Malignant bone tumors - symptoms, diagnosis, modern methods of therapy

Bone tumor is a collective name for malignant and benign tumors that affect skeletal bone tissue (bone or cartilage). Malignant bone tumors are called sarcomas.

Primary malignant bone tumors come in many different subtypes that make up from 0.2% to 1% of all human neoplasms. In Russia, no more than 1,500 new cases of the disease are diagnosed annually. More often, a malignant bone tumor is a metastasis, i.e. the primary tumor is located in another organ. We will consider primary bone tumors, i.e. sarcomas.

The exact reasons for the development of the disease have not been established. There are risk factors for developing the disease, such as previous radiation therapy, immunodeficiency state, Paget's disease, Ollier's disease, benign tumors bone lesions can also lead to malignant transformation, past injuries to long bones, fractures, etc. But in most patients, the specific causes of the development of the disease are not determined.

Bone tumors occur in patients of any age and regardless of gender. Modern diagnostic methods in oncology allow you to quickly establish a diagnosis, as well as determine effective method of treatment. Timely consultation with a doctor is also important because malignant tumors, localized in bone tissue, are characterized by increased aggressiveness and often recur.

Main types of bone sarcomas:

There are many histological types of malignant bone tumors. Each of them has its own characteristics course of the disease, prognosis and treatment tactics. Let's look at a few of the most common types:

• Osteosarcoma is the most common high-grade primary malignant bone tumor. Between the ages of 15 and 29 years, skeletal bone tumors account for 3% of all tumors, and osteosarcoma accounts for approximately half these cases. More common in men. The most common location of osteosarcoma is long bones.
• Chondrosarcoma is the second most common type, the risk of which increases with age and does not depend on gender. This form Cancer occurs due to abnormal growth of cells responsible for the formation of cartilage in the bones. The most common location of the tumor is in the femur, pelvic bones, humerus, ribs, sternum, scapula..
• Ewing's sarcoma is a bone cancer that, on the contrary, is more common in children and young people under 30 years of age. Most common the primary sites are the bones of the extremities (50%), followed by the pelvis, ribs and vertebrae. Potentially affected any bone, but extraskeletal origin is also possible, especially among adults (30%). In 25% of patients at diagnosis distant metastasis is detected.
• Giant cell tumor is a relatively rare neoplasm of skeletal bones, which is characterized by locally aggressive nature of the course, high frequency of local relapses. Most often the disease affects the distal femur or proximal tibia.
• Chordoma is a low-grade, slow-growing, but locally invasive and aggressive tumor. The most common location is the sacral/coccygeal region (50%), followed by the spheno-occipital region (35%) and mobile spine (about 10–15%). The clinical picture depends entirely on the location of the chordoma. Symptoms are often erased and appear for a long time in a weak form, which causes a delay in seeking medical attention.

Symptoms of the formation of neoplasms in the bones

In the early stages, a malignant bone tumor may not manifest itself, the disease is asymptomatic. Early bone cancer can only be detected during a routine medical examination.

The first symptom of the disease is often pain, which they often try to associate with injury to the relevant area in the recent past. Gradually the pain may increase.

Body temperature may increase. Subsequently, swelling and redness of the skin appears. in the affected area. If the tumor is localized near the joint, its function is impaired. In the absence of treatment, after some time, pronounced symptoms of intoxication appear (weakness, sudden weight loss, increased body temperature, etc.) which gradually increase.

If the pathological process is sufficiently widespread There are pathological fractures that are difficult to treat.

If left untreated, the tumor can metastasize to other organs and the clinical picture will depend on the location and size of metastases.

However, not in every case cancer manifests itself so clearly that it can be seen with the naked eye. In addition, often the clinical picture of the disease is similar to other pathological conditions, and diagnosis can be significantly difficult. Much depends on the qualifications of the specialist here. and the availability of modern diagnostic techniques.

Diagnostics of bone tumors

Accurate diagnosis of bone sarcomas is very important for choosing further treatment.

Differential diagnosis of bone sarcoma is carried out with osteomyelitis, other benign tumors, but to a greater extent with metastatic damage, since metastases in the bones of the skeleton are approximately 95% of all tumor lesions of skeletal bones.

• To diagnose bone tumors, the patient is sent for an X-ray examination, since this is the most accessible diagnostic tool and very fast.
• If a widespread form of the disease is suspected, bone scintigraphy of the whole body is performed.
• Magnetic resonance imaging (MRI) of the affected part of the skeleton to assess the presence of a soft tissue component of the tumor, muscle damage, involvement of vessels and nerves in the tumor process, assessment of the prevalence of formation along the bone marrow canal
• Computed tomography (CT) of the chest to exclude pathology of the chest organs, including metastases
• If a common form of the disease is suspected - ultrasound of the abdominal cavity, retroperitoneal space, peripheral lymph nodes to exclude metastases and pathology

However, only a biopsy can tell for sure whether it is a benign bone tumor or a malignant one. During this procedure A sample of tumor tissue is taken, and then a histological analysis of the cells is performed in the laboratory. Based on the results of the biopsy, the type of formation is determined, and only then can the necessary treatment tactics be chosen.

Methods of treating bone tumors

Treatment for bone cancer requires surgery in most cases. But in modern medicine they are trying adhere to organ-preserving techniques and do without amputation. This method is that part of the bone is removed and replaced with an endoprosthesis.

An equally important method is drug therapy, which includes chemotherapy, targeted therapy (the essence of targeted therapy is to target the tumor, making the tumor cells vulnerable and weakened), immunotherapy (this is a type of treatment that allows the body's own immune system to fight tumor cells). Used both in the perioperative period to reduce the risk of disease progression, and as an independent method in a common process.

Radiation therapy can also be used in treatment. Bone sarcomas have low sensitivity to radiation therapy, therefore the decision to conduct radiation should be made individually depending on the clinical situation.

As a rule, the treatment of bone sarcomas is carried out by a group of specialists from different fields: oncologist-surgeon, chemotherapy and radiation therapy specialist, traumatologist, orthopedist, etc.

The best results in treatment can be achieved with early detection of the disease, timely examination and diagnosis.

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