY (May 2021). "The 2020 WHO Classification of Tumors of Bone: An Updated Review". Advances in Anatomic Pathology. 28 (3): 119–138. doi:10.1097/PAP.0000000000000293. PMID 33480599. S2CID 231679037.
  8. ^ Anderson WJ, Doyle LA (April 2021). "Updates from the 2020 World Health Organization Classification of Soft Tissue and Bone Tumours". Histopathology. 78 (5): 644–657. doi:10.1111/his.14265. PMID 33438273. S2CID 231595171.
  9. ^ Jeon DG, Song WS, Kong CB, Kim JR, Lee SY. MFH of Bone and Osteosarcoma Show Similar Survival and Chemosensitivity. Clin Orthop Rel Res 469;584-90.
  10. ^ "Multiple Myeloma". The Lecturio Medical Concept Library. Retrieved 26 August 2021.
  11. ^ Maoz A, Matsuo K, Ciccone MA, Matsuzaki S, Klar M, Roman LD, et al. (May 2020). "Molecular Pathways and Targeted Therapies for Malignant Ovarian Germ Cell Tumors and Sex Cord-Stromal Tumors: A Contemporary Review". Cancers. 12 (6): 1398. doi:10.3390/cancers12061398. PMC 7353025. PMID 32485873.
  12. ^ "Osteosarcoma". The Lecturio Medical Concept Library. Retrieved 26 August 2021.
  13. ^ Murali S, Ilaslan H, Holden DM (2015). "2. An imaging approach to bone tumors". In Santini-Araujo E, Kalil RK, Bertoni F, Park YK (eds.). Tumors and Tumor-Like Lesions of Bone: For Surgical Pathologists, Orthopedic Surgeons and Radiologists. Springer. pp. 15–56. ISBN 978-1-4471-6577-4.
  14. ^ Costelloe CM, Madewell JE (January 2013). "Radiography in the initial diagnosis of primary bone tumors". AJR. American Journal of Roentgenology. 200 (1): 3–7. doi:10.2214/AJR.12.8488. PMID 23255735.
  15. ^ Bone tumor at Mount Sinai Hospital, New York
  16. ^ 10 year survival in Pediatric Osteosarcoma
  17. ^ Survival in Adult Osteosarcoma and MFH of Bone
  18. ^ "FDA ANDA Generic Drug Approvals". Food and Drug Administration.
  19. ^ Takeuchi A, Yamamoto N, Hayashi K, Matsubara H, Miwa S, Igarashi K, Tsuchiya H (December 2019). "Joint-preservation surgery for pediatric osteosarcoma of the knee joint". Cancer and Metastasis Reviews. 38 (4): 709–722. doi:10.1007/s10555-019-09835-z. PMID 31807972. S2CID 208650189.
  20. ^ Kendall SJ, Singer GC, Briggs TW, Cannon SR (September 2000). "A functional analysis of massive knee replacement after extra-articular resections of primary bone tumors". The Journal of Arthroplasty. 15 (6): 754–760. doi:10.1054/arth.2000.8104. PMID 11021451.
  21. ^ Rosenthal DI, Alexander A, Rosenberg AE, Springfield D (April 1992). "Ablation of osteoid osteomas with a percutaneously placed electrode: a new procedure". Radiology. 183 (1): 29–33. doi:10.1148/radiology.183.1.1549690. PMID 1549690.[permanent dead link]
  22. ^ Rimondi E, Mavrogenis AF, Rossi G, Ciminari R, Malaguti C, Tranfaglia C, et al. (January 2012). "Radiofrequency ablation for non-spinal osteoid osteomas in 557 patients". European Radiology. 22 (1): 181–188. doi:10.1007/s00330-011-2240-1. PMID 21842430. S2CID 21047698.
  23. ^ Rosenthal DI, Hornicek FJ, Torriani M, Gebhardt MC, Mankin HJ (October 2003). "Osteoid osteoma: percutaneous treatment with radiofrequency energy". Radiology. 229 (1): 171–175. doi:10.1148/radiol.2291021053. PMID 12944597.[permanent dead link]
  24. ^ Weber MA, Sprengel SD, Omlor GW, Lehner B, Wiedenhöfer B, Kauczor HU, Rehnitz C (July 2015). "Clinical long-term outcome, technical success, and cost analysis of radiofrequency ablation for the treatment of osteoblastomas and spinal osteoid osteomas in comparison to open surgical resection". Skeletal Radiology. 44 (7): 981–993. doi:10.1007/s00256-015-2139-z. PMID 25910709. S2CID 21496405.
  25. ^ Rosenthal DI, Hornicek FJ, Wolfe MW, Jennings LC, Gebhardt MC, Mankin HJ (June 1998). . The Journal of Bone and Joint Surgery. American Volume. 80 (6): 815–821. CiteSeerX 10.1.1.1018.5024. doi:10.2106/00004623-199806000-00005. PMID 9655099. S2CID 10709128. Archived from the original on 2016-10-06. Retrieved 2016-08-07.
  26. ^ Tong D, Gillick L, Hendrickson FR (September 1982). "The palliation of symptomatic osseous metastases: final results of the Study by the Radiation Therapy Oncology Group". Cancer. 50 (5): 893–899. doi:10.1002/1097-0142(19820901)50:5<893::aid-cncr2820500515>3.0.co;2-y. PMID 6178497.
  27. ^ Dupuy DE, Liu D, Hartfeil D, Hanna L, Blume JD, Ahrar K, et al. (February 2010). "Percutaneous radiofrequency ablation of painful osseous metastases: a multicenter American College of Radiology Imaging Network trial". Cancer. 116 (4): 989–997. doi:10.1002/cncr.24837. PMC 2819592. PMID 20041484.
  28. ^ Goetz MP, Callstrom MR, Charboneau JW, Farrell MA, Maus TP, Welch TJ, et al. (January 2004). "Percutaneous image-guided radiofrequency ablation of painful metastases involving bone: a multicenter study". Journal of Clinical Oncology. 22 (2): 300–306. doi:10.1200/JCO.2004.03.097. PMID 14722039.
  29. ^ Callstrom MR, Dupuy DE, Solomon SB, Beres RA, Littrup PJ, Davis KW, et al. (March 2013). "Percutaneous image-guided cryoablation of painful metastases involving bone: multicenter trial". Cancer. 119 (5): 1033–1041. doi:10.1002/cncr.27793. PMC 5757505. PMID 23065947.
  30. ^ Dittmer KE, Pemberton S (September 2021). "A Holistic Approach to Bone Tumors in Dogs and Cats: Radiographic and Histologic Correlation". Veterinary Pathology. 58 (5): 841–857. doi:10.1177/0300985821999832. PMID 33779406. S2CID 232409416.

January 13, 2023
bone, tumor, bone, tumor, abnormal, growth, tissue, bone, traditionally, classified, noncancerous, benign, cancerous, malignant, cancerous, bone, tumors, usually, originate, from, cancer, another, part, body, such, from, lung, breast, thyroid, kidney, prostate. A bone tumor is an abnormal growth of tissue in bone traditionally classified as noncancerous benign or cancerous malignant 1 4 Cancerous bone tumors usually originate from a cancer in another part of the body such as from lung breast thyroid kidney and prostate 1 There may be a lump pain or neurological signs from pressure 1 A bone tumor might present with a pathologic fracture 1 Other symptoms may include fatigue fever weight loss anemia and nausea 2 3 Sometimes there are no symptoms and the tumour is found when investigating another problem 2 3 Bone tumorNon ossifying fibroma of tibiaSpecialtyOrthopedicsSymptomsLump pain neurological signs 1 unexplained broken bone 2 fatigue fever weight loss anemia and nausea 2 3 Sometimes no symptoms 2 3 TypesNoncancerous benign or cancerous malignant 1 Diagnostic methodMedical imaging biopsy 1 PrognosisVaries with type 4 FrequencyCommon 4 Diagnosis is generally by X ray and other radiological tests such as CT scan MRI PET scan and bone scintigraphy 1 Blood tests might include a complete blood count inflammatory markers serum electrophoresis PSA kidney function and liver function 1 Urine may be tested for Bence Jones protein 1 For confirmation of diagnosis a biopsy for histological evaluation might be required 1 The most common bone tumor is a non ossifying fibroma 4 Average five year survival in the United States after being diagnosed with bone and joint cancer is 67 5 The earliest known bone tumor was an osteosarcoma in a foot bone discovered in South Africa between 1 6 and 1 8 million years ago 6 Contents 1 Classification 1 1 Primary bone tumors 1 2 Secondary bone tumors 2 Signs and symptoms 3 Diagnosis 3 1 Staging 4 Treatment 4 1 Chemotherapy and radiotherapy 4 2 Medication 4 3 Surgical treatment 4 4 Thermal ablation techniques 5 Prognosis 6 Epidemiology 7 History 8 Other animals 9 ReferencesClassification Edit X ray of a giant cell bone tumor in the head of the 4th metacarpal of the left hand An arm bone tumor Bone tumors are traditionally classified as noncancerous benign or cancerous malignant 1 Several features of bone tumors and soft tissue tumors overlap 7 Their classification was revised by the World Health Organization WHO in 2020 8 This newer classification categorises bone tumors into cartilage tumors osteogenic tumors fibrogenic tumors vascular tumors of bone osteoclastic giant cell rich tumors notochordal tumors other mesenchymal tumors of bone and hematopoietic neoplasms of bone 4 7 Bone tumors may be classified as primary tumors which originate in bone or from bone derived cells and tissues and secondary tumors which originate in other sites and spread metastasize to the skeleton Carcinomas of the prostate breasts lungs thyroid and kidneys are the carcinomas that most commonly metastasize to bone Secondary malignant bone tumors are estimated to be 50 to 100 times as common as primary bone cancers citation needed Primary bone tumors Edit 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 Some benign tumors are not true neoplasms but rather represent hamartomas namely the osteochondroma The most common locations for many primary tumors both benign and malignant include the distal femur and proximal tibia around the knee joint Examples of benign bone tumors include osteoma osteoid osteoma osteochondroma osteoblastoma enchondroma giant cell tumor of bone and aneurysmal bone cyst citation needed Malignant primary bone tumors include osteosarcoma chondrosarcoma Ewing s sarcoma fibrosarcoma and other types While malignant fibrous histiocytoma MFH now generally called pleomorphic undifferentiated sarcoma primary in bone is known to occur occasionally 9 current paradigms tend to consider MFH a wastebasket diagnosis and the current trend is toward using specialized studies i e genetic and immunohistochemical tests to classify these undifferentiated tumors into other tumor classes Multiple myeloma is a hematologic cancer originating in the bone marrow which also frequently presents as one or more bone lesions 10 Germ cell tumors including teratoma often present and originate in the midline of the sacrum coccyx or both These sacrococcygeal teratomas are often relatively amenable to treatment 11 Secondary bone tumors Edit Secondary bone tumors are metastatic lesions which have spread from other organs most commonly carcinomas of the breast lung and prostate Rarely primary bone malignancies such as osteosarcoma may also spread to other bones 12 Reliable and valid statistics on the incidence prevalence and mortality of malignant bone tumours are difficult to come by particularly in older adults those over 75 years of age because carcinomas that are widely metastatic to bone are rarely ever curable Biopsies to determine the origin of the tumour in cases like this are rarely done citation needed Signs and symptoms EditSee also Cancer pain Clinical features of a bone tumor depend on the type of tumor and which part of which bone is affected 2 13 Symptoms and signs usually result from the pressure effect of the tumor 1 There may be a lump with or without pain 1 Pain may increase with the growth of the tumor and may be worse at night and at rest 1 3 A bone tumor might present with an unexplained broken bone with little or no trauma 2 Additional symptoms may include fatigue fever weight loss anemia and nausea 2 3 If the tumor presses a nerve neurological signs may be present 1 Sometimes there are no symptoms and the tumour is found when investigating another problem 2 3 Diagnosis EditA bone tumour may be felt on examination following which a plain X ray is usually carried out 1 14 Blood tests might include a complete blood count inflammatory markers serum electrophoresis PSA kidney function and liver function 1 Urine may be sent for Bence Jones protein 1 Other tests that might be requested include a CT scan MRI PET scan and bone scintigraphy For confirmation of diagnosis a biopsy for histological evaluation might be required using either a needle or by incision open biopsy 1 2 Staging Edit Stage 1A bone cancer Stage 1B bone cancer Stage 2A bone cancer Stage 2B bone cancer Stage 3 bone cancerTreatment EditTreatment of bone tumors is dependent on the type of tumor 2 Where available people with bone tumors are treated at a specialist centre which have surgeons radiologists pathologists oncologists and other support staff 1 Generally noncancerous bone tumors may be observed for changes and surgery offered if there is pain or pressure effects on neighbouring body parts Surgical resection with or without cytotoxic drugs may be considered 1 Chemotherapy and radiotherapy Edit Chemotherapy and radiotherapy are effective in some tumors such as Ewing s sarcoma but less so in others such as chondrosarcoma 15 There is a variety of chemotherapy treatment protocols for bone tumors The protocol with the best reported survival in children and adults is an intra arterial protocol where tumor response is tracked by serial arteriogram When tumor response has reached gt 90 necrosis surgical intervention is planned 16 17 Medication Edit 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 Generic Strontium Chloride Sr 89 Injection UPS manufactured by Bio Nucleonics Inc it is the generic version of Metastron 18 Surgical treatment Edit Main article 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 replaced in one of two ways a bone graft in which bone is taken from elsewhere on the body or b artificial bone is put in In upper leg surgeries limb salvage prostheses are available citation needed There are other joint preservation surgical reconstruction options which including allograft tumor devitalized autograft vascularized fibula graft distraction osteogenesis and custom made implants 19 An analysis of massive knee replacements after resection of primary bone tumours showed patients did not score as highly on the Musculoskeletal Tumour Society Score and Knee Society Score as patients who had undergone intra articular resection 20 Thermal ablation techniques Edit Over the past two decades CT guided radiofrequency ablation has emerged as a less invasive alternative to surgical resection in the care of benign bone tumors most notably osteoid osteomas In this technique which can be performed under conscious sedation a RF probe is introduced into the tumor nidus through a cannulated needle under CT guidance and heat is applied locally to destroy tumor cells Since the procedure was first introduced for the treatment of osteoid osteomas in the early 1990s 21 it has been shown in numerous studies to be less invasive and expensive to result in less bone destruction and to have equivalent safety and efficacy to surgical techniques with 66 to 96 of patients reporting freedom from symptoms 22 23 24 While initial success rates with RFA are high symptom recurrence after RFA treatment has been reported with some studies demonstrating a recurrence rate similar to that of surgical treatment 25 Thermal ablation techniques are also increasingly being used in the palliative treatment of painful metastatic bone disease Currently external beam radiation therapy is the standard of care for patients with localized bone pain due to metastatic disease Although the majority of patients experience complete or partial relief of pain following radiation therapy the effect is not immediate and has been shown in some studies to be transient in more than half of patients 26 For patients who are not eligible or do not respond to traditional therapies i e radiation therapy chemotherapy palliative surgery bisphosphonates or analgesic medications thermal ablation techniques have been explored as alternatives for pain reduction Several multi center clinical trials studying the efficacy of RFA in the treatment of moderate to severe pain in patients with metastatic bone disease have shown significant decreases in patient reported pain after treatment 27 28 These studies are limited however to patients with one or two metastatic sites pain from multiple tumors can be difficult to localize for directed therapy More recently cryoablation has also been explored as a potentially effective alternative as the area of destruction created by this technique can be monitored more effectively by CT than RFA a potential advantage when treating tumors adjacent to critical structures 29 Prognosis EditThe 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 but the cure rate depends on the type of cancer location size and other factors citation needed Epidemiology EditBone tumors that originate from bone are very rare and account for around 0 2 of all tumors 7 Average five year survival in the United States after being diagnosed with bone and joint cancer is 67 5 History EditThe earliest known bone tumor was an osteosarcoma in a foot bone belonging to a person who died in Swartkrans Cave South Africa between 1 6 and 1 8 million years ago 6 Other animals EditBones are a common site for tumors in cats and dogs 30 References Edit a b c d e f g h i j k l m n o p q r s t u v Maruthainar N Bhumbra R Cannon S 2018 7 Orthopaedic oncology In Ramachandran M ed Basic Orthopaedic Sciences 2nd ed CRC Press pp 105 121 ISBN 978 1 4441 2098 1 a b c d e f g h i j k Bone Tumor Types and Treatments OrthoInfo AAOS www orthoinfo org Retrieved 27 June 2021 a b c d e f g Questions and Answers about Bone Cancer PDF Centers for Disease Control and Prevention Retrieved 27 June 2021 a b c d e Soft Tissue and Bone Tumours WHO Classification of Tumours International Agency for Research on Cancer 2020 pp 338 344 ISBN 978 92 832 4502 5 a b SEER Stat Fact Sheets Bone and Joint Cancer NCI Retrieved 18 June 2014 a b Strauss Mark 28 July 2016 Earliest Human Cancer Found in 1 7 Million Year Old Bone Culture Retrieved 27 June 2021 a b c Choi JH Ro JY May 2021 The 2020 WHO Classification of Tumors of Bone An Updated Review Advances in Anatomic Pathology 28 3 119 138 doi 10 1097 PAP 0000000000000293 PMID 33480599 S2CID 231679037 Anderson WJ Doyle LA April 2021 Updates from the 2020 World Health Organization Classification of Soft Tissue and Bone Tumours Histopathology 78 5 644 657 doi 10 1111 his 14265 PMID 33438273 S2CID 231595171 Jeon DG Song WS Kong CB Kim JR Lee SY MFH of Bone and Osteosarcoma Show Similar Survival and Chemosensitivity Clin Orthop Rel Res 469 584 90 Multiple Myeloma The Lecturio Medical Concept Library Retrieved 26 August 2021 Maoz A Matsuo K Ciccone MA Matsuzaki S Klar M Roman LD et al May 2020 Molecular Pathways and Targeted Therapies for Malignant Ovarian Germ Cell Tumors and Sex Cord Stromal Tumors A Contemporary Review Cancers 12 6 1398 doi 10 3390 cancers12061398 PMC 7353025 PMID 32485873 Osteosarcoma The Lecturio Medical Concept Library Retrieved 26 August 2021 Murali S Ilaslan H Holden DM 2015 2 An imaging approach to bone tumors In Santini Araujo E Kalil RK Bertoni F Park YK eds Tumors and Tumor Like Lesions of Bone For Surgical Pathologists Orthopedic Surgeons and Radiologists Springer pp 15 56 ISBN 978 1 4471 6577 4 Costelloe CM Madewell JE January 2013 Radiography in the initial diagnosis of primary bone tumors AJR American Journal of Roentgenology 200 1 3 7 doi 10 2214 AJR 12 8488 PMID 23255735 Bone tumor at Mount Sinai Hospital New York 10 year survival in Pediatric Osteosarcoma Survival in Adult Osteosarcoma and MFH of Bone FDA ANDA Generic Drug Approvals Food and Drug Administration Takeuchi A Yamamoto N Hayashi K Matsubara H Miwa S Igarashi K Tsuchiya H December 2019 Joint preservation surgery for pediatric osteosarcoma of the knee joint Cancer and Metastasis Reviews 38 4 709 722 doi 10 1007 s10555 019 09835 z PMID 31807972 S2CID 208650189 Kendall SJ Singer GC Briggs TW Cannon SR September 2000 A functional analysis of massive knee replacement after extra articular resections of primary bone tumors The Journal of Arthroplasty 15 6 754 760 doi 10 1054 arth 2000 8104 PMID 11021451 Rosenthal DI Alexander A Rosenberg AE Springfield D April 1992 Ablation of osteoid osteomas with a percutaneously placed electrode a new procedure Radiology 183 1 29 33 doi 10 1148 radiology 183 1 1549690 PMID 1549690 permanent dead link Rimondi E Mavrogenis AF Rossi G Ciminari R Malaguti C Tranfaglia C et al January 2012 Radiofrequency ablation for non spinal osteoid osteomas in 557 patients European Radiology 22 1 181 188 doi 10 1007 s00330 011 2240 1 PMID 21842430 S2CID 21047698 Rosenthal DI Hornicek FJ Torriani M Gebhardt MC Mankin HJ October 2003 Osteoid osteoma percutaneous treatment with radiofrequency energy Radiology 229 1 171 175 doi 10 1148 radiol 2291021053 PMID 12944597 permanent dead link Weber MA Sprengel SD Omlor GW Lehner B Wiedenhofer B Kauczor HU Rehnitz C July 2015 Clinical long term outcome technical success and cost analysis of radiofrequency ablation for the treatment of osteoblastomas and spinal osteoid osteomas in comparison to open surgical resection Skeletal Radiology 44 7 981 993 doi 10 1007 s00256 015 2139 z PMID 25910709 S2CID 21496405 Rosenthal DI Hornicek FJ Wolfe MW Jennings LC Gebhardt MC Mankin HJ June 1998 Percutaneous radiofrequency 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