Bone Cancer

 Bone cancer can be divided into primary bone
cancer and secondary bone cancer.
• Primary Bone Cancer

 Uncommon cancer: It accounts for only two in every 1,000
cancers diagnosed
 Males > Females
 Most commonly affect the long bones that up the arms and
legs.
• Secondary (metastatic) Bone Cancer
 means a cancer which started in another part of the
body has spread to a bone.
Types of Primary Bone Cancer
• Osteosarcoma
 is a type of cancer that produces immature
bone.
 It is the most common type of cancer that
arises in bones, and it is usually found at the
end of long bones, often around the knee.
 Most people diagnosed with osteosarcoma
are under the age of 25, and it is thought to
occur more often in males than females.
CAUSES
• Scientists have not discovered the cause

of most cases of osteosarcoma.
• Osteosarcoma can develop as a result of
radiation to an area of the body.
• It can also be associated with specific
genetic changes and diseases.
CLINICAL MANIFESTATIONS
 Bone pain or tenderness

 A mass (tumor) that can be felt through the skin
 Swelling and redness at the site of the tumor
 Increased pain with lifting (if it affects an arm.)
 Limping (if it affects a leg)
 Limited movement (if it affects a joint)
RISK FACTORS
• AGE - between 10-30y/o especially during the teenage

growth spurt, but rises again in older adults ( usually over
the age of 60).
• HEIGHT – children with osteosarcoma are usually tall for
their age. This also suggests that osteosarcoma maybe
related to rapid growth.
• GENDER – more common in males than females.
• RACE/ ETHNICITY- is slightly more common in African
Americans and Hispanic/Latinos than in whites.
• CERTAIN BONE DISEASE
• INHERITED CANCER SYNDROMES
DIAGNOSTIC PROCEDURE
• Physical Exam
• Bone x-ray
• MRI
• CT scan
• Chest x-ray
• Positron emission tomography (PET) scan
• Biopsy
TREATMENT
 Methotrexate(given in high dose along with Leucovorin to prevent
side effects).
 Ifosfamide
 Cisplatin or carboplatin.
NURSING MANAGEMENT
• The chemotherapy regimen of IV doxorubicin and IA cisplatin causes
several side effects. Patients are expected to lose all of their hair
and develop chemotherapy-related fatigue.
• Nausea can be a distressing problem with cisplatin, so patients are
discharged with appropriate antiemetic medication instructions
• Patients’ CBC is monitored closely at weekly ambulatory care visits.
• Growth factors routinely are administered to
prevent or reduce the neutropenic nadir.
• Regular audiograms and echocardiograms are
performed throughout treatment to assess for
toxicities.
• Renal function is monitored by regular blood tests;
a significant rise in blood urea nitrogen and
creatinine levels are investigated, and, if
necessary, a lower dose of cisplatin or
replacement with carboplatin may be ordered for
the next cycle.
EWING’S SACROMA
 is a type of cancer
that forms in bone or
soft tissue.
 The most common
areas where it begins
are the legs, pelvis,
and chest wall.
CAUSES CLINICAL MANIFESTATIONS
• It isn’t inherited, but it can  Pain or swelling in the area
be related to non-inherited of tumor.
changes in specific genes  loss of appetite
that happen during a
person’s lifetime.  fever
• When chromosomes 11 and  weight loss
12 exchange genetic  fatigue
material, it activates an  general unwell feeling
overgrowth of cells. This (malaise)
may lead to the
development of Ewing’s  a bone that breaks without
sarcoma. a known reason
 anemia
RISK FACTORS DIAGNOSTIC PROCEDURE
• 50% of people with the • X-ray
condition are diagnosed in
adolescence. • MRI
• In the United States, Ewing’s • CT scan
sarcoma is nine
timesTrusted Source more • Bone scan
likely to develop in
Caucasians than in African-
• PET scan
Americans. • Biopsy
• 59%were male and 41% • EOS imaging
were female.
TREATMENT
• Chemotherapy • Vincristine
• Radiation therapy • Doxorubicin
• Surgery
• Cyclophosphamide
• Targeted proton
therapy • Ifosfamide and
• high-dose Etoposide
chemotherapy
combined with stem
cell transplant
NURSING MANAGEMENT
• Monitor for infections, bleeding, mucosal
ulcerations and pain.
• Need for careful oral care in all patients
receiving chemotherephy.
• Prepared child in an age appropraite fashion
for all procedures.
CHONDROSARCOMA
 primarily affects the
cartilage cells of the
femur (thighbone),
arm, pelvis, or knee.
CAUSES CLINICAL MANIFESTATION
 Large mass on the affected bone
• The exact cause of  Feeling of pressure around the
chondrosarcoma is not mass
known.  Pain that increases gradually
over time. It is usually worse at
• There may be a night and may be relieved by
taking anti-inflammatory
genetic or medicines, such as ibuprofen. It is
not usually relieved through rest.
chromosomal  Pain that is usually worse at night
component that makes and may be relieved by taking
anti-inflammatory medicines, such
certain individuals as ibuprofen
more open to this type  Local swelling
of malignancy.
• can occur at any • Biopsy

age, the most • CT scan
prevalent variety • MRI
typically affects • PET scan
middle-aged to • X-ray
older adults • Physical exam
TREATMENT
• Vincristine (Oncovin)
• Doxorubicin (Adriamycin)
• Cyclophosphamide (Procytox)
• alternating treatments with ifosfamide (Ifex) and
etoposide (Vepesid, VP-16)
NURSING MANAGEMENT
• Assess and manage toxic effects of drugs ( report
to physician
• Manage nausea and vomiting , inflammation and
ulceration of mucous membranes, hair loss, and
anorexia,
• Monitor lab results
• Assess for dehydration, oncologic emergencies
SECONDARY BONE CANCER
 is when cancer cells spread to the bone from a
primary tumor elsewhere in the body.
 Secondary cancers in the bone might also be called
bone secondaries.
 Bone secondaries often develop in different bones
in the body, and not all secondaries will cause
symptoms or problems.
• Osteolytic
 This means the bone has become damaged.
 In some cases, small holes form in the bone. These
are known as lytic lesions, and can weaken the bone
and increase the risk of breakage or other
problems.
• Osteoblastic
 This means new bone is formed, but it grows
abnormally, causing the bone to become weak and
deformed.
CAUSES CLINICAL MANIFESTATION
• Bone metastasis occur  Bone pain

when cancer cells  Weakened bones
break away from the  Pressure on the spinal
orignal tumor and cord
spread to the bones,
 Bowel incontinence
where they begin to
multiply.
• Secondary bone cancer • X-ray
is always caused by
cancer cells spreading • Bone scan
to the bone from a • Blood test
primary cancer.
• CT scan
• It is not fully understood
why some people • MRI
develop secondary • PET scan
bone cancer and others
don’t.
• Biopsy
TREATMENT NURSING MANAGEMENT
• Chemotherapy • Teach patients and their

family about the disease,
• Hormone therapy diagnoses and treatment
• Both hormone therapy to help optimize outcomes.
and chemotherapy • Giving them the
information they need
• Bone-strengthening empowers them to become
drugs (biophosponates their own best advovates
and improves their
and monoclonal treatments adherence.
antibodies)

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 Bone cancer can be divided into primary bone

cancer and secondary bone cancer.

• Primary Bone Cancer

• Scientists have not discovered the cause

 Bone pain or tenderness

• AGE - between 10-30y/o especially during the teenage

• can occur at any • Biopsy

• Bone metastasis occur  Bone pain

• Chemotherapy • Teach patients and their

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