Ortho

Bone Neoplasm

search

Bone Neoplasm, Bone Tumor, Bone Cancer, Bone Malignancy

  • See Also
  1. Metastatic Cancer involving Long Bones
  • Epidemiology
  1. Primary Bone Cancers represent <1% of cancer diagnoses in the U.S.
  • Causes
  • Primary Bone Cancers
  1. Osteosarcoma
  2. Ewing Sarcoma
  3. Chondrosarcoma
  • Causes
  • Metastatic Bone Lesions
  1. See Metastatic Cancer involving Long Bones
  2. Cancers most prone to metastasize to long bones
    1. Breast Cancer (more common)
    2. Prostate Cancer (more common)
    3. Lung Cancer
    4. Renal Cancer
    5. Thyroid Cancer
  1. Multiple Myeloma
  2. Lymphoma
  3. Leukemia
  • Causes
  • Benign Bone Tumors
  1. Osteochondroma (35%)
  2. Giant cell tumour (20%)
  3. Osteoblastoma (14%)
  4. Osteoma (12%)
  5. Osteoid Osteoma (11-13%)
  6. Aneurysmal bone cyst (9%)
  7. Fibrous dysplasia (5-7%)
    1. Genetic Syndrome with typically benign bone lesions most often affecting femur, tibia, ribs skull, Humerus and Pelvis
    2. May be a part of larger syndrome
      1. McCune-Albright syndrome (with Cafe-Au-Lait Spots)
      2. Mazabraud Syndrome (with Intramuscular Myxomas)
  8. Enchondroma (2-3%)
  9. (Hakim) J Bone Oncol. 2015 Jun; 4(2): 37–41 +PMID:26579486 [PubMed]
  • Symptoms
  1. Focal symptoms
    1. Regional or localized pain
    2. Extremity tenderness
    3. Joint decreased range of motion
    4. Soft tissue swelling
  2. Systemic symptoms
    1. Fever
      1. Relapsing Fever in Ewing Sarcoma
  3. Other presentations (less common, but more suggestive of malignancy when present)
    1. Night pain
      1. Occurs in<37% of Osteosarcomas and 19% of Osteosarcoma
    2. Pathologic Fracture
      1. Occurs in 7-8% of Osteosarcoma patients
  • Imaging
  1. XRay
    1. Bone lesion may be found on xray obtained to evaluate for Fracture
  2. MRI (preferred over CT)
    1. Indicated to better define bony lesions
  3. Metastasis evaluation
    1. Chest CT (PET Scan in some cases)
    2. Bone Scan
  • Labs
  • Indicated for finding suggestive of Bone Cancer
  1. Erythrocyte Sedimentation Rate (ESR)
  2. Liver Function Test
  3. Blood Urea Nitrogen (BUN)
  4. Serum Creatinine
  5. Urinalysis
  • Diagnosis
  1. Bone biopsy (open or needle biopsy)
    1. Should be performed by experienced cancer surgeon
    2. Needle or biopsy track should be resected with cancer to pervent local recurrence
  • Management
  1. Avoid diagnostic delay
  2. Referral to cancer center
  • References
  1. Ferguson (2018) Am Fam Physician 98(4): 205-13 [PubMed]