Lecture 1 Types,generations Of Bone Tumors

Bone tumors • 200 benign types • 90 malignant conditions • Relative incidence benign/ malign 200 :1 • USA (2004) – annual incidence : 8600 2400 new cases • Cancer mortality – 563000 cases/year - sarcomas are just a small fraction

Etiology of musculuo-skeletal tumors Tumorigenesis -complex multiple-step process by which healthy tissue progressively from a normal phenotype into an abnormal colony of proliferating cells. -Cells aquire genetic abnormalities in oncogenesis, tumor supresor genes and other genes that directly or indirectly control proliferation -Such a process may progress beyond the controlled state of benigned deasease to became a dedifferetiated, aggressive and immortal phenotype by genomic instability -The instability allows the cell to progress tu fulminant malignancy

Evaluation and staging of tumors • History and physical examination Questions to ask : 1. The patients age 2. Duration of complaint 3. Rate of growth 4. Pain associated with the tumor 5. History of trauma 6.Personal or family history of cancer 7. Sistemic signs or simptoms

Distribution of bone tumors by age

NEUROBLA

Aspects of the physical examination • • • • • • • • • •

Skin colour Warmth Location Swelling Neurovascular exam. Joint range of motion Size Tenderness Firmness Lymph nodes

1 G0T0M0

IA

G1T1M0

2 G0T1M0

IB

G1T2M0

3 G0T1M0-1

II A

G2T1M0

II B

G2T2M0

III A

G1-2 T1M1

III B

G1-2 T2M1

CLINICAL SIGNS

• pain • diformity • fracture on pathological bone

Imaging studies CONVENTIONAL RADIOGRAPHY • lesion extensions • lesion aggressivity • bone distruction (OSTEOLYSIS) • bone formation (OSTEOCONDENSATION) • periosteal osteogenesis (periosteal reaction)

RADIOGRAPHY Periosteal reaction

LAB EXPLORATION Lung X-Ray

LAB EXPLORATION Computerised Tomography (CT) Defines the tumor extension in the extraosseous soft tissues

LAB EXPLORATION Magnetic Resonance Imager (MRI) Defines tumor extension

LAB EXPLORATION Scintigraphy Technetium99 Hyperfixation Early signs Tumor extension Tumor evolution Metastasis

LAB EXPLORATION Angiography Normal

Femur osteosarcoma

LAB EXPLORATION Biopsy SURGICAL

Trained team Atraumatic technique Between two tourniquets Using the electrocautery

Roentgen guided TRANSCUTANEOUS

Useful in metastasis

Histologic classification

TYPE BONE

SURGICAL CLASSIFICATION G tumor degree G0 benign histologic tumor G1 low malignancy tumor G2 high malignancy tumor

Enneking (1980)

T tumor topography T0 intracapsular and/or intracompartmenal tumour T1 extracapsular BUT intracompartmenal tumour T2 extracompartmental tumour M Metastasis M0 lack of metastasis M presence of metastasis

TUMOR TREATMENT Principles Treatment starts ONLY AFTER tumor histologic classification Treatment is realized by a TEAM formed by • radiologist • anatomopathologist • oncologist • surgeon

TUMOR TREATMENT Surgical principles EXCISION

TOTAL

AMPUTATION

TOTAL

EXTENDED EXTENDED

INTRALESIONAL MARGINAL (LIMITED)

TUMOR TREATMENT Filling bone defect

Plaster Graft Cement Osteosynthesis Reconstruction

TUMOR TREATMENT Filling articular defect

Pseudarthrosis Arthrodesis Arthroplasty

TUMOR TREATMENT Radiotherapy Curative action

Ewing sarcoma (child) Plasmocytoma (adult)

Symptomatic action (antalgic)

Scatter metastasis

Indications Stage 3 benign tumors Stage I malignant tumors Stage II malignant tumors

High penetrability/ Reduced treatment duration

TUMOR TREATMENT Chemiotherapy Cytotoxicity at DNA level Intraarterial selective administration Drug mixture Indications Stage 3 benign tumors Stage I malignant tumors Stage II malignant tumors (preoperatively)

Treatment result evaluation (histologic) I = necrotic cells < 50% II = necrotic cells 50-90% III = necrotic cells > 90% IV = necrotic cells 100%

TUMOR TREATMENT Extracorporeal irradiation

Pathological bone fracture - Osteosarcoma of humerus -

Osteosarcoma of humerus

Osteosarcoma of humerus

Ulcerated maligant tumor

Management of carcinoma metastasized to bone

SPITALUL CLINIC DE URGENŢE IAŞI

SPITALUL CLINIC DE URGENŢE IAŞI

Management of carcinoma metastasized to bone

day after tomorrow.wmv