Malignant oucholes( cancer) of bones and joints - Causes, symptoms and treatment. MF.

Malignant neoplasms of bones and articular cartilage( bone cancer) - a group of malignant tumors developing from the tissues of the skeleton. They can develop either independently or as a result of degeneration of benign tumors or processes.

Primary bone tumors are rare. Often occur in young people: 28-32 years or less. More often affected are long tubular bones( limbs) and pelvic bones. More than half of the tumors are in the periarticular bone, more often near the knee joint.

Often patients are identified in 4 stages of the process, with metastases.

There are several types of tumors of the skeleton:

- bone - from bone tissue: osteoblastoma, osteosarcoma.
- cartilaginous - from cartilaginous tissue: chondrosarcoma, chondroblastoma and their varieties.
- tumors of fibrous tissue: fibrosarcoma, fibrous histiocytoma.
- juvenile sarcomas - Ewing's sarcoma.

Causes of development of bone tumors:

- Genetic disorders are the most common causes of bone tumors.
- Chemical factors
- Radiation exposure-irradiation.
- Injury to extremities.

Symptoms of bone tumors.

The first symptoms that allow one to suspect a pathological process in the body are weakness, spontaneous body temperature rises, weight loss and appetite.

The most common symptom of bone tumors, found in 70% of patients, is pain. At the beginning of the pain may be weak and disappear spontaneously. Further characteristic are persistent, persistent, intensifying with time and at night pain, which is poorly removed or not removed with anesthetic drugs.

As a rule, from the moment of occurrence of the first painful sensations up to an establishment of the diagnosis passes from 6 till 12 months. Often carried out before the diagnosis of physiotherapy, can increase pain or reduce it only for a short time. The pain may be of different intensity, but the faster the growth of the tumor, the pain syndrome is stronger there.

In addition, it is possible to detect tumor formation of various sizes and restriction of mobility in the joint near which the tumor appeared. At the site of the tumor, the limb is enlarged in a circle, painful, the skin above it can be swollen and thinned, hot to the touch.

Similarly, with the development of malignant tumors of the lower extremities, one of the symptoms may be lameness.

In some cases, the first symptom of bone tumors may be pathological fractures, that is, not related to trauma or damage, but arising spontaneously, with lifting of gravity, bends, or even at rest. Fractures of the extremities are usually observed. In this case, the fracture is associated with instability of the bone structure, since during the growth of the tumor the bone loses its natural strength and the limb loses its support.

With the development of large massive tumor processes in the bones and soft tissues of the chest, it is customary in the foreign literature to call them Askin tumors. Such tumors reach large sizes and penetrate the chest, involving and germinating internal organs: the lungs, the pleura, the organs of the mediastinum. As a rule, the disease is asymptomatic and only in the late stage manifests itself with the development of complications: severe pain, respiratory failure and dyspnea, fluid accumulation in the chest cavity, body temperature rise to high figures and hemoptysis.

Many patients, even with primary treatment, may have distant metastases.

Sarcoma Young

One of the most aggressive bone tumors is Ewing's sarcoma. The place of their occurrence can be any bone, as well as soft tissue of the limb, head and trunk.

At the age of up to 20 years, these tumors are more likely to affect long bones: femoral, humerus, tibia;in older age - flat bones of pelvis and skull, ribs, scapula, vertebrae. Most tumors are located in the lower extremities and pelvis. About 75% of tumors are located near the knee joint, less often - ulnar.

The highly aggressive nature of Ewing's sarcoma causes the presence of distant metastases in 1/3 of the treated patients, many of whom are treated directly due to the presence of metastatic disturbances.

Stages of bone tumors:

Stage 1: tumor up to or greater than 8 cm in the largest measurement, degree of tumor aggressiveness( differentiation) 1-2
Stage 2: tumor more than 8 cm, aggressiveness 3-4;
Stage 3: a tumor complicated by a pathological fracture of the limb;
Stage 4: a tumor of any size, subject to the presence of metastases in regional lymph nodes or distant organs.

Bone tumors in 10-12% are able to give screenings( metastasize) to nearby lymph nodes.
The following organs are most often affected by distant metastases: lungs, other bones and bone marrow, as well as organs of the abdominal cavity, lymph nodes of the mediastinal and retroperitoneal space, the pleura, the brain and the meninges.

Diagnosis of bone tumors:

X-ray examination of of affected bones allows to identify the tumor, the extent of its spread to the bone and surrounding soft tissues and organs.

X-ray examination, bone cancer is indicated by the arrow

Computer or Magnetic-resonance tomography of the affected parts of the skeleton or soft tissues allows to more accurately determine the boundaries of the tumor distribution, as well as to clarify the relationship of the primary focus and surrounding soft tissues.

Computer or magnetic resonance imaging. Bone cancer is indicated by an arrow

Osteoscintigraphy is a study of a skeleton with a special radiopharmaceutical( usually technetium 99), followed by scanning the entire skeleton. The drug, administered intravenously, accumulates the affected area of ​​the bone and causes a special "glow" of this area in the pictures. This study allows us to identify, in addition to the tumor itself, distant metastases in other parts of the skeleton.
Biopsy of the tumor site of the tumor, usually an open biopsy is used: a piece of the tumor is taken by a small operation, while the tumor itself is not removed. In some cases, trepan biopsy is possible: taking a piece of the tumor for examination with a special needle.

Bone marrow examination : a bone marrow biopsy of the iliac bones is used.

Treatment of bone tumors.

The first place in the treatment of bone tumors is the surgical method. The volume of the operation depends on the size and location of the tumor. The entire tumor must be removed within the healthy tissues and surrounding muscles. For large tumor sizes, when a large volume of tissue or bone is required to be removed, permanent substitute metal structures are used. In some cases, when the tumor is close to large joints, it affects large vessels and nerves, when it is not possible to keep the limb, resort to the removal of the entire limb: amputation. Such operations are currently being avoided, and organ conservation and replacement operations are increasingly being used.

To other methods of standard antitumor treatment, such as radiation therapy and chemotherapy, bone tumors are almost insensitive.

Radiotherapy alone is not used, but is used only in combination with chemotherapy in preparation for surgery, in order to reduce the tumor in size.

Chemotherapy as an independent treatment method, also, is not applied. Use chemotherapy drugs in the preoperative period, in order to reduce the tumor in size. In such cases, large-scale clinics use local chemotherapy administration - an introduction to a nearby artery, which creates a large concentration of the drug in the tumor and reduces its toxic effect on the body.

In addition, chemotherapy is used at stage 4 of the disease, in the case of the presence of distant tumor metastases in other organs, in order to reduce their size, prolong the life of the patient. In this case, a combination of 3 or more drugs with different mechanisms of action is used.

With the purpose of the speedy recovery and strengthening of the operated extremity, early activation of patients, therapeutic massage and gymnastics are used.

In some cases, after surgery for bone tumors, rehabilitation rehabilitation treatment is required, it can consist of the use of medical gymnastics, physical education( LFK), wearing support devices( bandages, elastic bandages), the use of prostheses. In all cases of postoperative restorative treatment, specialist consultation is required.

The use of self-treatment methods, decoctions of herbs and poisons is unacceptable. Bone tumors grow rapidly and extremely aggressively, delay in referring to a specialist can be dangerous and lead to the sad consequences of .

Complications.

Complications of bone tumors include: pathological fractures - a fracture in the tumor area where a "weak spot" occurs.

Severe pain syndrome in the area of ​​tumor lesion.

Complications associated with the involvement of neighboring organs: in lung lesions - development of respiratory failure, hemoptysis;with the defeat of large vessels-the development of edema of the limb or arrosive bleeding.

In addition, with a large array of tumors, infection can be associated: persistent debilitating body temperature rises, exhaustion.

Prognosis for bone tumors.

With timely and adequate treatment( surgery to remove the entire tumor), the survival rate of patients reaches 60-70%, which depends on the stage of the tumor process and the aggressiveness of the tumor. But, it should be remembered that any malignant tumor is dangerous by the return of the disease: the development of relapse and metastases, in view of this, the patient should undergo timely preventive examinations with a specialist doctor.

No patient survives in stage 4 of the disease.

Prophylaxis of bone tumors.

As such, prevention of bone tumors does not exist, as, more often than not, their development is genetic. The success of treatment depends on the timely diagnosis of the disease: treatment to the doctor, detection and treatment of the disease.

Doctor's consultation on malignant bone tumors:

Question: What are the bony tumors dangerous?
Answer: Bone tumors are dangerous for rapid aggressive growth, as well as the ability to relapse after removal and give distant metastases.

Question: What is the treatment of bone tumors?
The leading method of treatment of malignant, and, in some cases, benign, tumors of the bones is surgical. Only surgery can give the patient a chance to recover.

Doctor oncologist Barinova N.Yu.