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Malignant Bone Tumors

Malignant bone tumor fundamentals

Malignant bone tumors are much less common than benign tumors. They are also much more dangerous. The term "malignant" indicates that there is moderate to high probability that the tumor will spread beyond the site where it initially develops. These tumor cells can travel through the blood stream or through lymph vessels. The most common site where malignant bone tumors spread is the lungs. There are approximately 5,000 to 6,000 new malignant bone tumors each year in the United States.

Types of malignant bone tumors:

  • Osteosarcoma: Osteosarcoma is the most common type of cancer that originates in the bone. Although it most often occurs in those between ages 10 and 30, about 10% of cases develop in people in their 60s and 70s from secondary bone abnormalities. These tumors develop most often in the bones of the arms, legs, and pelvis and are more common among men than women.
  • Chondrosarcoma: This is a cancer of the cartilage cells, and is the second most common form of malignant bone tumor. It is uncommon in people younger than 20 and those older than 75. Although the cancer usually occurs in the bones of the arms, legs, and pelvis, the ribs and some other bones are occasionally affected. Although this cancer usually develops from normal cartilage, it may also form within prior benign tumors of cartilage and bone called osteochondromas.
  • Ewing’s Sarcoma: This cancer most often arises in the middle portion of the long bones of the legs and arms but also may develop in the pelvis and other bones. Ewing’s Sarcomas form in the cavity of the bone. This cancer usually appears in children and adolescents and is uncommon among adults older than 30.

Fortunately, in over 90% of patients in whom a malignant tumor is discovered there is no visible evidence that the tumor has spread. Furthermore, in the past 15 years, dramatic improvements have been made in the treatment of malignant bone tumors. In the case of the most common malignant bone tumor, high grade osteosarcoma, these improvements have resulted in a five- to 10-fold increase in the likelihood of cure (now approaching 80%). In addition, the combination of improved techniques for surgical removal of these tumors and improved methods for functional reconstruction now allows 90-95% of patients with these aggressive tumors to be treated without the need for amputation.

What are the symptoms of a malignant bone tumor?

Symptoms of a malignant bone tumor include:

  • Bone pain
  • Stiffness
  • Bone tenderness

What are my bone tumor treatment options?

Optimal treatment demands the combined skills of an exceptional surgeon, pathologist, radiologist, radiotherapist, medical oncologist, and sometimes a plastic surgeon. However, the choice of treatment depends upon the location, size, and stage of cancer, the patient’s age and general health, and how the tumor responds to treatment.

Medical Treatments

Non-surgical treatments for malignant bone tumors include the following:

  • Chemotherapy: This therapy uses drugs to kill cancer cells. It may be ingested via a pill or a needle inserted into a vein for intravenous drug therapy.
  • Radiation therapy: This therapy uses high-energy rays to kill cancer cells and shrink tumors.
Surgical Treatments

The goal of surgery is to remove the cancer and some of the tissue around it. It may also be used to remove any tumor that is left after chemotherapy or radiation therapy.

What are the risks of malignant bone tumor surgery?

Risks of malignant bone tumor surgery include nerve injury, infection, bleeding, and stiffness.

How do I prepare for malignant bone tumor surgery?

  • Complete any pre-operative tests or lab work prescribed by your doctor.
  • Arrange to have someone drive you home from the hospital.
  • Refrain from taking aspirin and non-steroidal anti-inflammatory medications (NSAIDs) one week prior to surgery.
  • Call the appropriate surgery center to verify your appointment time. If your surgery is being done at Cleveland Clinic, call 216.444.0281.
  • Refrain from eating or drinking anything after midnight the night before surgery.

Are there exercises I can start now prior to surgery?

Patients with lower extremity procedures most likely will require crutches. Physical therapy, including crutch instruction, is easier to accomplish before the bone tumor surgery.

What do I need to do the day of surgery?

  • If you currently take any medications, take them the day of your surgery with just a sip of water.
  • Do not wear any jewelry, body piercing, makeup, nail polish, hairpins or contacts.
  • Leave valuables and money at home.
  • Wear loose-fitting, comfortable clothing.

What happens after bone tumor surgery?

A post-operative instruction sheet will be provided.

How long is the recovery period after surgery?

The recovery period depends upon the bone lesion and location. Wound healing takes about two weeks. If bone healing is necessary, the physician may require patients to protect the extremity for six weeks from major forces such as full weight-bearing.

What is the rehab after surgery?

Depending on the procedure, physical therapy for crutch use, range-of-motion and strengthening may be required.

How can I manage at home during recovery from malignant bone tumor surgery?

Instructions from the physician will be provided. These will vary according to the procedure.

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