BONE TUMORS

DEFINITION: A bone tumor is an abnormal growth of cells within a bone. A bone tumor may be cancerous (malignant) or noncancerous (benign). They may be primary tumors or secondary tumors (metastatic tumors) from primary cancers elsewhere in the body (breast, lung, prostate, kidney) Metastatic bone tumors are common than primary bone tumors.

CLASSIFICATION: BE !" B# E T$M#%&'

Bone and soft tissues &low(growing, well circumscribed, and encapsulated) present few symptoms and are not cause of death.

Musculoskeletal system #steochondroma *most common benign bone tumor) occurs as large pro+ection of bones at the long end of long bones (knee,shoulder)) it de-elops during growth and then becomes a static bony mass Enchondroma *is a common tumor of the hyaline cartilage that de-elops in the hand , femur, tibia or humerus) usually the only symptom is a mild ache) pathological fractures may occur. Bone cysts *are e.panding lesions within the bone Aneurismal bone cyst *(widening) seen in young adults, who present with a painful, palpable mass of the long bones, -ertebrae or flat bone. $nicameral bone cyst *(single ca-ity)) occur in children and cause mild discomfort and possible pathologic fractures of the upper humerus and femur, which may heal spontaneously.

#steoid osteoma *painful tumor that occurs in children and young adults) the neoplastic tissue is surrounded by reacti-e bone formation that can be identified by /(%A0 or %habdomyoma *it is a benign tumor of striated muscle) it may either be 1cardiac1 1e.tracardiac1 (occurring outside of the heart)

2ibromas (fibroid tumors) *are benign tumors that are composed of fibrous or connecti-e tissue.

"iant cell tumors (osteoclastomas)*it is benign for long periods but may in-ade local tissue and cause destruction) occur in young adults and are soft and hemorrhagic) e-entually may undergo malignant transformation and metastasi3e. MA4!" A T B# E T$M#%&' 5rimary malignant musculoskeletal tumors ((%elati-ely rare and arise from connecti-e and supporti-e tissue cells (sarcomas) or bone marrow elements(multiple myeloma) #steosarcoma *is the most common and most often fatal primary malignant bone tumor) appears most in males age 67 to 89 years (in bones that grow rapidly), in older people with 5aget:s disease and as a result of radiation e.posure. ;hondrosarcoma *malignant tumors of the hyaline cartilage) second most common primary malignant bone tumor) they are large, bulky, slow( growing tumors that affect the adults) pel-is, femur, humerus, spine, scapula, and tibia *common sites) metastasis to the lungs might occur) amputation of affected e.tremities Ewing:s sarcoma 2ibrosarcoma *it is a malignant mesenchymal tumour deri-ed from fibrous connecti-e tissue and characteri3ed by the presence of immature proliferating fibroblasts or undifferentiated anaplastic spindle cells in a storiform pattern &oft tissue sarcomas 4iposarcoma 2ibrosarcoma of soft tissue %habdomyosarcoma Bone tumor metastasis to the lungs is common.

CLINICAL MANIFESTATIONS: &ymptom(free or may ha-e pain (mild, occasional to constant and se-ere) <arying degrees of disability #b-ious bone growth

 =eight loss, malaise and fe-er may be present &pinal cord compression (=ith spinal metastasis) eurologic deficits (progressi-e pain, weakness, gait abnormality, paresthesia, paraplegia, urinary retention, loss of bowel or bladder control) *decompressi-e laminectomy to pre-ent spinal cord in+ury.

ASSESSMENT AND DIAGNOSTIC FINDINGS: >istory 5hysical e.amination ?iagnostic studies (;T and bone scans, myelography, arteriography, M%!, biopsy, and biochemical assays of the blood and urine) ;hest /(%A0& *presence of lung metastases %esults' @serum alkaline phosphatase *ele-ated if osteogenic sarcoma @serum acid phosphatase *ele-ated if with metastatic carcinoma @hypercalcemia or ele-ated calcium *if with bone metastases fro breast, lung, or kidney cancer.

MEDICAL MANAGEMENT: 5rimary Bone Tumors "oal' To destroy or remo-e the tumor surgical e.cision radiation therapy chemotherapy limb(sparing *remo-e tumor and ad+acent tissue the %eplacement' customi3ed prosthesis, total +oint arthroplasty, bone tissue from patient (autograft), or from a cada-er donor (allograft) @surgical remo-al of the tumor may reAuire amputation of the affected e.tremity, with the amputation e.tending well abo-e the tumor to achie-e local control of the primary lesion @because of the danger of metastasis with malignant bone tumors, combined chemotherapy is started before and continued after surgery in an effort to eradicate micrometastatic lesions.

with

@the goal of combined chemotherapy is greater therapeutic effect at a lower to.icity rate reduced resistance to the medications.

&econdary Bone Tumors "oal' To relie-e patient:s pain and discomfort while promoting Auality of life The treatment of metastatic bone cancer is palliati-e 5rophylactic internal fi.ation *strengthen large bones with metastatic lesion !nternal fi.ation of pathologic fractures disability Arthroplasty Methymethacrylate (bone cement) reconstruction E.ternal beam radiation *for metastatic sites %adiation and hormonal therapy *original cancer treatment) promote healing and osteolytic lesion ;hemotherapy @at higher risk for postop pulmonary congestion, hypo.emia, ?<T, and hemorrhage ;omplications' >ypercalcemia *results from the breakdown of bone Treatment' >ydration with !< administration of normal saline solution ?ieresis !mmobili3ation Medications such as bisphosphonates, pamidronate, and calcitonin Assist the pt to increase acti-ity and ambulation *to p,- loss of bone mass and increased calcium in the blood ?isrupted >ematopoeisis *c,b tumor in-asion of the bone marrow or by the treatment Treatment' Blood component therapy 2or 5ain' appropriate and adeAuate opioid and non(opioid and nonpharmaceutical inter-entions minimi3e assoc. pain and

5#TE T!A4 ;#M54!;AT!# &' ?elayed wound healing d,t tissue trauma from surgery, pre-. radiation therapy, inadeAuate nutrition and infection utritional deficiency d,t s,e of chemotherapy, which are loss of appetite, nausea and -omiting

!nfection d,t chemotherapy, pt has lowered immune system >ypercalcemia

NURSING MANAGEMENT: 6. 5romoting understanding of the disease process and treatment regimen 8. %elie-ing pain (pharmacologic,nonpharmacologic) B. 5re-enting pathologic fracture C. 5romoting coping skills 9. 5romoting self(esteem D. Monitoring and managing potential complications