BONE TUMOUR GENERAL CONCEPT

 BONE TUMOUR

 

•Definition:

•Defined as abnormal growth of cells in bone tissue and its components.

 

 

Diagnosis :

•Clinical Feature

•Investigation

 

•Clinical Feature—

•History-Present , Previous, Life style

•Age-  •Childhood and adolescence- Benign tumour, Ewing’s sarcoma, Osteosarcoma.

            •Old age- Chondrosarcoma,

 •Pain -

•Swelling-

•Neurological symptom

•Pathological fracture 

 

 

 

•Investigation:

•Imaging-

•Laboratory Findings-

•Histopathology-

 

 

 •Imaging-

•X-ray

•USG

•CT

•MRI

•Bone Scan(Radio nuclide Scanning)

 

•Laboratory Investigation

            

CBC ESR Hb%

  PTH-------- Brown Tumour

  S. Protein electrophoresis

  Bence jone’s protein

  Acid Phosphatase--- Prostatic Cancer

  Alkaline Phosphatase—Non specific

  CRP--  

     

•Histopathology- Biopsy 

•Closed Biopsy-

•FNAC, Trephine Needle

•Open Biopsy-

•Incisional

•Excisional

           Typing, Grading, and Staging.

 

  •Differential Diagnosis

•Soft Tissue Haematoma

•Myositis ossificans

•Stress Fracture

•Tendon Avulsion

•Bone Infection

•Gout

•Other Bone Lesions—

•Fibrous cortical defects,

•Medullary Infract

•Bone Islands

 

  

  

•Principle Of Management

 

•Multidisciplinary team approach

•Best conducted in tertiary centre

•Consultation and cooperation between the

• Orthopaedic surgeon

•Radiologist

•Pathologist

•Oncologist

•Also be involved- physiotherapist,

  Occupational therapist, Prosthetist.

 

•Methods of treatment—

•Benign and asymptomatic-

•Small, and can afford to temporize

•Observation

•Biopsy is advisable  with excision or curettage.

•Benign,Symptomatic,Enlarging-

•Biopsy for confirm diagnosis,

•Marginal excision or curettage.

 

 •Suspected Malignant Tumour

•Tumour Excision-

•Limb Salvage-Operation (G-II)

•Amputation

•Multi agent Chemotherapy

•Radiotherapy

 

 

 •Multi Agent chemotherapy

•Reduce the size,

•Prevent Metastasis seeding

•Improves survival rates-(combined with surgery)

•Methotraxate

•Doxorubicin

•Cyclophosphamide

•Vincristin

•Cis platinum.

  

•Radiotherapy—

•Adjuvent therapy before operation

•Combined with adjuvant chemotherapy

•Tumour in inaccessible site,

•Inoperable lesion

•Palliative local control

•Postoperatively-Marginal or intralesional excision

•Chance of post irradiation spindle cell sarcoma, Pathological fracture.