BONE TUMORS

Bone cancer, also known as primary bone cancer, is a form of cancer that develops in hard bone tissues and sometimes in the cartilage tissues of the bone. Primary bone cancer is rare, and differs from cancers that develop in: 1). other organs of the body and spread to the bones when metastasis (spreads), or 2). bone marrow cells (such as leukemia, multiplemyeloma, and lymphoma).

Neoplasms of the musculoskeletal system are of various types, including osteogenic, chondrogenic, fibrogenic, muscle (rhabdomyogenic), and marrow (reticulum) cell tumors as well as nerve, vascular, and fatty cell tumors. They may be primary tumors or metastatic tumors from primary cancers elsewhere in the body (eg, breast, lung, prostate, kidney). Metastatic bone tumors are more common than primary bone tumors.

Tumors may be benign (not cancer), or malignant (cancer). Also called neoplasm. Cancer is a term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems.

Types

Bone cancer is divided into separate types based on the type of cell where the cancer started. The most common type of bone cancer include:

  • Osteosarcoma. Osteosarcoma begins on bone cells. Osteosarcoma occurs most often in children and young adults.
  • Chondrosarcoma. Chondrosarcoma begins in the cartilage cells are normally found in the bone ends. Chondrosarcoma most commonly affects older adults.
  • Ewing’s Sarcoma. It is not clear where ewing sarcoma begins. Ewing’s sarcoma is believed that to begin in nerve tissue in the bone. Ewing’s sarcoma occurs most often in children and young adults.

Benign Bone Tumors

Benign bone tumors are slow growing, well circumscribed, and encapsulated. They produce few symptoms and do not cause death. Benign primary neoplasms of the musculoskeletal system include osteochondroma, enchondroma, bone cyst (eg, aneurysmal bone cyst), osteoid osteoma, rhabdomyoma, and fibroma. Benign tumors of the bone and soft tissue are more common than malignant primary bone tumors.

Osteochondroma, the most common benign bone tumor, may become malignant. Enchondroma is a common tumor of the hyaline cartilage of the hand, femur, tibia, or humerus. Osteoid osteoma is a painful tumor that occurs in children and young adults. Osteoclastomas (giant cell tumors) are benign for long periods but may invade local tissue and cause destruction. These tumors may undergo malignant transformation and metastasize. Bone cysts are expanding lesions within the bone (eg, aneurysmal and unicameral).

Malignant Bone Tumors

Primary malignant musculoskeletal tumors are relatively rare and arise from connective and supportive tissue cells (sarcomas) or bone marrow elements (myelomas). Malignant primary musculoskeletal tumors include osteosarcoma, chondrosarcoma, Ewing’s sarcoma, and fibrosarcoma. Soft tissue sarcomas include liposarcoma, fibrosarcoma, and rhabdomyosarcoma. Metastasis to the lungs is common. Osteogenic sarcoma (osteosarcoma) is the most common and is often fatal owing to metastasis to the lungs. It is seen most frequently in children, adolescents, and young adults (in bones that grow rapidly); in older people with Paget’s disease of the bone; and in persons with a prior history of radiation exposure. Common sites are distal femur, the proximal tibia, and the proximal humerus.

Chondrosarcoma, the second most common primary malignant bone tumor, is a large, bulky tumor that may grow and metastasize slowly or very fast, depending upon the characteristics of the tumor cells involved. Tumor sites may include pelvis, femur, humerus, spine, scapula, and tibia. Tumors may recur after treatment.

Metastatic Bone Disease

Metastatic bone disease (secondary bone tumors) is more common than any primary malignant bone tumor. The most common primary sites of tumors that metastasize to bone are the kidney, prostate, lung, breast, ovary, and thyroid. Metastatic tumors most frequently attack the skull, spine, pelvis, femur, and humerus and often involve more than one bone.

Stages of Bone Cancer

  1. Stage I: In this stage, the cancer is confined to the bone and hasn’t metastasized to other parts of the body. This stage is considered not aggressive and low grade.
  2. Stage II: In this stage, the cancer is confined to the bone and hasn’t metastasized to other parts of the body; however, biopsy testing reveals that the bone cancer is aggressive and high grade.
  3. Stage III: In this stage, the cancer is present in two or more different parts of the same bone. Biopsy testing reveals that the cancer can be either low grade or high grade.
  4. Stage IV: In this stage, the cancer has metastasized from the bone to other regions of the body, such as liver, lungs or brain.

Causes of Bone Cancer

The cause of many bone cancers is not clear. Doctors believe the cancer occurs due to an error in the DNA of a cell. This error causes the cell to grow and divide uncontrollably resulting in cancer. These abnormal cells continue to live instead of dying at a particular time. The buildup of these mutated cells result in a tumor/mass, which in turn infiltrates the nearby structures and/or metastasize to other parts of the body.

Risk Factors of Bone Cancer

  • Inherited genetic syndromes, such as hereditary retinoblastoma and Li-Fraumeni syndrome may cause or increase the risk of having bone cancer.
  • Precancerous conditions such as Paget’s disease of bone affects the older adults and also increases the risk of developing bone cancer.
  • Exposure to radiation from cancer treatment increases the risk of having a bone cancer in the future.

Symptoms of Bone Cancer

Characteristic feature of bone cancer or bone cancer symptoms include:
Bone pain.

  • Swelling and pain near the affected area.
  • Fracture.
  • Fatigue.
  • Weight loss is not desired.
  • Spinal metastasis results in cord compression and neurologic deficits (eg, progressive pain, weakness, gait abnormality, paresthesia, paraplegia, urinary retention, loss of bowel or bladder control).

Assessment and Diagnostic Findings

  • May be diagnosed incidentally after pathologic fracture
  • CT scan, bone scan, myelography, MRI, arteriography, x-ray studies
  • Biochemical assays of the blood and urine (alkaline phosphatase levels are frequently elevated with osteogenic sarcoma; serum acid phosphatase levels are elevated with metastatic carcinoma of the prostate; hypercalcemia is present with breast, lung, and kidney cancer bone metastases)
  • Surgical biopsy for histologic identification; staging based on tumor size, grade, location, and metastasis

Medical Management

The goal of treatment is to destroy or remove the tumor. This may be accomplished by surgical excision (ranging from local excision to amputation and disarticulation), radiation, or chemotherapy.

  • Limb-sparing (salvage) procedures are used to remove the tumor and adjacent tissue; surgical removal of the tumor may, however, require amputation of the affected extremity.
  • Chemotherapy is started before and continued after surgery in an effort to eradicate micrometastatic lesions.
  • Soft tissue sarcomas are treated with radiation, limb-sparing excision, and adjuvant chemotherapy.
  • Metastatic bone cancer treatment is palliative; therapeutic goal is to relieve pain and discomfort as much as possible while promoting quality of life.
  • Internal fixation of pathologic fractures, arthroplasty, or methylmethacrylate (bone cement) minimizes associated disability and pain in metastatic disease.

Nursing Interventions for Bone Cancer

Pain management

  • Psychological pain management techniques (deep breath relaxation techniques, visualization, and guided imagery) and pharmacological (providing analgesic).

Teach effective coping mechanisms

  • Motivation clients and families to express their feelings, and give moral support and encourage families to consult a psychologist or clergy.

Provide adequate nutrition

  • Decreased appetite, nausea, vomiting often occur as a side effect of chemotherapy and radiation, so it should be given adequate nutrition. Antiemetic and relaxation techniques can reduce gastrointestinal reactions. Parenteral nutrition can be carried out in accordance with the indications of the doctor.

Health education

  • Patients and families are given health education on the likelihood of complications, treatment programs, and wound care techniques at home .

If necessary; traction, Traction Treatment Principles

  • Provide comfort measures (eg frequently change position, back massage) and therapeutic activity.
  • Give the drug as an indication of examples; analgesic muscle relaxant.
  • Give local heating as indicated.
  • Give strength in early bandage / replacement in accordance with the indications, use aseptic technique correctly.
  • Keep linen remains dry, free of wrinkles.
  • Encourage the client to use loose cotton clothing.
  • Encourage the client to use stress management, for example: guided imagery, deep breathing.
  • Assess the degree of immobilization produced.
  • Identification signs or symptoms that require medical evaluation, eg edema, erythema.

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