Types of bone tumors: treatment and prognosis. Tumors of bone and cartilage tissue

- a group of malignant and benign neoplasms arising from bone or cartilage tissue. Most often, this group includes primary tumors, but a number of researchers call bone tumors and secondary processes, which develop in the bones during metastasis of malignant neoplasms located in other organs. To clarify the diagnosis, radiography, CT, MRI, ultrasound, radionuclide methods and tissue biopsy are used. Treatment of benign and primary malignant bone tumors is usually surgical. For metastases, conservative methods are more often used.

ICD-10

C40 C41 D16

General information

Bone tumors are malignant or benign degeneration of bone or cartilage tissue. Primary malignant bone tumors are rare and account for about 0.2-1% of the total number of tumors. Secondary (metastatic) bone tumors are a common complication of other malignancies, such as lung or breast cancer. Primary bone tumors are more often detected in children, and secondary ones in adults.

Benign bone tumors are found less often than malignant ones. Most neoplasms are localized in the area of ​​tubular bones (in 40-70% of cases). The lower extremities are affected twice as often as the upper extremities. Proximal localization is considered a prognostically unfavorable sign - such tumors are more malignant and are accompanied by frequent relapses. The first peak of incidence occurs at 10-40 years (during this period, Ewing's sarcoma and osteosarcoma develop more often), the second - after the age of 60 years (fibrosarcomas, reticulosarcomas and chondrosarcomas occur more often). Orthopedists, traumatologists and oncologists treat benign bone tumors; only oncologists treat malignant ones.

Benign bone tumors

Osteoma– one of the most favorable benign bone tumors. It is a normal spongy or compact bone with elements of restructuring. Osteoma is most often detected in adolescence and adolescence. It grows very slowly and can be asymptomatic for years. Usually localized in the bones of the skull (compact osteoma), humerus and thigh bones(mixed and spongy osteomas). The only dangerous localization is on the inner plate of the skull bones, since the tumor can compress the brain, causing an increase in intracranial pressure, seizures, memory disorders and headaches.

It is a stationary, smooth, dense, painless formation. On an x-ray of the skull bones, a compact osteoma appears as an oval or round dense homogeneous formation with a wide base, clear boundaries and smooth contours. On radiographs of tubular bones, spongy and mixed osteomas are revealed as formations with a homogeneous structure and clear contours. Treatment is removal of the osteoma in combination with resection of the adjacent plate. In asymptomatic cases it is possible dynamic observation.

Osteoid osteoma– a bone tumor consisting of osteoid, as well as immature bone tissue. Characterized by small sizes, a clearly visible zone of reactive bone formation and clear boundaries. It is more often detected in young men and is localized in the tubular bones of the lower extremities, less often in the area of ​​the humerus, pelvis, wrist bones and phalanges of the fingers. As a rule, it appears sharp pain, in some cases it is possible asymptomatic. On radiographs it appears as an oval or round defect with clear contours, surrounded by a zone of sclerotic tissue. Treatment is resection along with the focus of sclerosis. The prognosis is favorable.

Osteoblastoma– a bone tumor, similar in structure to osteoid osteoma, but differing from it in its larger size. Typically affects the spine, femur, tibia and pelvic bones. Manifests itself as a severe pain syndrome. In the case of a superficial location, atrophy, hyperemia and swelling of soft tissues may be detected. X-ray reveals an oval or rounded area of ​​osteolysis with unclear contours, surrounded by a zone of slight perifocal sclerosis. Treatment is resection along with the sclerotic area located around the tumor. At complete removal the prognosis is favorable.

Osteochondroma(another name for osteochondral exostosis) is a bone tumor that is localized in the cartilage zone of long tubular bones. It consists of a bone base covered with cartilage. In 30% of cases, osteochondroma is detected in the knee area. May develop in the proximal part humerus, head of the fibula, spine and pelvic bones. Due to its location near the joint, it often causes reactive arthritis and impaired limb function. X-ray examination reveals a clearly defined, tuberous tumor with an inhomogeneous structure on a wide stalk. Treatment is resection; if a significant defect is formed, bone grafting. In case of multiple exostoses, dynamic observation is carried out; surgery is indicated when rapid growth or compression of adjacent anatomical structures. The prognosis is favorable.

Chondroma– a benign bone tumor that develops from cartilage tissue. Can be single or multiple. Chondroma is localized in the bones of the foot and hand, less often in the ribs and tubular bones. May be located in the medullary canal (enchondroma) or along outer surface bones (ecchondroma). It becomes malignant in 5-8% of cases. Usually asymptomatic, mild pain is possible. X-ray photographs reveal a round or oval lesion with clear contours. There is uneven expansion of the bone; in children, deformation and growth retardation of a limb segment is possible. Surgical treatment: resection (if necessary with endoprosthetics or bone grafting), when the bones of the foot and hand are affected, amputation of the fingers is sometimes required. The prognosis is favorable.

Malignant bone tumors

Osteogenic sarcoma– a bone tumor arising from bone tissue, prone to rapid development and rapid formation of metastases. Develops mainly between the ages of 10 and 30, men are affected twice as often as women. Usually localized in the metaepiphyses of the bones of the lower extremities, in 50% of cases it affects the femur, followed by the tibia, fibula, humerus, ulna, bones of the shoulder girdle and pelvis. On initial stages manifests itself as dull, unclear pain. Then the metaepiphyseal end of the bone thickens, the tissues become pasty, a visible venous network is formed, contractures form, the pain intensifies and becomes unbearable.

Manifests intense pain, difficulty moving in the adjacent joint and swelling of the soft tissues. When located in the vertebrae, lumbosacral radiculitis develops. The flow is usually slow. Radiographs reveal a focus of destruction. Cortical layer destroyed, periosteal overlays are not clearly expressed, have the appearance of spicules or a visor. To clarify the diagnosis, MRI, CT, osteoscintigraphy, open and penetrating needle biopsy may be prescribed. Treatment is often complex – chemosurgical or radiosurgical.

Ewing's sarcoma is the third most common malignant bone tumor. More often it affects the distal parts of the long tubular bones of the lower extremities, less often detected in the area of ​​​​the bones of the shoulder girdle, ribs, pelvis and spine. Described in 1921 by James Ewing. Usually diagnosed in teenagers, boys are affected one and a half times more often than girls. It is an extremely aggressive tumor - even at the stage of diagnosis, metastases are detected in half of the patients, detected using conventional research methods. The incidence of micrometastasis is even higher.

On early stages manifests itself as vague pains that intensify at night and do not subside with rest. Subsequently, the pain syndrome becomes intense, disrupts sleep, interferes with daily activity, and causes restriction of movements. On late stages pathological fractures are possible. Also characteristic general symptoms: loss of appetite, cachexia, fever, anemia. Upon examination, dilation of the saphenous veins, pasty soft tissue, local hyperthermia and hyperemia are revealed.

To clarify the diagnosis, radiography, CT, MRI, positron emission tomography, angiography, osteoscintigraphy, ultrasound, trephine biopsy, tumor biopsy, molecular genetic and immunohistochemical studies may be prescribed. X-ray images reveal a zone with areas of destruction and osteosclerosis. The cortical layer is indistinct, stratified and disintegrated. Needle-shaped periostitis and a pronounced soft tissue component with a homogeneous structure are revealed.

Treatment - multicomponent chemotherapy, radiation therapy, if possible, radical removal of the tumor (including the soft tissue component) is carried out, while last years Organ-preserving operations are often used. If it is impossible to completely remove the tumor, non-radical intervention is performed. All operations are performed against the background of pre- and postoperative radiation and chemotherapy. The five-year survival rate for Ewing's sarcoma is about 50%.

Reference! Bones contain several types of cells. Osteoblasts are responsible for the formation of the basis of bones, namely, connective tissue and inorganic substances (minerals) that provide bone strength.

Osteoclasts help regulate levels inorganic substances in the blood, influencing the deposition and removal of these substances from the bones, which allows the bones to maintain the required shape. Bone marrow, found in some bones, contains fat and, most importantly, hematopoietic cells that produce various blood cells.

Distinguish primary And metastatic (secondary) tumors of bone and cartilage tissue.

Primary tumors arise directly from bone or cartilage, and metastatic lesions are observed when other tumors (for example, lung, breast, prostate cancer, etc.) spread to the bone.

Benign tumors and tumor-like bone lesions

Benign tumors of bone and cartilage tissue include: osteoma, osteoid-osteoma, osteoblastoma, osteochondroma, chondromyxoid fibroma.

These tumors do not metastasize and, as a rule, are not life-threatening for the patient. Surgical removal of the tumor is the only treatment method that results in a complete recovery for patients.

Osteoma - a benign tumor growing from bone tissue. Osteomas grow slowly and often, having reached a certain size, stop growing.

There are three types of osteomas:

1) compact(or hard: osteoma durum) - consists of lamellar bone with a few narrow Haversian canals, devoid of bone marrow tissue; has a high density;

2) spongy(osteoma spongiosum) - consists of bone crossbars, between which there are bone marrow spaces.;

3) medullary(osteoma medullosum) - contains large cavities filled with bone marrow.

According to Virchow, two groups of osteomas are distinguished:

Hyperplastic - develops from the skeletal system

Heteroplastic - from connective tissue of different organs

The first include osteophytes - small deposits on the bones; if they occupy the entire circumference of the bone, they are called hyperostosis ; if the bone mass appears in the form of a tumor in a limited area - exostoses, if it is enclosed inside a bone - enostosis.

Hard exostoses are often found on the bones of the skull, face and pelvis; in the latter case, they can greatly complicate the birth act.

Heteroplastic osteomas are localized at tendon attachment sites and in muscles; there are extensive bone plates in the dura mater, but without any pathological significance; the same can be said about bone deposits in the cardiac shirt, pleura and diaphragm; It is relatively rare to find osteomas in the brain matter. Until now, they have not been found in the female genital organs, but in the male penis, bone deposits have been found more than once and put them in parallel with normal bones in the penis of some animals.

Clinical picture. Osteomas develop very slowly and therefore go unnoticed for a long time. Sometimes the first signs of osteoma are painful sensations caused by compression of the nerve, or the appearance of facial asymmetry. Clinical symptoms depends on the direction of growth and size of the tumor. Osteoma, located on the outer plate of the skull bones, manifests itself in the form of a dense, immobile, painless formation with a masonry surface. Developing on the inner plate of the bones of the cranial vault, osteoma can cause headache, memory disorders, epileptic seizures, symptoms of increased intracranial pressure. When localized in the area of ​​the sella turcica, hormonal disturbances may appear. When localized in the paranasal sinuses (due to irritation of the branches trigeminal nerve) various eye symptoms- exophthalmos, diplopia, decreased vision, anisocoria, ptosis, etc. when reaching large sizes, located near the nerve root, localized in the arch or process of the vertebra, osteoma can cause pain and symptoms of compression spinal cord, spinal deformity. Osteomas of long tubular bones grow slowly and are exophytic formations.

Multiple osteomas are considered casuistry. However, they can be part of Gardner's syndrome, a hereditary disease that manifests itself as a clinical triad: colon polyposis, multiple osteomas of various locations and soft tissue tumors.

Treatment Osteoma is surgical only. It is indicated for clinical symptoms or with for cosmetic purposes. The operation consists of removing the tumor with mandatory resection of the underlying plate of healthy bone. In cases of asymptomatic disease and small tumor sizes, only dynamic observation is considered appropriate.

Osteoid osteoma(syn. osteoid cortical) - a benign tumor of the cortical layer of bone, which is a focus of bone resorption filled with tissue containing a large number of osteoblasts and osteoclasts, surrounded by a zone of osteosclerosis.

Frequency: Osteoid osteoma is detected in individuals young(11–20 years), men get sick 2 times more often. Typically, osteoid osteoma is a solitary tumor localized in any part of the skeleton (usually in long tubular bones). The first place in the frequency of lesions is the femur, then the tibia and humerus.

Clinical picture. pain, especially at night, localized, aggravated by pressure on the lesion. The skin is unchanged. When the tumor is localized on lower limbs- lameness. X-rays reveal an oval-shaped area of ​​bone tissue destruction with clear contours. Around the lesion there is a zone of osteosclerosis due to periosteal and, to a lesser extent, endosteal changes. To clarify the nature of the lesion and more clearly identify the lesion, CT is indicated. Differential diagnosis for osteoid osteoma is carried out with Brody's bone abscess

Treatment surgical. After radical removal, as a rule, osteoid osteoma does not recur.

Osteoblastoma- a tumor that is significantly larger in size than osteoid osteoma, but its histological structure is practically no different from it. Some authors call osteoblastoma a “giant osteoid osteoma.” The most common location of the tumor is the spine, where up to 40% of osteoblastomas of the entire skeleton are detected. The age of patients varies between 10 and 20 years. Much less often, osteoblastomas affect the femur, tibia and humerus (30%).

Clinical picture osteoblastoma is very similar to that of osteoid osteoma. Pain in osteoblastoma is constant, does not depend on the time of day, is more often noted at rest and decreases or disappears for some time after taking analgesics.

Diagnostics osteoblastoma is difficult and must include a complex of clinical, radiological and functional methods. X-ray diagnostics, in addition to routine techniques, should include computed tomography, which helps in making a differential diagnosis and choosing adequate tactics for the upcoming operation.

Treatment: surgical, consists in radical removal pathological tissue, which is the prevention of relapses.

Osteochondroma (osteocartilaginous exostosis)- a bone tumor formed from cartilage cells. It is a colorless mass that most often forms between the ages of 10 and 25 years on the epiphysis of a long tubular bone. Since some of these tumors, if untreated, may become malignant, they are usually removed surgically.

Localization: mainly in long tubular bones (medial surface of the proximal metaphysis of the humerus, distal metaphysis of the femur, proximal metaphysis of the tibia)

X-ray examination: the tumor is presented in the form of an additional shadow connected to the bone by a stalk, less often by a wide base. The contours are lumpy and uneven. With large tumor sizes, pronounced deformation of adjacent bones is detected.

Differential diagnosis- with single and multiple osteochondral exostoses.

Osteoblatoclastoma ( giant cell tumor ) - occurs at a young age (in persons under 30 years of age), affects both the epiphysis and metaphysis of long tubular bones.

Pathomorphology: Along with mononuclear oval cells such as osteoblasts, multinucleated large giant cells such as osteoclasts are found.

Shapes: lytic, active-cystic and passive-cystic.

Clinical picture: pain in the affected area, sometimes skin hyperemia, bone deformation, pathological fractures are possible.

X-ray examination: the tumor has the appearance of an oval center of clearing. An important radiological sign of all forms of osteoblastoclastoma, distinguishing it from tuberculous bone lesions, is the absence of osteoporosis.

Differential diagnosis: examines to exclude dysplasia (chondroma, chondroblastoma, fibrous dysplasia, etc.).

Treatment surgical osteoblastoclast. Gentle bone resection with tumor removal and simultaneous bone grafting (auto-, homografts or replacement with methyl methacryl) is the method of choice. If the spine is affected by a tumor, radiation therapy is used.

Chondroblastoma- an extremely rare benign tumor of the epiphyses of long tubular bones, which occurs mainly in young people.

Clinical picture: moderate pain, slight swelling in the area of ​​the affected bone, limited movement in the adjacent joint. The diagnosis is based on the results of an x-ray examination (periosteal reaction and calcifications allow chondroblastoma to be distinguished from other bone tumors).

Treatment operational.

Chondromyxoid fibroma- a benign, painless tumor consisting of a cartilaginous interstitial substance in which elongated and stellate cells are located. Its metaphyseal eccentric location in a long bone with thinning and swelling of the cortex resembles chondroblastoma. Most often occurs before the age of 30 years.

Clinical manifestations minimal; remains asymptomatic for a long time; detected accidentally on radiographs in the form of a focus of destruction, sometimes surrounded by a sclerotic rim. Against the background of the focus of destruction, a trabecular pattern and petrification are visible.

Treatment- surgical (excochleation of the tumor followed by replacement of the bone defect with a graft).

Fibrous dysplasia(fibrous osteodysplasia, fibrous bone dysplasia, Liechtenstein-Braitsev disease) is a disease characterized by the replacement of bone tissue with fibrous tissue, which leads to bone deformation. This is a disease of childhood and adolescence. By prevalence pathological process differentiate polyostotic(affecting several bones) - unilateral and bilateral fibrous dysplasia - and monoosseous(damage to one bone).

Clinical picture characterized by great diversity and steady progression. Deformations of skeletal bones, often pathological fractures, leading to sharp curvatures and shortening of the limbs, severe functional disorders. The bones of the lower extremities are most often subject to deformation. The femurs are characterized by a “shepherd’s stick” deformity. The shins often have a saber shape combined with valgus curvature. Lameness is caused by inequality in the length of the limbs, as well as the presence pain syndrome, which occurs with microfractures of the affected segment. At the same time, pain is also observed at rest and disappears without a trace after short-term plaster immobilization of the limb.

The X-ray picture of fibrous dysplasia is characterized by a sharp thickening of the bone, swelling and thinning of the cortical layer, and sometimes a violation of its continuity. Most often the focus is located in the metaphysis of the bone. The structure of the bone within the affected segment, as a rule, is not the same; areas of compaction alternate with areas of rarefaction. The densified areas have a smudged “frosted glass” appearance.

Treatment of fibrous dysplasia consists of surgical removal of the pathological focus and replacement of the resulting defect with implants.

It is classified as a separate nosological form osteofibrous dysplasia or as sometimes found in literature " aggressive form of fibrous dysplasia" Osteofibrous dysplasia is a benign tumor-like process that affects the long bones of the skeleton in children and adolescents. A characteristic feature of the course of the disease is the inevitability of recurrence of the disease. The most commonly affected bones are the tibia.

Clinical picture similar to fibrous dysplasia and is not specific. The patient experiences deformities, pain, and limited movement in the affected segment.

Of the two treatment concepts (conservative orthopedic and surgical), preference is given to conservative in case of limited bone damage, absence or mild severity of segment deformity and pain. In the case of progression of the pathological process and the spread of the dysplastic focus over a significant extent of the bone, the question of surgical treatment should be raised immediately.

Bone cyst - a unique dynamic skeletal disease characteristic of childhood and adolescence. Solitary (SBC) and aneurysmal (ABC) bone cysts in the International Histological Classification of Bone Tumors are classified as a group of tumor-like bone lesions of incompletely clarified etiology.

Pathogenesis Bone cysts remain unclear, but it has been established that they are the result of a hemodynamic disorder in a limited area of ​​the bone. The formation of a bone cyst is essentially a dystrophic process. The type of cyst depends on the biomechanical conditions in a particular part of the musculoskeletal system, on an acute (with ACC) or prolonged (with SKS) hemodynamic disturbance in the bone. Despite the common nature of the disease, SCM and ACC are divided, since each of them is characterized by its own clinical symptoms and radiological picture.

Bone cysts account for 55-58% of all benign bone tumors in children and adolescents. SCCs are more common (78%) than ACCs (22%). The predominant age of onset of the disease for cysts is from 8 to 15 years.

The predominant localization of the pathological focus is the proximal parts of the femur, humerus, tibia, pelvic bones, and spine.

In 25% of cases, cysts are accidentally discovered by parents while bathing the child, when the swelling indicates already existing pathology, during games, sports, when limb stiffness and pain of an undefined nature in the affected area rapidly progress. After rest, these symptoms disappear, then reappear. Only an X-ray examination allows a diagnosis to be made in such cases.

In 75% of cases, the cyst is manifested by a pathological fracture that occurs against the background full health with sudden movements, a fall, or a fracture in a place where pain has existed for a long time.

When the ACC is localized in the vertebrae, protective muscle tension occurs on the affected side, and pain intensifies. There is a violation of the supporting function of the spine, and children compensate for it by resting their hands on the pelvic area, hips, and supporting their head with their hands. A mandatory clinical symptom is neurological disorders, the severity of which depends on the anatomical features of the affected vertebra, the level of the pathological process, and the degree of compression of the spinal cord membranes. Paresis and paralysis, which develop suddenly and early in the course of the disease, are caused by pathological fractures of the vertebral bodies.

X-ray examination most often reveals an eccentrically located structureless lytic focus of destruction with a sharp thinning of the cortical layer. Sometimes there is a cellular nature of the structure of the lesion.

Phase I - osteolysis;

II - delimitation;

III - recovery, thereby emphasizing the dynamics of the disease and the correspondence of clinical and radiological manifestations.

Duration clinical symptoms from 1 month to 3 years.

Treatment methods aneurysmal and solitary cysts can be treated either conservatively or surgically. Depending on the location and stage of the pathological process, the method of treatment is determined. Errors in surgical treatment, the technique of its implementation and the nature of postoperative rehabilitation contribute to relapses of the disease, which, according to various sources, range from 10% to 50%.

Bone tumors develop when cells in the bone multiply abnormally. can completely replace healthy bone tissue, leading to bone weakening and destruction. Bone tumors of the legs medical practice are quite rare, accounting for 3-6% of the total number of bone tumors and are benign in 75-85% of cases.

Leading clinics abroad

Types of malignant neoplasms of the leg bone

Malignant tumors of the leg bone are characterized by aggressive growth. The prognosis for patients with metastases is generally unfavorable. In the area of ​​the foot bones, the following cancerous lesions are distinguished:

• Chondrosarcoma:

This is a malignant tumor of cartilage tissue, which mainly occurs in people aged 40-70 years.

• Ewing's sarcoma:

Affects children and adolescents under 20 years of age. The tumor may remain small for many months before it reaches a large enough size. In such cases, it causes pain and swelling. The survival rate of patients with forefoot lesions is much higher than with tumors posterior section feet.

• Osteosarcoma:

This bone tumor on the leg, which is relatively easy to diagnose. The localization of osteosarcoma is considered calcaneus feet.

Diagnosis of bone oncology

To carry out a diagnosis, the oncologist must first exclude such skin lesions as infectious inflammation and callus formation after a fracture. The doctor must collect detailed information about the state general health patient and examines family history (presence in all family members of the patient).

The physical examination focuses on determining the type, size, and location of the tumor in the foot. Also, during the examination, the oncologist examines other parts of the body, which is necessary to determine possible metastases of the disease.

After a visual and manual examination, the patient is usually prescribed to undergo radiography, computed tomography and magnetic resonance imaging. These methods of studying bone tissue make it possible to determine the boundaries, structure and localization of the malignant process.

To clarify the diagnosis, a biopsy is mandatory, which determines the tissue identity of the tumor tissue with the greatest possible accuracy. The manipulation consists of excision of part of the affected tissue and performing histological analysis.

Symptoms of leg bone cancer

In most cases, bone tumors of the leg are asymptomatic in the initial period. Foot injuries that involve malignant bone lesions cause acute attacks pain. In later stages of the disease, the tumor causes weakening of the bone tissue, leading to frequent foot fractures. Pain is the main complaint of patients. She might be dumb aching character and pester a person preferably at night.

Additional signs of leg bone cancer:

• pain when walking;
• swelling formation;
• numbness of the skin of the foot;
• tingling sensations in the lower extremities.

Leading specialists from clinics abroad

Treatment of cancerous lesions of the leg bones

Some types of malignant tumors in the early stages are treated conservative treatment. In later stages of the disease, surgical, chemotherapy and radiation methods treatment.

1. Surgical removal of the tumor

Includes excision of the pathological process along with the affected area of ​​bone tissue. After radical surgery in case of significant bone defects, restorative therapy is carried out using metal implants or bone tissue transplantation. When the cancer spreads to more than half of the foot, surgeons perform amputation.

Surgery to remove a tumor from the leg bone, as a result of which the unaffected one is sutured to the remaining healthy thigh tissue Bottom part legs turned 180°. The heel turned forward performs the function of the knee. The prosthesis is attached directly to the foot itself.

2. Radiation therapy

This is the use of radioactive radiation to kill cancer cells. The method is mainly used as an adjunct to surgery to target mutated cells remaining in the body. Also, using radiation therapy carry out preparatory stage limb amputation in late stages of the disease. Since bone oncology very often forms metastases to regional The lymph nodes, then the use of highly active radiation is indicated to treat potential sites of tumor metastasis.

3. Chemotherapy

Leg bone cancer in some cases, it involves a combination of surgical and chemotherapy methods of therapy. Method of influencing cancer pharmaceuticals used before surgery.

After successful treatment malignant tumor Patients are recommended to undergo annual radiological monitoring of the condition of the bone tissue of the leg. Such measures are necessary for timely detection of relapse of the disease.

IN postoperative period Orthopedic doctors prescribe the use of special orthopedic shoes, which reduces pressure on the operated area of ​​the foot.

Bone tumor - growth pathological cells in the bones. A bone tumor can be benign or malignant.

Benign bone tumors are relatively common; malignant ones are rare. Benign or malignant tumors can be primary, when they come directly from bone cells, or secondary (metastatic), when malignant tumors from another organ (such as the breast or prostate) spread to the bones. In children, malignant bone tumors are often primary; in adults – usually metastatic.

The most common symptom of bone tumors is bone pain. In addition, sometimes an increase in bone volume or swelling is noticeable. Often a tumor, especially if it is malignant, weakens the bone, resulting in a fracture that may occur with low load or even at rest ( pathological fracture).

At constant pain in a joint or limb, the patient must undergo an x-ray examination. However, X-rays only show the presence of a tumor and usually cannot determine whether it is benign or malignant. CT scan(CT) and magnetic resonance imaging (MRI) often help determine the exact location and size of the tumor, but also do not provide a definitive diagnosis.

An accurate diagnosis usually requires taking a sample of tumor tissue for examination under a microscope (biopsy). For many tumors, a piece of tissue can be obtained by inserting a needle into the tumor ( aspiration biopsy); however, this can often only be done surgically(open incisional biopsy). When a malignant tumor is detected, it is extremely important to immediately begin treatment, which may include drug therapy, surgery and radiation therapy.

Benign bone tumors

Osteochondromas (osteochondral exostoses) is the most common type of benign bone tumor. Most often, osteochondromas occur in young people aged 10 to 20 years. These tumors grow on the surface of the bone and appear as hard growths. The patient may have one or more tumors; The tendency to develop multiple tumors is sometimes inherited. About 10% of people who have more than one osteochondroma will develop a malignant bone tumor called chondrosarcoma during their lifetime. People who have only one osteochondroma are unlikely to develop chondrosarcoma.

Benign chondromas most often occur in young people aged 10 to 30 years and develop in the central part of the bone. These tumors are often found when x-ray examination appointed for other reasons. On an x-ray they have a characteristic appearance, which often makes it possible to diagnose accurate diagnosis. Some chondromas are accompanied by pain. If there is no pain, the chondroma does not need to be removed or treated. However, X-rays should be repeated periodically to monitor tumor growth. If a tumor cannot be accurately diagnosed on x-ray or if it is accompanied by pain, a biopsy may be necessary to determine whether the growth is benign or malignant.

Chondroblastomas – rare tumors, which develop in the terminal sections of bones. They most often occur in young people aged 10 to 20 years. These tumors can cause pain, which is why they are discovered. Treatment consists of surgical removal of the tumor; Sometimes tumors recur after surgery.

Chondromyxoid fibromas– very rare tumors that occur in people under 30 years of age and are usually accompanied by pain. Chondromyxoid fibromas have a characteristic appearance on radiographs. Treatment consists of surgical removal of the tumor.

Osteoid osteomas– very small tumors that usually develop in the bones of the arms or legs, but can occur in other bones. They are usually accompanied by pain, which intensifies at night and is partially relieved in small doses aspirin. Sometimes the muscles surrounding the tumor atrophy; this condition often goes away after the tumor is removed. To determine the exact location of the tumor, a bone scan using radioactive isotopes is prescribed. Sometimes it may be necessary to determine the location of the tumor additional research, such as CT and special radiological methods. Surgical removal of the tumor is the only way to radically eliminate pain. Some people do not agree to surgery and prefer to take aspirin continuously.

Giant cell tumors most often occur in people after 20-30 years. These tumors usually begin to develop at the end of the bone and can grow into adjacent tissue. As a rule, tumors are accompanied by pain. Treatment depends on the size of the tumor. When a tumor is surgically removed, the resulting defect is filled with bone graft or synthetic bone cement to preserve the bone structure. Sometimes, for very large tumors, it is necessary to remove the entire affected segment of bone. In about 10% of people, tumors return after surgery. Sometimes giant cell tumors develop into malignant ones.

Primary malignant bone tumors

Multiple myeloma, the most common type of primary malignant bone tumor, comes from cells bone marrow producing blood cells. Most often it occurs in older people. This tumor may affect one or more bones; Accordingly, pain occurs either in one place or simultaneously in several places. Treatment must be comprehensive and often includes chemotherapy, radiation therapy and surgery.

Osteosarcoma(osteogenic sarcoma) is the second most common primary malignant bone tumor. Osteogenic sarcoma most often occurs in people between 10 and 20 years of age, but can occur at any age. This type of tumor sometimes develops in older people suffering from. About half of osteosarcomas develop in the area knee joint, but in general they can come from any bone. These tumors tend to metastasize to the lungs. Typically, osteosarcomas cause pain and swelling of the tissue (edema). The diagnosis is made based on the results of a biopsy.

Treatment for osteogenic sarcomas usually includes chemotherapy and surgery. Chemotherapy is usually prescribed first; often the pain subsides already at this stage of treatment. The tumor is then surgically removed. About 75% of operated patients live at least 5 years after diagnosis. Because the surgical methods are constantly being improved, nowadays it is usually possible to save the affected limb, but in the past it often had to be amputated.

Fibrosarcomas And malignant fibrous histiocytomas similar to osteogenic sarcomas appearance, localization and symptoms. The treatment is similar.

Chondrosarcomas– tumors consisting of malignant cartilage cells. Many chondrosarcomas grow very slowly and are often cured radically with surgery. However, some of them are highly malignant and tend to metastasize (spread) quickly. The diagnosis is made based on the results of a biopsy. Chondrosarcoma must be completely removed, since chemotherapy and radiation therapy are ineffective for this tumor. The need to amputate a limb is rare. If the entire tumor is removed, more than 75% of patients are completely cured.

Ewing tumor(Ewing's sarcoma) affects men more often than women, mainly between the ages of 10 and 20 years. Most of these tumors develop in the bones of the arms or legs, but they can occur in any bone. Pain and swelling (edema) are the most frequent symptoms. The tumor sometimes reaches very large sizes and sometimes affects the entire length of the bone. CT and MRI often help determine the size of the tumor, but a biopsy is required for an accurate diagnosis. Treatment includes surgery, chemotherapy, and radiation therapy, curing more than 60% of patients with Ewing's sarcoma.

Malignant bone lymphoma(reticular cell sarcoma) most often affects people aged 40-60 years. It can originate from any bone or other organ and then metastasize to the bones. This tumor usually causes pain and swelling, and the damaged bone breaks easily. Treatment consists of combined chemotherapy and radiation therapy, which is no less effective than surgical removal tumors. Amputation is rarely required.

Metastatic bone tumors

Metastatic bone tumors are malignant tumors that have spread to the bone from a primary site located in another organ.

Malignant tumors of the breast, prostate, and thyroid gland. Metastases can spread to any bone, but usually bones in the elbow and knee are affected. If a person who is being treated or has been treated for cancer develops bone pain or swelling, the doctor will usually order a test to look for a metastatic tumor. These tumors are detected by X-ray examination, as well as by scanning using radioactive isotopes. It happens that symptoms of a metastatic bone tumor appear before the primary tumor site is detected. Usually this is pain or a broken bone at the site of the tumor. The location of the primary malignant tumor can be determined by the results of a biopsy.

Bone tumor- a certain mass of bone tissue that is formed during uncontrolled cell division. In this case, a malignant tumor replaces healthy tissue to abnormal, The majority of diagnosed bone tumors are benign, non-life-threatening formations, but there are also malignant tumors that tend to metastasize, in other words, through the blood and lymphatic system, distribute their cells throughout the body.

Happens primary bone cancer – (a tumor that appeared on the bone) and secondary bone cancer – (a tumor that appears on the bone as a result of metastasis of cancer cells from another organ affected by a malignant tumor).

There are four most common types of primary bone cancer.

Multiple myeloma

Multiple myeloma (a malignant bone marrow tumor) is the most common primary bone cancer.

This type of tumor occurs in approximately 6/55 per 100,000 people (6 and 55 are rates in different years). Most cases occur in patients aged 50 to 70 years. Any bones can be involved in the process.

Osteosarcoma

Osteosarcoma is the second most common type of bone marrow cancer. Every year, 2 to 3 people per million become ill with this type of bone tumor. Most often, the disease affects teenagers, and the tumor develops, in most cases, around the knee. Other favorite sites for osteosarcoma are the hips and shoulders.

Ewing's sarcoma

Basically, this type of sarcoma occurs in young people aged 5 to 20 years. The most common locations are the thighs, shins, pelvis, shoulders and ribs.

Chondrosarcoma

Chondrosarcoma – usually occurs in patients between 40 and 70 years of age. In most cases it develops in the bones of the pelvis, hips and shoulders.

Benign bone tumors

There is a large number different types, benign bone tumors. The most common are:

• Bone cyst.
• Osteochondroma.
• Giant cell tumor.
• Enchondroma.
• Fibrous dysplasia.

The reasons for the development of most bone tumors remain unknown.

Symptoms

The main symptom of any bone tumor is pain, most often at night. Sometimes the pain is not very strong and does not even prevent a person from continuing to live ordinary life, less often, but it happens that patients feel strong, sharp pain and prefer to lie down all the time.

People believe that bone tumors are caused by trauma, but not all doctors agree with this belief. Some agree that trauma such as, for example, can cause formation on the damaged area. malignant neoplasm, others are confident that trauma, in itself, does not cause the development of a tumor, but is a factor due to which the tumor manifests itself, that is, it begins to hurt.

In any case, if a new growth has developed on any bone, sooner or later it begins to hurt, the person feels general weakness, suffers from night sweats - the quality of life of such people sharply deteriorates.

Sometimes the discovery of benign bone tumors occurs by chance, e.g. x-ray examination person, for some other reason (injury to the pelvic bones, etc.)

Diagnostics

At the slightest suspicion of a bone tumor, an individual should consult a doctor, as early diagnosis and correspondingly, early start treatment may be decisive in the prognosis of the disease.

In addition, it happens that infection, fractures and other traumatic conditions for the bone may have symptoms similar to those of a bone tumor, while the treatment of these pathologies is different. This circumstance is another reason for timely diagnosis.

Diagnosis begins with a medical examination. The doctor carefully probes the site of the suspected tumor. Checks the mobility of nearby joints and, if the doctor suspects the secondary origin of the tumor, some may be palpated internal organs(stomach, liver, ovaries in women, etc.).

• An x-ray of the bone is required. When there is a tumor, it is visible on x-rays. Different bone tumors have different characteristics on x-rays.
• If according to x-ray It is difficult to determine what process is occurring in the affected area of ​​the bone, then doctors prescribe MRI (magnetic resonance imaging) and CT (computed tomography).
• Blood and urine tests are necessary.
• When the tumor site is accessible, a biopsy is performed, that is, a tissue sample is taken from the tumor and examined under a microscope.

There are two main biopsy methods.

1. Needle biopsy

The doctor inserts a needle into the tumor and obtains a microscopic piece of tissue, which will be examined. The procedure is performed under local anesthesia.

1. Open biopsy

The tissue for examination is taken surgically. The procedure is carried out in the operating room. The patient is given general anesthesia, a small incision is made, and the amount of tumor tissue required for examination is taken.

Treatment

Benign tumors

In many cases, benign tumors There is no need to treat them, they are simply observed so as not to miss the deterioration of the condition. It often happens, especially in children, that over time, benign bone tumors disappear on their own.

Benign bone tumors are sometimes treated therapeutic methods. The prescription of medications depends on the type of tumor, the age of the patient and his physical condition.

Malignant tumors

Bone cancer, no matter what type it is, is treated by several specialists. Typically, the team of doctors includes: an oncologist, an orthopedist, and a radiologist.

Treatment of a malignant bone tumor depends on several factors, the main ones being:

1. Localization of the tumor.
2. Stage of the disease.
3. Metastatic state (that is, whether the metastases have spread to other organs and tissues).

Some treatments

Radiation therapy

Used in radiation therapy high doses X-ray radiation, which kills cancer cells. Usually, after a course of radiation therapy, the tumor shrinks.

Systemic treatment (chemotherapy)

The purpose of chemotherapy is the same as that of radiation therapy, that is, the destruction of tumor cells. Chemotherapy is prescribed when there is high probability tumor metastasis.