This document discusses bone tumors. It begins with an introduction stating that most bone tumors are benign lesions usually found in young people, while malignant tumors are more common in the elderly. It then covers the causes, classification, clinical presentation including symptoms of pain, mass, and hypercalcemia. Diagnosis involves blood tests, radiology like x-rays and CT scans, biopsy, and staging. The document discusses the most common primary sites of bone tumors and metastases. Differential diagnosis and treatment methods like surgery, radiation, chemotherapy are also summarized.

1. ‫د‬
.
‫سعيد‬
‫بامشموس‬ ‫عبدهللا‬
‫أول‬ ‫استشاري‬
‫وأستاذ‬
‫إلمراض‬
‫وجراح‬
‫والكسور‬ ‫العظام‬ ‫ة‬
‫والمفاصل‬
‫الرحيم‬ ‫الرحمن‬ ‫هللا‬ ‫بسم‬

2. CAUSES
. GENETIC
. CONGENITAL
. IMMUNOLOGY
. NUTRITIONAL
. INFECTION
. ONCOLOGY
. TRAUMATIC ( Dir, Chemi, Phisc )
. DEGENERETIEV

3. B O N E
T U M O R S

4. Factors
1. Oncogenic viruses (ex. HSV/HPV & cerv CA)
2. Chemicals (ex. Smoking & lung CA)
3. Chronic irritation (ex. hyperkeratosis & oral cavi
ty cancer)
4. Genetic factors (ex. breast CA)
I n t r o d u c t I o
n
E t I o l o g y

5. I n t r o d u c t I o
n
• Most bone tumors are benign lesions.
• Most benign lesions are in young.
• A new bone tumor in the elderly is more likely
to be malignant.
• No bone is safe (most primaries are in long bo
nes).
• Metastases came from Prostate or Brest.

6. • Bone tumors are very diverse in morphology
and biological potential (can be no big deal o
r rapidly fatal).
• Bone tumors are rare tumors( less than 2% o
f all cancers).
I n t r o d u c t I o n

7. • Locale examination of bone gives Diagnosis info.
• More common benign lesions typically present as i
ncidental findings (non-painful, stable size).
• Be cautious with painful lesions and those that gro
w relatively fast (over weeks or months).
• Pathological fracture can be the first sign of tumor.
I n t r o d u c t I o n

9. BONE TUMURS
1. 1. CLINICAL PRESENTATION
A. HISTORY
B. PHYSICAL EXAMINATION
2. DIAGNOSIS,
3. BIOPSY,
4. STAGING.
5. CLASIFFICATION.
6. METASTASES .
7. DIFFRENTIAL DIAGNOSIS.
8. METHOUDS OF TREATMENT.

10. A. H I S T O R Y
•
AGE,
•
SEX,
•
RACE,
•
FAMILY HISTIRY,
•
C/O PAIN (at REST and NIGHT),

11. • A common complication.
• Often the initial symptom of bone metas
tases.
1. Pain
A. H I S T O R Y

12. • The thick membrane that covers each bo
ne, called the periosteum, has many nerv
es, making it a highly sensitive tissue.
• Damage or pressure to this tissue caused
by bone metastases may result in a great
deal of pain.
1. Pain

13. 2. M A S S
• THE MASS MEASURED,
• LOCATION,
• SHAPE,
• CONSISTENCY,
• MOBILITY,
• TENDERNESS,
• TEMPERATURE ,
• CHANGE WITH POSITION,
• ATROPHY SURROUNDING MUSCULATURE.

14.  Nausea
 Fatigue
 Ext. muscle weakness,
 Lethargy, (
‫خمول‬
)
 Moodiness (
‫مزاجي‬
)
 Irritability
 Anorexia
 Confusion
 Vomiting
 Stomach Pain
 Constipation
 Excessive thirst,
 Dry mouth or throat
 Irregular heart beat
 Frequent urination ,
 Coma.
3. Hyper calcimia

15. B. PHYSICAL EXAMINATION
• GENERAL HEALTH,
• EXAMINATION OF ALL THE PART OF BODY,
• BACK STIFFNESS MUSCLE SPAZM,
• JOINT EFFUSION,
• LIMITATION OF MOVEMENT NEAR THE JOINT,
• NEUROLOGICAL SYMPTOMS
 PARASTHESIA NUMBNESS
 NEUROLOGICAL DEFICITS

17. Sites of Tumors
• Diaphyseal:
Ewings, Osteoid Osteoma, Mets,
Adamantinoma, Fibrous Dysplasia
• Epiphyseal:
Chondroblastoma.
Chondrosarcoma, GCT, Ganglion.
• Metaphyseal: Everything!!!!!!

18. Age of Tumors
• 20>…..Osteogenic Sarcoma, Ewings.
• 40……GCT, Chondrosarcoma, Lymphoma,
Mets.
• 60……Mets, Myeloma, Chondrosarcoma,
late Osteogenic, Fibrosarcoma.

20. Differences between:
Age group Young Different
Path. Fracture Rare More
common
Metastasis No Yes
Gen. Condition Normal Affected
benign & malign
ant

21. Differences between:
benign & malignant

23. 1) Laboratories Tests

24. BLOOD
TESTS
• CBC (ANAEMIA)
• ESR
• ELECTROPHORESIS
PROSTATE SPECIFIC
ANTIGEN.
 HYPERCALCEMA
 ALKALINE PHOSPH
ATASE,
 THYROID PARATHY
ROID
 Renal Function : (C
REATININE , UREA,
urine analysis,…)

25. 2) R A D I O L O G Y

26. 1 Plain x-ray
Most useful
Could see:
○A lump
○Bone destruction
○Cortical thickening+ peri
osteal reaction
○Cysts
Important to notice:
○Where
○How many
○Cystic or not
○Margins
○destruction

27. Bone loss occurs when th
ere is decreased calcificati
on or reduced density of t
he bones.
The result is weak bones t
hat are at increased risk o
f PATHOLOGICAL
fracture.
a Bone loss

28. Plain x-ray
b This is a simple x-ray RDIOLUCENT MATERIAL
. Changes
. If secondary bone cancer.

29. 2) COMPUTED TOMOGRAPHY (CT)
NB. For metastasis CT of lung and body

30. 3) RADIONUCLIDE SCANNING
This is a more
sensitive test
than an x-ray
and shows up
any abnormal
areas of bone
in any part of
the body

31. 4) ULTRSONOGRPY
liver metastases

32. • 5) MRI (Magnetic Resonance Imaging)

33. Biopsy types:
- Closed = Needle aspiration.
- Open = Incisional or excision
al.
6) BIOPSY
• To obtain adequate tissu
e for diagnosis & gradin
g.
• Use the shortest possible
way to reach the tumor.
• The biopsy site should be
respectable.

35. STAGING Enneking 1986
BENIGN 1. LATENT
2. ACTIVE
3. AGGRESSIVE
MALIGNANT
IA IB IIA IIB III
NB. FOR TREATMENT + PROGNOSIS

36. From imaging: the extent of the tumor
Intra-compartmental I
Extra-compartmental II
Metastasis III
From biopsy: histological grading :
Low grade A
High grade B
STAGING

38. CLASSIFICATION OF THE PRIMARY BO
NE TUMOUR
CELL TYPE BENIGN MALIGNANT
BONE OSTEOID OSTEOMA OSTEOSARCOMA
CARTILGE CHONDROMA
OSTEOCHONDROMA (E
XOSTOSIS)
CHONDROSARCOMA
MARROW HAEMANGIOMA ANGIOSARCOMA
EWING`S SARCOMA
MULTIPE MYLOMA
UNCERTAIN GIANT CELL TUMOUR
BONE CYST
ANEURYSMAL
CELL TUMOUR

39. OSTEOID OSTEOMA
OSTEOSARCOMA

40. CHONDROMA CHONDROSARCOMA
EXOSTOSIS
OSTEOCHONDROMA

41. EXOSTOSIS OSTEOCHONDROMA

42. EXOSTOSIS
OSTEOCHONDROMA

43. BONE CYST
ANEURYSMAL BONE CYST
HAEMANGIOMA

44. EWING`S SARCOMA

45. SOFT TISSUE TUMOURS
FATTY TUM. LIPOMA LIPOSARCOMA
FIBROUS TUM. FIBROMA FIBROSARCOMA
SYNOVIAL TUM. GIANT CELL TUM. SYNOVIAL SARCOMA
BLOOD VESSEL TU
M.
HEMANGIOMA GLOMUS TUM
NERVE TUM NEUROMA NEUROSARCOMA
MUSCLE TUM RHABDOMYOMA RHABDOMYOSARCOMA

46. FIBROMA
GIANT CELL TUMOUR

48. THE MOST PRIMERY SO
URCE FORE BONE META
STASES CAME FROM:
1) PROSTATE CANCER
BREAST CANCER
2) LUNG CANCER
3) RENAL CELL CARCINOMA
METASTASE = Secondary

49. NB. CT CHEST OR WHOLE BODY SCAN
METASTASES

51. DIFFRENTIAL DIAGNOSIS
• SOFT TISSUE HEMATOMA,

52. DIFFRENTIAL DIAGNOSIS
• MYOSITIS OSSIFICATION,

53. DIFFRENTIAL DIAGNOSIS
• STRESS FRACTURE,

54. DIFFRENTIAL DIAGNOSIS
• TENDON AVULSION INJURIES,

55. DIFFRENTIAL DIAGNOSIS
• BONE INFECTIN,

56. DIFFRENTIAL
DIAGNOSIS
• GAUT

58. METHOUDS OF TREATMENT
I. SURGICAL

59. PRINCIPLES OF SURGERY.
1. Determine stage during surgery.
2 .Histologic confirmation.
3. “En-bloc resection”
– Nodal dissection not picking
– Avoid tumor spillage
4. Attain tumor free margins.

60. METHOUDS OF TREATMENT
A. CURITAGE

61. B. TUMOUR EXCISION
1. MARGINAL EXCISION
2. WIDE EXCISION
3. RADICAL EXCISION

62. c. AMPUTATION VERSUS LIMP SALVAGE

63. d. RESECTION AND RECONSTRUCTION

65. Vertebro-plasty
Cifo-plasty

66. II. RADIATION THERAPY

67. •
(THE DOSE GRAY (Gy) 1JOULE OF ABSORBED ENER
GY PER KILOGRAM
1 RAD 1CENTIGRAY (cGy)
Radiation Therapy
Radiation therapy is the use of
ionizing radiation to kill cancer cells
and shrink tumors.
Radiation therapy injures or
destroys cells in the area being
treated by damaging their genetic material, maki
ng it impossible for these cells to continue to gro
w and divide.
RADIATION THERAPY

68. III. CHEMOTHERAPY
PRINCIPLES OF CHEMOTHERAPY
GOAL
• To kill cancer cells by in
terfering with its meta
bolic pathway without
serious damage to nor
mal cells

69. PRINCIPLES OF CHEMOTHERAPY
1. ALKYLATING AGENTS
(i.e. Cyclophosphamide)
• Binds to nucleic acids thereby
altering the structure
• Cell cycle nonspecific
• Cross resistance with other alk
ylating agents
CLASSIFICATION / MECH OF ACTION:

70. PRINCIPLES OF CHEMOTHERAPY
2. ANTIMETABOLITES (5-FU, Methotrexate)
• Structural analogues of nucleic acid precursor
s results in production of false intermediate
metabolites
• S phase specific agents

71. PRINCIPLES OF CHEMOTHERAPY
3. ANTIBIOTICS (ex. Adriamycin, Bleomycin)
–Interferes with various points in sequence of D
NA to RNA to protein formation
–Interferes with DNA replication or inhibition of
RNA synthesis
–Cell cycle non-specific

72. PRINCIPLES OF CHEMOTHERAPY
4. ANTI-MICROTUBULAR AGENTS
• Plant origin.
• Causes disorganization of mitotic spindles.
• Produce mitotic arrest of the cell in metaphase.
• Cell cycle specific
4.1 Vinca alkaloids (ex. Vincristine, Vinblastine)
inhibit assembly of microtubules
4.2 Taxanes (ex. Paclitaxel, docetaxel)
inhibit microtubular disassembly

73. PRINCIPLES OF CHEMOTHERAPY
Side Effects
– Vomiting
– Hair loss
– Depress immunity
– Weakness/anorexia
– Anemia
– Organ specific (cardiac, liver, kidney)

74. T H A N K S F O R
Y O U R L I S T E
N I N G . . ..