usefull for bsc Nursing students

1. BONE TUMOR
Mr Yogendra Mehta
Lecturer, HOD(Adult Health Nursing)
BRNC Biratnagar

2. INTRODUCTION
•Bone tumors develop when cells within a bone divide
uncontrollably, forming a lump or mass of abnormal tissue.
•Affect any bone in the body and develop in any part of the
bone — from the surface to the center of the bone, called the
bone marrow.
• Most bone tumors are benign (not cancerous).
•Benign tumors are usually not life-threatening and, in most
cases, will not spread to other parts of the body.
• Some bone tumors are malignant (cancerous). Malignant
bone tumors can metastasize.

3. INTRODUCTION…
• It is either a primary bone cancer or a secondary bone
cancer.
A primary bone cancer actually begins in bone
A secondary bone cancer begins somewhere else in the
body and then metastasizes or spreads to bone.

4. INTRODUCTION…
Types of cancer that begin elsewhere and commonly spread
to bone include:
•Breast
•Lung
•Thyroid
•Renal (kidney)
•Prostate

5. Warning Signs of Bone Tumor
•Pain: pain or Tenderness most of time even in rest.
•Swelling
•Problem moving around
•Fatigue
•Fever
•Weakened bone
•Weight Loss

6. WHO Nomenclature & Classifications
1 Bone forming tumors
Benign Osteoid osteoma, osteoma, Osteoblastoma
Indeterminate Aggressive osteoblastoma
Malignant Osteosarcoma
2 Cartilage forming tumors
Benign Osteochondroma, Chondroblastoma,
Malignant Chondrosarcoma
3 Gaint cell tumor(Osteoclastoma)
4 Marrow tumor
primary tumor commonest Multiple myeloma
5 Vascular tumor
Benign hemangioma
Malignant Angiosarcoma

7. Osteoma
•It is a benign tumor composed of sclerotic,
well formed bone protruding from cortical
surface of a bone.
• The bone involved most often are the skull
and facial.
• Generally, the tumor has no clinical
significance except that it may produce visible
swelling.
• Sometimes it may bulge into the air sinuses
and cause obstruction to the sinus cavity, and
leading to pain.

8. Treatment
•No treatment is generally required except for cosmetic reasons.
• Simple excision is sufficient.

9. Osteoid osteoma
•It is the most commonest true benign tumor of the
bone.
• Pathologically, it consists of a nidus of tangled arrays
of partially mineralized osteoid trabeculae surrounded
by dense sclerotic bone.
•Tumor is mainly located at diaphysis of long bones.
• posterior elements of the vertebrae are common site.
Clinical Features:
-Seen commonly between the age of 5-25 yrs
- bone of the lower extermity are more commonly
affected; Tibia
- nagging pain, worst at night and relieved by salicylates
- Mild tenderness at the site of the lesions
-palpable swelling if it is superficial

10. Contd….
•Diagnosis:
-Confirmed by X-Ray: tumor is visible aa
a zone of sclerosis surrounding a
radiolucent nidus usually less than 1 cm
in size.
-CT scan
Treatment:
-Complete excision of the nidus along
with the sclerotic bone is done.
- Prognosis is good.

11. Osteoblastoma
• It is a benign tumor consisting of vascular
osteoid and new bone.
• It occurs in the jaw and the spine.
• If in long bones, it occurs in the diaphysis
or metaphysis, but never in the epiphysis.
• It occurs in patients in their 2nd decade of
life.
•The patients with aching pain.
• Radiologically, it is a well-defined
radiolucent expansible bone lesion 2-12 cm
in size.
• There is minimal reactive new bone
formation.
• Treatment is by curettage.

12. Chondroblastoma
• It is a cartilaginous tumor containing
characteristic multiple calcium deposit.
• It occurs in young adults and is located
around the epiphyseal plate.
• Bones around the knee are commonly
affected.
• Radiologically, There is a well- defined
lytic lession surrounded by a zone of
sclerosis.
• Are of calcification within the tumor
substance give rise to a mottled
appearance.
• Treatment is by curettage and bone
grafting.

13. Hemangioma of the bone
• This is the benign tumor of angiomatous origin commonly affecting the
vertebrae and skull.
• It occurs in young adults.
•Common presenting symptoms are persistent pain and features of cord
compression.
• Typically, one of the lumbar vertebrae is affected.
• Radiologically, it appears as loss of horizontal striation and prominence
of vertical striation of the affected vertebral body.
• Treatment is by radiotherapy.

14. Osteoclastoma(GCT)
• Giant cell tumor is a common bone tumor.
• The tumor consist of undifferentiated spindle cells, profusely
interspersed with multi-nucleate giant cell.
• The tumor stroma is highly vascular.
• The tumor is seen commonly in the age group of 20-40 years i.e after
epiphyseal fusion.
•The bone affected commonly are those around the knee and lower end
of the radius.
Clinical Features:-
-Swelling & vague pain
-Pathological fracture

15. Contd……
Examination:-
-Examination reveals a bony
swelling
- surface of the swelling is smooth
- limb may be deformed
Diagnosis:-
-Lytic lesion seen in X-ray
-Soap- bubble appearance seen
-No calcification seen within the
tumor

16. Contd……
Treatment:-
- Whenever possible, excision of the tumor is the best treatment.
-If excision is not possible then radiotherapy is done.
-Following treatment methods are commonly used:
a. Excision:-
- It is the treatment of choice when the tumor affects a bone whose
removal does not hamper with function e.g., fibula, lower end of
ulna

17. Contd……
b. Excision with reconstruction:-
- When excision of a tumor at some site may result in significant
functional impairment & reconstructed by as follows-
 Arthrodesis by the Turn-O- Plasty procedure
 Arthrodesis by bridging the gap by double fibula, one taken from
same extremity and other from the opposite leg.
 Arthroplasty- Tumour is excised and attempt is made to reconstruct
the joint in some way. It can be carried out using an autograft.
c. Curettage with or without supplemetary procedure:-
- High reoocurance rate
- Cryotherapy: Liquid nitrogen is used to produce freezing effect and
thus kill the residual cells and thermal burning of the cells by using
cautrization.

18. Contd……
d. Amputation:-
e. Radiotherapy:-
- It is preferred treatment for GCT affecting the vertebrae
Prognosis:
- Recurrence is more common.

19. Osteosarcoma
- It is the second most common and high
malignant primary bone tumor.
- It is defined as a malignant tumor of
the mesenchymal cells characterized
by formation of osteoid or bone by the
tumor cell.
- It occurs between the age of 15-25
years.
- lower end of femur , upper end of the
tibia and upper end of humerus most
common site.
- It looks like greyish white , hard.
- Histologically tumors vary in the
richness of the osteoid, cartilaginous
or vascular components.

20. Contd……
Clinical Features:
- Pain is usually the first symptoms soon followed by swelling
- Pain is constant and boring and becomes worse as the swelling
increase in size.
- h/o trauma
- sometime pathological fracture
Examination:
- Swelling at the metaphysis region.
- Shinny with prominent vein seen over the skin
- Margin of swelling are not well defined
- Regional lymphnodes may be enlarged

21. Contd……
Investigation
- X-ray shows the irregular destruction in the metaphysis,
overshadowed by the new bone formation.
- Codman’s triangle: A triangle area of subperiosteal new bone is seen
at the tumor host cortex junction at the ends of the tumor.
- Serum Alkaline Phosphatase
- Biopsy

22. Contd……
Treatment
- Confirmation of the diagnosis
- Evaluation of spread of tumor
- To plan amputation surgery
- Treatment of the tumor
 Local Control: surgical ablation, amputation
 Radiotherapy
 Chemotherapy Immunotherapy
- Portion of the tumor is implanted into a sarcoma survivor and is
removed after 14 days.

23. Contd……
Follow up:
- Checked up every 6-8 wks
- Any evidence of recurrence of the primary tumor.
Prognosis:
- Without treatment death occurs within 2 yrs, usually within 6 month
of detection of metastasis.
- 5 yrs survival with surgery alone is 20%
- With surgery and adjuvant therapy, 5 yrs survival is 70%

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