INTRODUCTION

BON TUMOUR AND Primary bone tumours,

CARCINOMA are
in which the cancer has
both benign and malignant,
relatively rare in adults. Metastatic bone cancer
more common problem. spread from another site is a

The name
of the
given to the tumour is based on the
bone and area
surrounding tissue that is affected,
and on the
type of cells
These type of tumors areforming
the tumor.
are more
often cured by surgery and
common than
primary malignant tumors.

Primary bone cancer is called sarcoma.

Sarcomas can develop in cartilage, muscle CAUSE OF BONE TUMORS
fatty tissue and nerve tissue. fibres, The cause of bone tumors
is not knoWn. Often the
tumors occur when parts of the body are growing,
.The rapidly. A few possible causes are genetics, radiation
more common
types of bone cancer are treatment, and injuries to the bones.
osteogenic sarcoma, chondrosarcoma, ewings
sarcoma and chondroma. Osteosarcoma has been linked to radiation treatment
particularly high doses of radiation) and other
anticancer drugs, especially in children. However, a
.Primary malignant tumors occur most often direct cause has not been identified. Peopleiwho have
had bone fractures repaired with metal implants are also
during childhood through young adulthood. likelier to later develop osteosarcoma.
They are characterized by their rapid metastasis
and bone destruction. Osteochondromas are the most common noncancerous
(benign) bone tumors, and occur most often in people
between the ages of 10 and 20.
 RISK FACTORS
It's
TYPES OF PRIMARY BONE TUMORS
clear what causes bone cancer, but doctors have
not
found certain tactors are associated with an increased
It is classified majorly into two
risk, including:
Inherited genetic syndromes. Certain rare genetic types,
Syndromes passd through families increase the risk of Benign tumor
bone cancer, including Li-Fraumeni
hereditary retinoblastoma. syndrome and Malignant tumor
Paget's disease of bone. Most conmmonly
occurring
older adults, Paget's disease of bone can increase in
the risk
of bone
cancer
developing later.
Radiation therapy for Exposure to large
doses of radiation, such ascancer.
those given
therapy for cancer, increases the risk during radiation
the future. of bone cancer in

BENIGN TUMOR
TYPES DESCRIPTION
oSTEOCHONDROMA Most common
benign tumor; frequently located in
MALIGNANT TUMOR
metaphyseal portion of long bones,
particularly in the
leg. pelvis or scapula. TYPES DESCRIPTION
Ocurs most often person ages 10-25.
in OSTEOGENIC SARCOMA Most
Malignant transformation may occur common primary bone (osteosarcoma);E
occurs mostly in young malescancer
and 25; most often in bones between the age of 10
oSTEOCLASTOMA A tumor that arises in the
cancellous ends of the arm
of the arms,
legs or pelvis.
and leg bones; about 10% of all
cell tumor) are locally osteoclastomas (giant
aggressive aud
the lungs; high rate of local recurrencemay spread to
after surgery
and chemotherapy.
ENDOCHROMA An
CHONDROSARCOMA Occurs in cartilage cells most
intramedullary cartilage tumor usually found in commonly in the arm,
leg and pelvic bones of older adult
thecavity of a single hand or foot bone; rare ages 50-70; can
also arise from benign tumors
malignant transformation may occur; if tumor wide surgical resection is (osteochondromas);
becomes painful, a surgical resection mopstly
incidence in person
is done; peak rarely responds to radiation and done as tumor
ages 10-20 survival rate depends on chemotherapy
stage, size and grade of
tunmor.
g11TNG'S S A R C O M A
DESCRIPTION
Develops in medullary cavity of
bones, long
especially the femur, humerus,
pelvis and
tibia;
children and usually occurs
teenagers; use of
in
surgical resection, radiation andwide osteochondromas
chemotherapy has greatly
year survival rate to improved the 5 Incidence:
60%; occurs most
often in white
people. Benign tumors are more common than malignant
ones. According to the American Academy of
CHORDOMA Rare tumor that occurs in
the base
skull and vertebral bones of the of the Orthopaedic Surgeons, the most common type is
older
adult ages 50-70;
and
wide surgical resection osteochondroma.
radiation are difficult because the This type accounts for between 35 and 40 percent of
spinal cord and nerves may also be
involved; chemotherapy may be used for all benign bone tumors (AAOS).
late-stage disease; tumor may recur 10 or
more years after treatment Osteochondromas develop adolescents and

teenagers

.
The tumors form near the
ends of long bones, such as
the arm or leg bones.
tend to affect the lower
Specifically, these
tumors

the upper end of the

end of the thighbone (femur), Mar
and the upper end of the upper
lower leg bone (tibia)
arm bone (humerus).
found at the actively
Basically, they are usually
bones.
growing ends of long bone
tumors are
combination
formed of a of
.These
and cartilage be an
to
osteochondroma has been considered
The
develop a single
abnormality of growth. A child may
osteochondroma or many.
 OSTEOGENIC SARCOMA:
It is a
primary bone tumor that is extremely OSTEO BLASTOMA:
aggressive.

it usually occurs in the

bones of the extremities metaphyseal region of long I t is an uncommon osteoid tissue forming
particularly in the regions
of the distal femur, proximal primary neoplasm of bone.
tibia and proximal
humerus, as well as the pelvis. The cause of osteoblastoma is unknown.
I t is the
most common tumor
affecting children and Histologically,
osteoid
ostoblastomas are similar to
younger adults. osteomas, producing both amidst
I t is
commonly associated with pagets disease.
fibrovascular connective tissue.
the difference being that osteoblastoma can
There is a
the knee.
gradual onset of pain and
swelling around grow larger than 2cm in diametre while osteoid
osteomas cannot.

Giant cell tumor:

Patients with osteoblastoma
low intense pain.
usually present with Giant cell tumor is relatively ucommon tumor of
the bone. it is characterized by the presence of
I f the lesion is
superficial, the patient may have multinucleated giant cells.
localized swelling and tenderness. The malignant degeneration occur in the cell it is
In addition the lesions may
mechanically likely to metastasize to the lungs.
interfere with the spinal cord or nerve roots, Giant cell tumor are normally benign, with
producing neurological deficits unpredictable behavior.
Pain and general weakness are the common I t is composed of heterogenous tumor
complaints. composed of three different cell population.
 iant cell tumor stromal cells
a
The
n s t i t u t e
the (GCTSC)
neoplasti cells which are from
teoblastic origin and are an
pression of osteoblast cellclassified based on
markers such as
alkaline pnospnatase and osteo calcin.
Signs and symptoms:
. In contrast the mononuclear Patient usually present with pain and limited
histolytic cells
(MNHC) and the multinucleated range of motion caused by tumor proximity to
giant cell
(MNGC) fractions are secondarily recruited the joint space.

compromise the non-neoplastic cell and Swelling may occur as well if tumor has been
They are derived from
osteoclast monocyte an
population. growing for a long period of time.
lineage determined primarily by CD68, a marker
for monocytic precursor cells.

The bone's surface becomes altered, and the contours enlarge

in the area of the tumor growth.
PATHOPHYSIOLOGY
Malignant bone tumors invade and destroy boneadjacent bonee
The resorplion
etiology of bone tumors is unknown, but there is a tissue by producing substances that promote
or by interfering with a bone's blood supply.
connection between increased bone activity and the
development of primary bone tumors.
Benign bone tumors, unlike malignant
ones. have a
growth pattern. As they grow, they pus
Bone tumors frequently occur when primary bone growth is at symmetric, controlled
its peak in adolescence or is over stimulated during disease, against neighboring bone tissue.
such as Paget's disease.
This weakens the bone's structure until it becomes unable
withstand the stress of ordinary use, frequently resuling
Primary tumors cause bone breakdown. called osteolysis, pathologic fracture.
which weakens the bone, resulting in bone fractures.

Normal bone adjacent to the tumor responds to tumor pressure

by altering its normal pattern of remodeling.
 MANIFESTATIONS of Neoplasms of the
Musculoskeletal System
femur,
Bony Sarcomas Site ii): Metaphysis of distalhumerus, and
Site i): Upper or lower extremity and proximal tibia, proximal
pelvis pelvis
Manifestations
Manifestations: with
S o f t tissue mass extending from bone
Worsening deep bony pain skin over tissue mass
erythematous or warm
Pain at night or during rest that may radiate
and become severe Change in ability to perform
ADLs

Muscular weakness or atrophy Fever

Site ii): Thigh,shoulder and pelvis

Manifestation
dilation over skin
Erythema or warmth and venous

Muscular weakness and atrophy with limited range

2. SOFT TISSUE SARCOMAS
of motion, change in ability to perform ADLs and
.Site i): Upper or lower extremity and pelvis change in gait
Manifestations Paresthesias with neurologic involvement and
distal swelling
Enlarging firm mass with irregular borders,
which causes pain in surrounding soft tissue Palpable local lymph nodes
structures Site ii): Pelvis
Manifestation
Altered bowel and bladder habits or pain with
intercourse
 CARCINOMA
Carcinomatheis a
type of cancer that
make
the
up skin or the tissue liningstarts in cells
that
liver or kidneys. organs, such as
.Carcinoma (from the Greek karkinos,
and -oma, "growth)is Like other
types of cancer, carcinomas are
type of cancer that"crab".
or
cells that divide
develops from epitheliala cellIs. to other without control. abnormal
of the body, but They are able to spread
parts
.

Specifically, carcinoma
tissue
a
is a
cancerthat begins in a
in situ"
stays in the cells where don't always. "Carcinoma
that lines the
inner or outer surfaces
it started.
body, and that generally arises from cells of the Not all cancers
in the aren't carcinomascarcinoma.
endodermal
during embryogenesis.ectodermal germ layer
or originating are
Other
invade the body intypes
of cancer that
different
Those cancers ways.
Carcinomas begin in other types of tissue, such
is damaged oroccur when the DNA of a cell Bone as:

altered and the

cell begins to grow Blood vessels
uncontrollably and become malignant. Immune system cells
Brain
Spinal cord

TYPES OF CARCINOMA Basal cell carcinoma.

.This is the most common form
occurs in cells
of all cancers. It
lining the deepest
part of the
Although carcinomas can occur in many parts of skin's outer layer.
the body, you may often hear should get quick treatment for
people talk about basal cell
carcinoma to avoid scars. But only in
these common types of carcinoma: very rare
cases does this type of carcinoma
Basal cell carcinomna parts of the body.
spread to other
Squamous cell carcinoma
Renal cell carcinoma Basal cell carcinomas often look like:
Ductal carcinoma in situ (DCIS) Open sores
Invasive ductal carcinoma Red patches
.Pinkgrowths
Shiny bumps or scars
 Renal cell carcinoma.
Squamous cell carcinoma:
.This is the most common type of kidney cancer. It
It develops on the skin is usually caused by single within the kidney.
tumor
usually grows as a
sending too much time in the
sun.
carcinoma is sometimes discovered
when
tends to grow and spread Renal cell
This type of skin cancer a CT scanor a n ultrasound for
another
more than basal cell cancers. you have
Sometimes it is detected after it has already
ln rare cases, it nnay spread to the lymph nodes. reason.
become very large or spread to other organs.

Squamous cell carcinomas may crust o r bleed and

can include: Ductal carcinoma in situ (DCIS).
Scaly red patches This type of cancer is found in cells inside the ducts
of the breast. But in DCIS, the cancer has not spread
Open sores
Growth with a depression in the middle into nearby a r e a s . Nearly all w o m e n diagnosed with
this can be cured.
Warts

Invasive ductal carcinoma.

. This type of breast cancer starts in a milk duct but Adenocarcinoma.
spreads into the fatty tissue of the breast. It can spread This is a type of carcinoma that starts in cells
to other parts of the body through the lymph system and
called "glandular cells." These cells make mucus
bloodstream.
It may be discovered as a suspicious mass through and other fluids. The glandular cells are found in
a mammogram by your
health provider o r during a different organs in your body.
breast self-exam. Adenocarcinomas can occur in different parts of
Other symptoms may include:
the body. Some examples of cancers that can be
Thickening of the breast skin
Rash or redness of the breast adenocarcinomas include:
Swelling in one breast Breast cancer
New pain in one breast
Dimpling around the nipple or on breast skin
Prostate cancer
Nipple pain, nipple turning inward, or nipple discharge Colon cancer
Lumps in underarm area Lung cancer
GRADING
well
r
differentiated:
Graacrmal parent tissue, andthere is
thc tumorclose, or very close, resemblance
a

sificd as a
particular malignant cclls are easily identificd
histological cntity; and
Cade 2,or moderatey
Grade DIAGNOSTIC EVALUATION
teTentated:
tcells and tissues, but there is considerable resemblance to
the more compie Teatures are notabnormalities
particularlycan commonly be seen anaand
well-formed Blood and Urine Tests
Crade 3. or pooriy airerentdated: there is An alkaline phosphatase test is one common tool
malignant tiSsue and The normai parentvery little resemblance bethwes
architecturaltissue,
dent, and the more comprex drchitectural abnormalities are
abnormalitieebetween
foa used in diagnosing bone tumors.
rudimentary or primitive: features are usually When your bone tissue is especially active in
d e s, or undifterentiated carcinoma: foming cells, large quantities of this enzyme show
cant resemblance to the these carcinomas bear no
Sisible formation of glands, corTesponding parent cells and tissues, with
ductS, bridges, stratified up in your blood.
Dearls. Or other motable cnaracterstics consistent with a layers, keratin
more highly This could be because a bone is growing, such
asin
differentiated neoplasm. is
young people, or it could mean a tumor producing
abnormal bone tissue.

CT or
CAT scan, also known as computed
tomography: This test produces a series of detailed
taken from several angles. It
images of your insides, emission tomography: The
for the further characterization of lesion positron
is best used .PET scan, or
in vein.
your
with regard to the presence of a matrix
the doctor injects a little radioactive sugar
mineralization. Since cancer cells use more glucose than regular
locate the site of the
tumor.

cells, this activity helps to

magnetic resonance imaging: This test
MRI, or
best defines the soft
It
takes detailed pictures. Angiogram
tissue extension.

demonstrates
Bone scintigraphy (bone scan): of the
accumulation
radiotracer
the abnormal
affected site.
Biopsics: Radiation TherapPy
In of the tissue that Radiation is often used in conjunction with surgery.
this test,sample
a
makes up
your tumor will be removed. The sample is High-dose X-rays are used to shrink
tumors before

examined in a laboratory under a microscope. cells. Radiation can also

surgery and kill cancer
The main types of biopsies are a needle biopsy and reduce pain and
decrease the chance of bone
an incisional biopsy. fractures.

A needle biopsy may be done in your doctor or by a Chemotherapy cells are likely to
radiologist under local anesthesia to block the pain. I f yourdoctor thinks your cancer or she
The doctor will insert a needle into your might
bone, using spread (or if they already have) he uses
it to remove a small bit of tumor tissue with the
help recommend chemotherapy. This therapy
of X-ray, CT or MRI. cancer
rapidly-growing
anticancer drugs to kill the
cells.
An incisional biopsy, also called an open biopsy, is Chemotherapy does have unpleasant side effects,
done in an operating room under general anesthesia hair loss, and extreme
The including nausea, irritablity,
.

physician cuts an incision and removes your

fatigue.
tissue through it.

MEDICAL MANAGEMENT SURGICAL MANAGEMENT

One ofthe major concern in bone tumor is bone Cryosurgery
density and bone loss. Cryosurgery is This treatment
another possibility.
Non hormonal bisphosphanates increase involves killing cancer cells by freezing them with
bone strength. liquid nitrogen.
Metastron is also known as strontium -89 A hollow tube is inserted into your tumor, and liquid
chloride is an intravenous medication given to nitrogen or argon gas is pumped in.
help with pain and can be give in 3 month
interval.
 Vas nes rotation or rotionoplasty:
It is the form of amputation in which the patient
imb sparing surgery: foot is turned upwards in a 180 degree turn and
Treatment tor some bone cancer may require the upturned foot is used as a knee.
this as a supporive surgery.
This is otherwise known as limb salvage surgery
Hemipelvectomy: is
in which the limb is spared from amputation. I t is the surgery in which the whole leg
It is often done with chemotherapy and removed with one half of the pelvis.
radiation therapy.
Bonegratt

Thermal ablation technique

ablation which
I t is a CT fuided radiofrequency
alternative to surgical
Hemicorporectomy: is less invasive and
in tumors
I t is the translumbar or
wais amputation resection in the care of benign
system, is introduced into the
which the legs, the pelvis, urinary I n this technique a probe
genital area.
a cannulated
needle under
excretery system
and the tumor nidus through
I t is done in two stages. CT guidance.
the
First stage is doing
colostomy and urinary And the heat is applied locally to destroy
is amputation.
conduit, the second stage as a
tumor cells.
and is only done
This is a mutilating surgery
last resort.
 Interventions
und to
Nursing Diugnoses nursing care meet
tumor requires of injury, relief
The patient with a boneincluding prevention the
NURSING CARE many hecallh
problems, and teaching
about
a s s i s t a n c e with mobility,

Nursing care for the patient wvith bone tumors o! pain, treatment
discase process and
requires innovative interventions from the time with u bone tumor,
Risk for Injury In the patient pathologic
of diagnosis through the rehabilitation phase. In
the acute phase, problems associated with pain, changes in bone tissue
can cause

as by
fractures. falls or injury to
the tumor site, such
Teach how to avoid
home
lack of knowledge, immobility, coping, and devices when walking and
ensuring the
remoVe
using asSistive
anxiety are foremost. If the patient develops environment is not conducive
to falling (1or example, may
use night-lights). PathologiIC
tractures
complications from treatment or if a malignancy throw
rugs and because bone
destruction c a n weakeen

occur at the tumor site

metastasizes, problenms related to home health the area.

to physical or occupational
therapy for fitting
maintenance management, self concept, and Provide referralabout assistive devices for ambulating, such as
of and teaching can reduce the
prevention of further complications take cane, crutches,
or
a walker. Assistive devices weakness of an
risk of the
falling when has significant
patient of
priority. extremity or when balance has been
aftected by treatment

the disease.

Acute Pain, Chronic Pain In the patient with a bone Impaired Physical Mobility Pain, muscle wusting, or surgical
the physical mobility of the patient
procedures can impair
tumor, pain may be related to direct invasion of the
tumor or to pathologic fractures. Patients may
with a bone tunmor.
experience both acute and chronic pain. exercises
Begin muscle strengthening and active and passive ROM (CPM)
Develop strategies for controlling both acute pain (from immediately after surgery. A continuous passivetomotion
surgery, tracture, orinflammation) and chronie pain (trom machine may be used upper or
after surgical procedures either be
progressIon of the disease. Analgesics combined with lower
extremities. Muscle strengthening exercises must
and
nonpharmacologic methods of pain control provide optimum encouraged as s0on as possible to prevent muscle wastin8
relief of pain. Chronic pain, when mild in nature, is best shorten the rehabilitation period.
managed with NSAIDs or aspirin. Moderate pain is best
managed with a combination of codeine and NSAIDs. Severe Encourage exercises that help strengthen the triceps muscles. The
pain is best relieved with long-acting or sustained-reliet triceps are the major muscles in the arms and must be strengthened
to assist in use of crutches or other assistive devices.
narcotic analgesics.

Provide assistive devices (e.g., canes, walkers, crutches) when

For the patient who has undergone an amputation of a lower and
the patient ambulates. Assistive devices lessen the pain by extremity, encourage quadriceps and gluteal setting
will benefit the
exerciSes
when the
leg raises. These exercises patient
supporting weight bearing during ambulation. rehabilitation period begins.
necisional Conflict A lack of knowledge
about the diagnosis and treatment
regimen can impair the patient's ability to
nake informed decisions about the
treatment plan.
Discuss issues related to diagnosis, radiologic
evaluation, biopsy, surgery, chemotherapy, Thank you
radiation therapy, potentialcomplications,
alternative therapies, risks, benefits, nursing
management, discharge plans, home care, and
longterm treatment and follow-up. The
patient
requires this intormation in order to make
informed decisions about treatment.