Prepared By students:
1.Raveen Ismail
2.Kajeen Salih
3.Rojan Abdullah
3/4/2011
University of duhok/ Kurdistan
College of nursing

MyObjectives
• Simple introduction about skeletal system
• Definition of bone tumor
• Bone tumor Classification
• Deference between malignant and benign
bone tumor
• The staging of bone tumor
• Clinical features ,causes ,complications ,risk
factors of bone tumor
• Diagnostic tests for bone tumor, treatment
, epidemiology for bone tumor in united state
• Applying nursing process for patient with
bone tumor ,home care

• The Skeletal System
• The skeleton is the name given to the collection of
bones that holds our body up. It does three major
jobs.
A. It protects our vital organs such as the
brain, the heart, and the lungs.
B. It gives us the shape that we have
C. It allows us to move..
• . When we were born our skeleton had around
350 bones. By the time we become an adult, we
will only have around 206 bones
Introduction

• Bone comes in several shapes and sizes
the structure and composition of bone is
the same in all. Bone is composed of
protein , minerals and cells.
The main part are:
shaft
neck
head

A tumor is a lump or mass of tissue that
forms when cells divide uncontrollably. A
growing tumor may replace healthy tissue
with abnormal tissue. It may weaken the
bone, causing it to break (fracture).
Bone tumor

A bone tumor is an abnormal growth of
cells within the bone that may be
noncancerous (benign) or cancerous
(malignant).
Definition

Fatal without treatment
May recur after removal
Rarely fatal
Rarely recur after removal
Rapid growth
Slow growth
Distant metastases , not
localized
No metastases , localized
The difference between
malignant benign and
tumors
Benign Malignant

• Enneking described the most widely used
staging system for (benign bone tumors )
The stages are denoted by the Arabic
numerals 1, 2, and 3, whereas malignant
bone tumors are classified by Roman
numerals (I, II, III).
Many benign bone tumors have the
potential to present at, and progress
through, various stages during their
disease course.
Stage of benign tumors

Stage of benign bone
tumors
. Stage 1-LATENT, it do not have any
characteristics of growth or progressive
change, may resolve spontaneously.
Stage 2-ACTIVE, lesion deform the host
bone but remain contained in bone, require
intralesional curettage.
Stage 3-AGGRESSIVE , tumor extend
beyond the bone, require complete work-up
and a removal with wide margins to avoid
possible local recurrence.

The staging system for malignant tumor
adopted by the Musculoskeletal Tumor
Society, and originally developed by
(Enneking) is based on the histological
grade, the local extent(Tumors whether
they are intra-compartmental or extra-
compartmental)
and the presence or absence of metastasis
Stage of malignant bone
tumors

Stage of malignant bone
tumors
Stage IA is defined as G1 and Intra-
compartmental
Stage IB is G1 and extra-compartmental
Stage IIA is G2 and Intra-compartmental
Stage IIB is G2 and extra-compartmental
Stage III is G1 or G2, intra- or extra-
compartmental, and has evidence of
metastasis

Bone
tumor
primary
Benign tumors:
for ex.
osteochondroma
malignant tumors: for ex
Ewing's sarcoma
secondary Metastatic
tumors
Classification

Is a tumor which have spread from other organs
,The most common cancers that spread to the bone
are cancer of the:
1. Breast
2. Kidney
3. Lung
4. Prostate
5. Thyroid
These forms of cancer usually affect older people
metastatic tumors

1. Age
2. Combinations of radiation and chemotherapy for
treating prior cancer
3. Certain kinds of anticancer drugs (alkylating agents)
4. Family history of bone cancer
5. An overactive parathyroid gland
6. Multiple benign tumors
7. Paget's disease
8. osteomyelitis
9. Radiation
Risk factors

1. Movement problems
2. Stiff bones
3. Bone lumps and masses
4. Bone tenderness
5. Anemia
6. Weight loss, Fatigue
7. Bone pain, may be worse at night
8. fevers and night sweats
9. Bone fracture, especially fracture from slight injury
(trauma)
10. Note ! Some benign tumors have no symptoms
Clinical features

 The cause of bone tumors is unknown.
They often arise in areas of rapid growth
 Inherited genetic mutations
 Radiation
 Trauma
Causes

1. Delayed wound healing
2. Nutritional deficiency
3. Infection
4. Hypercalcaemia
5. muscle wasting, bone weakening
6. pathological fracture
7. temporary burn to the skin and fatigue
from radiation therapy
Complications

8. nausea, vomiting, mouth sores, hair loss,
and lowered resistance to infection from
chemotherapy.
9. infection of the surgical site and possible
blood clotting disturbances from surgery.
10.Pain
11.Spread of the cancer to other nearby
tissues (metastasis)
Complications

Blood test
Bone biopsy
Bone scan computed tomography (CT).
MRI ( magnetic resonance imaging )
X-ray of bone
CT scan
Diagnosis & Tests

Open Biopsy
Needle Biopsy
insert a needle into the tumor to remove
some tissue
small incision is made and the tissue is
removed
removal of a sample of bone tissue to test for
cancer cells.
Bone biopsy:

Systemic therapy
 Local therapy
1.Chemotherapy
2. hormone therapy
3.Immunotherapy ex.
Interferon α
1.Radiation therapy
2. surgery
Nutritional therapy
• Provide foods high in protein, vitamins
and folic acid.
Treatment

• Hormone therapy
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.
• Chemotherapy
used to kill tumor cells when they have
spread into the blood stream
Systemic therapy

• Radiation Therapy
Radiation therapy uses high-dose x-rays to
kill cancer cells and shrink tumors. may be
given either before or after surgery
Local therapy

Surgical Treatment
 Amputation
 Rotationplasty
 Bone graft
 Artificial bone
removes all or part of an arm or leg when the tumor is
large and/or nerves and blood vessels are involved.
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.
affected bone is removed, bone from elsewhere from the
body is taken.
affected bone is removed, putting an artificial bone in.
Local therapy

Narcotics
analgesics
Ex. Biphosphonates
are drugs that can be used to reduce bone pain
and slow down bone damage in people who have
cancer that has spread to their bones,increase bone
strength
Ex. 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
Pain medications

• Age: Bone tumor are more common in
children and young adults when bones
grow rapidly
• The incidence of bone cancer is higher in
families with familial cancer syndromes.
The incidence of bone cancer in children is
approximately 5 cases per million children
each year , in united states
Epidemiology

Nursing assessment
Nursing diagnosis
Nursing planning
Nursing Implementation
Nursing evaluation
Nursing process

Collection Of Subjective Data:
1. Bone pain in the area of the tumor , may be worse at night,
pain is generally described as dull and achy
2. pain may or may not get worse with activity
3. Fatigue, anxiety
Collection Of Objective Data:
1. Bone lumps and masses determining the location and size of
tumor ,soft tissue swelling
2. Stiff bones
3. Weight loss
4. Bone fracture, especially fracture from slight injury (trauma)
5. fevers and night sweats
6. Movement problems
7. Anemia
Nursing assessment

Nursing
Diagnosis
Nursing
Planning
Nursing Implementation Nursing
evaluation
Acute or
chronic pain
related to
the
pathologic
process and
surgery
Control
of pain
Administer analgesics
as necessary. Make sure
the patient has received
his analgesic before
morning care or any
activity that may increase
pain
Regularly monitor the
Experiences no
pain or
decreased pain
patient’s degree of pain
and the effectiveness of
analgesics and other pain
relief measures, such as
positioning or guided
imagery
1

Deficient
knowledge
related to the
disease
process and
therapeutic
regimen
Giving
knowledge
about the
disease
process and
treatment
regimen
Nursing
Diagnosis
Nursing
Planning
Nursing Implementation Nursing
evaluation
Promoting
understanding of the
disease process and
treatment
regimen(Provide foods
high in protein,
vitamins and folic acid)
Don’t give I.M.
injections or take rectal
temperature
During radiation
therapy or
chemotherapy, take
measures to reduce
adverse reactions, such
as providing the patient
with plenty of fluids to
drink and saline
mouthwash for gargling
Described disease
process and
treatment
regimen
2

Nursing
Diagnosis
Nursing
Planning
Nursing Implementation Nursing
evaluation
Risk for
injury:
pathologic
fracture
related to
tumor and
metastasis
Absence of
complication
Absence of
The effective extremities
must be supported and
handled gently
pathologic
fracture
Exhibits absence of
complication
3

Nursing
evaluation
Nursing
Implementation
Nursing
Planning
Nursing
Diagnosis
Risk for
situational
Improved self-
esteem
low self-
esteem
related to
loss of body
part
(Promoting self –
Esteem)Try to help the
patient develop a
positive attitude
toward recovery and
urge him to resume an
independent lifestyle
Demonstrate
positive self –
concept
4

Nursing
Diagnosis
Nursing
Planning
Nursing
Implementation
Nursing
evaluation
Ineffective
coping
related to
fear of the
unknown
,perception
of disease
process
Effective
pattern of
coping
(Promoting coping
skills)Encourages the
patient and family to
verbalize their fears
,concerns, and
feelings
Demonstrates
effective coping
pattern

Home care

 http:// www.google.com
 http:// www.wekipedia.org
 http://www.bonetumor.org
 help.com/Bonetumors.htm
References

Books
1. Writer :Patricia M , Dillon
Book :nursing health assessment
Edition :second edition
Pages :467_470
Year :2003
References

Books
2.Writer :Suzanne C .smltzor
Book :medical and surgical nursing
Edition :eleventh edition
pages:2419_2413
year :2008
References