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Tumours metastatic to bone are found most commonly in the pelvis,
spine, ribs, proximal femur and proximal humerus. They
come from the breast, prostrate, lungs, kidney and thyroid
gland. Check these areas if metastatic disease is suspected.
Primary bone tumours arise from bone tissue, cartilage, synovium,
collagen and bone marrow cells. Malignant tumours have a high
mortality rate and most commonly metastasize to the lungs.
Evaluation and diagnosis
Presenting signs and symptoms include:
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Deep
pain which may not be not related to activities |
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Swelling
and tenderness |
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Pathological
fracture. |
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It
may be a community in its own right |
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It
must be involved in community public health education
and political solutions to common health problems. |
X-ray and biopsy are necessary to determine the diagnosis.
Obtain a chest X-ray if metastatic lesions are suspected. The
major differential diagnosis is infection. If in doubt, aspirate
the lesion to look for pus.
X-ray characteristics
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Benign
tumours
| • |
Lucent
area surrounded by dense bone which contains the
lesion |
| • |
Cortex
intact |
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No
soft tissue mass |
|
| :: |
Malignant
tumours
| • |
Lucent
area diffuse, without surrounding dense bone |
| • |
Often
has a patchy type of bone destruction with perforation
of the cortex |
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May
have periosteal new bone at the tumour margins |
| • |
May
have soft tissue mass |
|
| :: |
Metastatic
tumours
| • |
Similar
to malignant tumours |
| • |
May
have sclerotic bone in lesions from the prostrate
or breast. |
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Treatment
Arrange for treatment where the facilities are adequate. Benign
tumours may be watched or have bone graft inserted to prevent
a fracture through the lesion. If such fractures occur, treat
them using the usual closed methods. When healed, arrange for
definitive treatment of the tumour. Malignant tumours need
special facilities, including chemotherapy, radiation therapy
and surgery.
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Tumours in bone are either primary
(originating in the bone) or metastatic (originating
elsewhere and spreading to bone)
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Differentiating
between benign and malignant tumours requires X-rays
and, usually, biopsy
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Treatment
of malignant bone tumours requires special facilities,
including chemotherapy, radiation therapy and surgery.
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