This document provides information on various types of bone sarcomas (bone cancers), including Ewing sarcoma, osteosarcoma, chondrosarcoma, and secondary bone malignancies. It describes the epidemiology, location, diagnostic approach, treatment options, and prognosis for each type. It concludes with multiple choice questions to test understanding.

1. BONE SARCOMAS
VINAYAK HARIKUMAR
RACHEL ISAAC
REHANA RAHMAN
AQEEL JAFAR
JESHMA REJI
ANNA VINCENT GOMEZ
NISHAL NAZEER

2. INTRODUCTION
• Cancer can start in any part of any bone.
Cancer begins when healthy cells in the bone
change and grow out of control, forming a
mass called a tumor. A bone tumor can be
cancerous or benign.
• Malignant bone tumors can be classified as
primary (arising from abnormal bone
or cartilage cells) or secondary (bone
metastases of other tumors). The most
common primary bone tumors
are osteosarcomas, Ewing sarcomas,
and chondrosarcomas. These tumors differ
with regard to primary localization,
radiographic characteristics, and the patient
age at which they usually develop.

6. Ewing sarcoma
• Highly malignant bone tumor arising
from neuroectodermal cells
• Some sources suggest that Ewing
sarcoma originates from mesenchymal stem cells
• Etiology: translocations of
the EWSR1 gene (chromosome 22)
• Epidemiology
• peak at 10–20 years
• ♂ > ♀
• primarily affects white individuals
• Localization
• Primary tumor: often diaphyses of long
bones (particularly femur, tibia, fibula,
and humerus) and bones of the pelvis

7. Diagnostics
• Conventional X-ray
• Lytic bone lesions
• Onion skin appearance of the periosteum
• Biopsy
• Anaplastic small-blue-round-
cell malignancy
• Tumor cells resemble lymphocytes.
• Differential diagnoses
include lymphoma and chronic
osteomyelitis.
• Chromosomal
translocation t(11;22); fusion
protein EWS-FLI1

9. Osteosarcoma
• Definition: malignant, osteoid, and bone-forming tumor arising from mesenchymal stem
cells (osteoblasts)
• Etiology
• Secondary osteosarcoma: Paget disease of bone, radiation injury, bone infarction
• Increased incidence in individuals with retinoblastoma and Li-Fraumeni syndrome
• Epidemiology
• Primary osteosarcoma: in puberty/adolescence (peak incidence age 10-30 years)
• Secondary osteosarcoma: advanced age
• Sex: ♂ > ♀
• Most common primary bone malignancy
• Localization
• Primary tumor: metaphyses of long bones (particularly distal femur and proximal tibia)

11. Diagnostics
• Imaging
• Conventional x-ray
• Sunburst
appearance of lytic
bone
lesions and/or Codma
n triangles
• Biopsy
• Pleomorphic,
malignant osteoblasts th
at produce osteoid

13. Chondrosarcoma
• Definition: a malignant
tumor arising from
mesenchymal cells that
produce cartilage
• Epidemiology
• Age: usually > 50 years
• Localization: most common in
the medullary cavity of
the pelvis, ribs, proximal femur,
and proximal humerus

14. Diagnostics
• Conventional X-ray or CT
• Osteolysis with a moth-
eaten appearance
• Intralesional calcifications (rings
and arcs calcification, popcorn
calcification)
• Endosteal scalloping; and cortical
breach with infiltration of soft
tissue
• Biopsy
• Malignant chondrocytes

16. Secondary malignancies of the bone (bone
metastasis)
• Etiology: lung, breast(common), and prostate
cancer
• Epidemiology
• More common than primary bone tumors
• Classification: based on radiological findings
• Osteoblastic metastasis
• increase in radiographic density
• prostate cancer, small cell lung cancer
• Osteolytic metastasis
• decrease in radiographic density
• multiple myeloma
• Mixed metastasis: e.g., breast cancer,
gastrointestinal cancer

17. Diagnosis of secondary bone cancer
• Blood tests
• You will have a full blood count and your calcium levels will be checked.
• X-rays
• X-ray scans will be taken of your chest and bones to check for bone damage, the formation of new bone or
fractures.
• Bone scan
• You will have a small amount of radioactive dye injected into a vein that will show any abnormal changes using a
scanning machine.
• CT or MRI scans
• Scans, including three-dimensional imagery, create pictures of your body that help to highlight any bone abnormality.
The scans generally take between 30 and 90 minutes.
• PET scan
• In a positron emission tomography (PET) scan, you will have a small amount of radioactive glucose injected into the
body, which highlights any cancerous areas.
• Bone biopsy
• A biopsy is when some cells and tissues are removed for examination under a microscope.

18. Treatment
• Secondary bone cancer can’t be cured, but treatment can reduce symptoms and improve quality of
life. In some cases, treatment can keep secondary bone cancer under control for many years.
• Your treatment options will depend on:
• the type of primary cancer, if it is known
• the treatment you have already had
• how many bones are affected by cancer
• whether the cancer has spread to other parts of the body
• your symptoms and general health.

19. • Hormone therapy
• Hormone or endocrine therapy may be used to treat prostate or breast cancer that has spread to the
bone. Hormone therapy aims to lower the levels of hormones in the body or to stop hormones reaching
cancer cells that need hormones to grow. It can be given as tablets or by injection.
• Chemotherapy
• Chemotherapy uses drugs to kill cancer cells or slow their growth. The drugs are usually given via an
injection into the vein (intravenously) over several hours. Targeted therapy
• Targeted therapy uses drugs that attack specific features of cancer cells to stop the cancer growing and
spreading. Targeted therapy can only be used to treat cancers that grow in response to certain proteins in
our cells. TImmunotherapy
• Immunotherapy aims to stimulate the body’s own immune system to attack the cancer most often by using
checkpoint inhibitor drugs. Some cancers create ‘checkpoints’ which block the immune system so the
checkpoint inhibitors allow the immune system to bypass these checkpoints.

20. Surgery
• As cancer can weaken a bone
and cause fracture, surgery
may be used to insert metal
rods, plates, screws, wires or
pins. You may also have
surgery if the cancer is
pressing on the spinal cord.
• If pathologic fractures have
occurred or are likely:
stabilize and restore function

21. PROGNOSIS
• Ewing sarcoma-
• Extremely aggressive, early metastases
• Usually responsive to chemotherapy
• Osteosarcoma-
• Aggressive course
• Primary osteosarcoma: five-year survival rate of ∼ 70% (usually responsive to treatment)
• Secondary osteosarcoma: poor prognosis (less responsive to treatment)
• Chondrosarcoma. Almost 70 out of 100 people (almost 70%) survive their cancer for 5 years or more
after they are diagnosed. Survival is better for people with chondrosarcoma starting in the arms or
legs than for those with chondrosarcoma in the spine (vertebral) and hip (pelvic) bones.
• Malignant giant cell tumors of bone--The five-year relative survival rate for a regional malignant giant
cell tumor of bone is 74 percent. Patients with distant metastatic giant cell bone tumors have a five-
year relative survival rate of 42 percent.

22. MCQs
• 1.Which of the following is a common primary malignant bone tumor that predominantly affects
adolescents and young adults?
• A) Osteoarthritis
• B) Osteoporosis
• C) Ewing sarcoma
• D) Rheumatoid arthritis
• 2.Which of the following statements is true regarding osteosarcoma?
• A) It is a benign tumor of the bone.
• B) It primarily affects the soft tissues surrounding the bones.
• C) It is most commonly seen in older adults.
• D) Osteosarcoma is a malignant tumor arising from bone tissue.

23. • 3.Which of the following is a malignant tumor arising from cartilage cells?
• A) Osteosarcoma
• B) Chondrosarcoma
• C) Ewing's sarcoma
• D) Liposarcoma
• 4.What is the primary source of most secondary bone tumors?
• a) Lung
• b) Breast
• c) Colon
• d) Prostate

24. • Mr. Johnson, a 45-year-old male, presents to the orthopedic clinic with a gradually
increasing pain in his right hip for the past few months. He denies any recent
trauma but reports a dull ache that worsens at night. Physical examination reveals
limited range of motion in the right hip, and there is tenderness upon palpation
over the greater trochanter. An X-ray of the hip is obtained, showing a well-defined
lytic lesion with Intralesional calcifications.
• Question: Based on the clinical presentation and imaging findings, what is the most
likely diagnosis?
• a) Osteosarcoma
b) Ewing sarcoma
c) Chondrosarcoma
d) Fibrosarcoma