Iliac cancer: causes, stages, diagnosis and treatment. Auxiliary predictive factors include

Fracture of the ilium of the pelvis is observed in 6% of the injured who seek medical help. The problem develops as a result of a fall from a height, a car accident, a bruise, a blow, or a squeeze on the pelvis. Often, the pathology is accompanied by rupture of internal organs, leading to extensive bleeding, which increases the risk of death.

Types and characteristic symptoms of injury

There are the following types of damage to the pelvic bones:

1. Stable. An isolated or marginal fracture of the wing or crest is noted, which does not violate the integrity of the skeleton.
2. Unstable. The pelvic ring is damaged. Diagnose vertical, posterior and double fractures.
3. Rotational. There is a displacement of fragments in the horizontal plane.
4. Combined with dislocation of the pubic bone or sacroiliac.
5. Injury to the edges or bottom of the acetabulum.

Depending on the nature of the lesion, the following types are identified:

1. Closed. The integrity of the skin is preserved.
2. Open. A detachment process is observed: muscles, skin surface, tendons are injured.

Accompanied by a fracture characteristic signs:

1. When moving, there is severe pain.
2. The damaged area swells, a bruise appears, so it is easy to identify the affected area. If the hematoma gradually grows, internal bleeding is not excluded.
3. Because of the pain on the side of the fracture, it is impossible to move the leg.
4. When the nerve fibers are damaged, the buttocks, shins or feet lose sensitivity.

Possible development of traumatic shock:

1. The heart rhythm is disturbed.
2. Arterial pressure decreases.
3. Increased perspiration.
4. A person feels weak, often loses consciousness.

Specific symptoms include:

1. The victim adopts a frog posture, in which pain is reduced if the ischium or upper pubic bone is injured.
2. Lies on the side opposite the affected side, with damage to the back of the pelvic skeleton.
3. To eliminate pain, he moves his back forward. This technique allows you to reduce the symptom in case of damage to the anterior superior bone.
4. Often there is asymmetry of the pelvic ring.

If a person has difficulty emptying, and blood is present in the urine or feces, an injury to the bladder or intestines is not excluded. The rupture of the reproductive organs located in the pelvic area is not excluded.

First aid

The medical team is called immediately. Before their arrival, they try to alleviate the patient's condition:

1. Lay on a hard surface in a frog pose. The person lies on his back, legs apart and bent at the knees.
2. Rolls of fabric are placed under the knees.
3. With symptoms of traumatic shock, unfasten clothing that restricts breathing.

It is impossible to fix the place of injury on your own, as it is easy to displace the debris.

Therapeutic measures

During therapy, the following measures are gradually applied:

1. Local or systemic anesthesia. Anesthesia is used when surgery is required.
2. Restoration of the volume of lost blood.
3. Fixing the site with a tire.
4. Compliance with bed rest for 1 month.

If the lesion is simple and is not accompanied by displacement, skeletal traction is performed. Surgery is recommended for open trauma with displaced debris.

With complications caused by the presence of multiple fragments, osteosynthesis is indicated. After surgical treatment, the Ilizarov apparatus is installed, which clearly fixes the necessary position of the bones.

For recovery use:

1. Preparations that provide the body with the necessary minerals.
2. Therapeutic exercise.
3. Massage.
4. Electrophoresis, magnetic therapy.

With high-quality rehabilitation, recovery after removal of the splint takes up to 4-6 weeks. The patient can move around with crutches. This device is used for 2-3 months to reduce the load on the injured area.

Possible consequences

The following complications often develop:

1. infectious process. It occurs when the skin, internal organs are damaged as a result of the penetration of pathogenic bacteria and viruses.
2. Prolonged splicing of debris.
3. Violation of the blood supply to the damaged area.
4. Rupture of the intestines and bladder, reproductive organs.
5. Sexual dysfunction.
6. Lameness.
7. Osteomyelitis.
8. Damage to nerve fibers, which further provokes chronic pain, loss of sensation in certain areas of the lower extremities.
9. Sometimes, after a fracture, it becomes necessary to amputate the leg.

Often, such complications develop in the absence of timely therapy, non-compliance with the doctor's recommendations. But sometimes their development is caused by the nature of the injury, and doctors are powerless.

If you seek medical attention in a timely manner, you can avoid most common consequences and restore health in 6 months.

How and what can relieve spasm of the piriformis muscle

Piriformis syndrome is a type of pain that is caused by pinching of the sciatic nerve. The cause of this symptom is a spasm of the piriformis muscle. It can shorten and thicken muscle fibers, and spasm also limits femoral rotational motion. Pain can also radiate to the groin, legs, or lumbar region.

• • Primary Causes of Piriformis Syndrome
  • Secondary Causes of Piriformis Syndrome
• • Local symptoms of piriformis syndrome
• How to diagnose piriformis syndrome?
• Treatment of spasm of the piriformis muscle
• Exercises to get rid of piriformis spasm
• Folk methods for treating the syndrome at home

All this is a consequence of irritation of 1 cross root of the spinal nerve. What are the symptoms of this syndrome, and how to relieve spasm of the piriformis muscle through one or another treatment, we will describe below.

Why Piriformis Syndrome Occurs?

Piriformis syndrome develops due to various reasons, they depend on what served as the source of spasms.

Primary Causes of Piriformis Syndrome

The primary causes of this syndrome include such muscle stimuli:

Secondary Causes of Piriformis Syndrome

There are reasons that do not directly affect the muscle, but can provoke the appearance of piriformis syndrome:

• pain in the sciatic nerve;
• pathology of the small pelvis;
• inflammation of adjacent organs;
• violations of the connective structures of the sacrum;
• iliac bone problems.

Also, piriformis syndrome can occur due to causes, depending on the relationship to the spinal column. They are vertebrogenic and non-vertebrogenic.

In the first case, the reasons are:

• injuries of the spinal cord, spine and other organs;
• vertebral diseases;
• narrowed intervertebral foramen;
• the presence of tumors on the spine;
• sciatica in the lumbar region.

In the second case, the cause of the piriformis syndrome can be any pathology of the internal organs or a malfunction of the muscular apparatus in the area of ​​spasms.

Typical Symptoms for Piriformis Syndrome

Symptoms of piriformis muscle spasm can be local in nature, respectively, spasms appear directly in the region of the piriformis muscle and are directly related to muscle spasms. If the symptoms indicate a violation of innervation, then this is a sign of compression of the sciatic nerve. If there is poor nutrition of the internal organs, then the symptoms of this syndrome are a sign of compression of blood vessels and arteries.

Local symptoms of piriformis syndrome

Local symptoms of the condition include:

There is also pain in the ischial region. Signs of compression of the sciatic nerve include:

• pain and spasms spread to the entire leg;
• pains are accompanied by a burning sensation and stiffness;
• the Achilles reflex is inhibited;
• muscle pain when the fibers that form the tibial nerve are pinched.

And with compression of blood vessels and arteries, the following symptoms are observed:

• numbness of the toes;
• the skin turns pale;
• bouts of lameness appear.

Most of the symptoms appear in groups rather than singly, when the pain moves to areas adjacent to the piriformis muscle, the diagnosis of the syndrome is more difficult.

How to diagnose piriformis syndrome?

Experienced doctors can immediately recognize this syndrome by the patient's gait and posture, as well as the features of his movements. Other diagnostic measures include:

• checking the patient for the symptom of Bonnet-Bobrovnikova;
• tapping of the feet to identify Vilenkin's symptom;
• tapping of the lower lumbar processes and superior crusades. Grossman's symptom appears when the muscle of the buttocks contracts;
• palpation of the sites of attachment of the piriformis muscle - the cross-iliac joint and the greater trochanter of the femur. Pain is a symptom of piriformis spasms;
• tests for the condition of the sacrospinous and iliac-sacral ligaments;
• transrectal palpation of the piriformis muscle;
• injection of an anesthetic solution into the piriformis muscle. With the disappearance of symptoms, the presence of the syndrome is confirmed.

If this syndrome is suspected as a concomitant of spinal injuries or oncological diseases, treatment should be prescribed after the following diagnostics:

• tomography;
• x-ray of the lumbosacral region;
• scanning with a radioisotope method in the presence of suspicions of a tumor.

Treatment of spasm of the piriformis muscle

Treatment of a spasm of this kind should be carried out in a complex manner. To relieve the key symptoms of spasm, you must first treat the cause of its occurrence. In some cases, treatment may include surgery.

First of all, in the presence of spasm of the piriformis muscle, the following medications are prescribed as treatment:

• non-steroidal anti-inflammatory drugs;
• muscle relaxants to relieve pain syndromes;
• analgesics, which are prescribed when the pain becomes unbearable.

To relieve the inflammatory process and in order to get rid of vascular compression, treatment may include taking drugs that dilate blood vessels and improve blood circulation.

But treatment includes more than just medication. It also includes activities such as:

• different types of physiotherapy, including electrophoresis, magnetic laser manipulations and much more;
• relaxation massage;
• vacuum therapy;
• acupuncture and pharmacopuncture;
• therapeutic and preventive exercises.

All of the above is prescribed by the doctor as part of the treatment after the removal of an acute similar syndrome. And if it is in a state of tension for a very long time, then it is necessary to block it with the use of an anesthetic.

In this case, three zones should be outlined on the buttocks:

• superior posterior iliac axis;
• the very top of the greater trochanter;
• ischial tuberosity.

Based on this triangle, a needle is inserted into the piriformis muscle and an anesthetic is applied through it.

Exercises to get rid of piriformis spasm

The treatment of this syndrome also lies in how to choose the right physical exercises in order to achieve a good result. They should help in relaxing the problem area and return it to its former ability to move.

The most effective method of treating the syndrome is such a set of physical exercises:

The key rule that must be followed when performing all physical exercises is the accuracy and smoothness of their execution. Any sudden movement will only exacerbate the situation. After completing the exercises, you need to perform a massage in the presence of a spasm, it will relieve pain and tension.

Folk methods for treating the syndrome at home

Even a chronic spasm of this kind can be cured at home through the use of various folk remedies.

One of the safest and most effective methods of treating the syndrome at home looks like this:

• mix bay leaf and juniper needles in a ratio of 6 to 1;
• grind everything well to a powder state;
• add 12 parts of melted butter to the resulting mixture;
• as a result, a specific ointment is obtained, which must be rubbed into the diseased area of ​​\u200b\u200bthe skin in small portions.

This tool will help to perfectly relieve pain, spasms and relax the piriformis muscle.

In order not to subsequently resort to different methods of treating a spasm of this nature, the following preventive measures should be applied:

• do not overstrain the muscular system, do not overcool and do not stay too long in one position for a long time;
• constantly monitor yourself in terms of your condition. For any discomfort, contact your doctor immediately;
• physical activity should be moderate and regular.

Treatment of piriformis syndrome should be timely and comprehensive. If it is not started on time, it can turn into more serious problems with the small pelvis, as well as lead to degradation of the ligaments and joints. And this is not a complete list of possible consequences of untimely treatment of this syndrome. Therefore, do not leave your condition to chance.

Spondylitis of the spine - signs, symptoms and treatment of the disease

The term "spondylitis" is derived from the Greek word spondylos, meaning vertebra, and the ending -itis, indicating the inflammatory nature of the process. This is a group of diseases of the spine, united by the primary destruction of the vertebrae. Subsequently, spinal deformity develops. The lesion is caused by microorganisms, that is, it is an infectious process.

• Forms of the disease
• Causes of spondylitis
• Spondylitis: symptoms and signs
• Spinal osteomyelitis
• Tuberculous spondylitis
• Other specific spondylitis
• Diagnostics
• Treatment methods for spondylitis
• Spondylitis operation
• Rehabilitation and recovery. Exercises
• Alternative treatment of spondylitis

It is necessary to distinguish between spondylitis and spondyloarthritis. The latter occur, as a rule, in rheumatic diseases, primarily in Bechterew's disease. Spondyloarthritis is not directly related to the ingress of an infectious agent into the tissue of the vertebrae, they have other methods of recognition and therapy

Forms of the disease

Inflammation in the bone tissue that forms the vertebrae can be caused by various infectious agents, which are divided into specific and nonspecific. Each of the specific infections is characterized by a specific pathogen and symptoms characteristic of this particular disease. A nonspecific infectious process can be caused by any pyogenic microorganism, but the pathological manifestations are similar regardless of the pathogen.

Specific spondylitis:

• tuberculosis;
• actinomycotic;
• brucellosis;
• gonorrheal;
• syphilitic;
• typhoid.

Nonspecific forms include hematogenous or traumatic purulent spondylitis, or osteomyelitis of the spine. It can be caused by bacteria such as:

• staphylococcus epidermidis or golden;
• coli and proteus;
• streptococci;
• Pseudomonas aeruginosa and Haemophilus influenzae and others.

In a separate form, a type of disease caused by fungi is isolated.

In one-third of cases of spondylitis, its cause cannot be found out; accordingly, it is impossible to accurately classify the disease. Tuberculous spondylitis is registered in 21%, in 15% the disease is caused by Staphylococcus aureus. Other forms of the disease are rarely found.

Causes of spondylitis

Microorganisms are the direct cause of the disease.

The infection can get into the blood from the kidneys and urinary tract, which is often the case in older people with prostate adenoma. The source of infection may be a urinary catheter inserted during any operation, or an intravenous conductor. Bacteria enter the blood during soft tissue infections (wounds, infected burns, trophic ulcers, abscesses, bedsores).

Osteomyelitis of the spine can develop after salmonellosis or brucellosis. In some cases, the infection enters through the bloodstream from carious teeth, foci of thrombophlebitis, tonsils in chronic tonsillitis. Spondylitis can be complicated by such processes as pancreatitis, pneumonia, prostatitis, and a condition after an abortion.

The vertebral bodies are composed of spongy bone and are well supplied with blood vessels. When microbes enter the bloodstream (for example, staphylococcus aureus in a wound), they penetrate into the bone tissue. Then the pathogens overcome the intervertebral discs and affect the adjacent vertebral bodies.

In addition to the hematogenous method, microbes enter the bone tissue when the spinal column is injured or if asepsis requirements are not observed during operations on nearby tissues. In such cases, traumatic osteomyelitis of the spine develops.

As with any infectious and inflammatory process, the state of the patient's body matters in the formation of spondylitis - its resistance to infectious agents, the state of immunity and nonspecific protection, the presence of debilitating chronic diseases, the use of glucocorticoids or other drugs that suppress immunity, spinal injuries.

The risk of developing the disease is especially high in patients with diabetes mellitus, those receiving hemodialysis for kidney disease, as well as injection drug addicts.

Spondylitis: symptoms and signs

Different forms of spondylitis have some features of the clinical course.

Spinal osteomyelitis

The disease is predominantly recorded in middle-aged and older men. In 50% of patients, the lumbar region suffers, less often the thoracic or cervical vertebrae. Therefore, the main symptom of pathology is pain in the corresponding section of the spine. It can be dull constant or have a pulsating character.

If damage to the vertebrae is accompanied by compression of the spinal roots, then there are unpleasant sensations in the areas innervated by the corresponding nerve trunks. So, in 15 patients out of 100 there is pain in the parts of the body, limbs.

With movements, tapping, pain in the area of ​​the affected vertebra increases. Often, the muscles along the spine are very tense, as a result of which mobility is limited - a person cannot bend over, turn the body.

Body temperature may be normal or slightly elevated. Fever occurs with hematogenous osteomyelitis with the development of sepsis and ulcers in other organs.

Why spondylitis is dangerous: a purulent focus formed in the bone tissue can break through to the spinal cord, causing myelitis. It often leads to paralysis, loss of sensation, urinary and fecal incontinence.

Acute osteomyelitis without treatment becomes chronic. Exacerbations are accompanied by increased pain, fever, swelling of the skin, the formation of fistulas. Surrounding tissues are often infected, myositis, fasciitis develops.

Sometimes a chronic process in the vertebrae proceeds secretly for many years, manifesting only discomfort in the back, a slight increase in the level of leukocytes in the blood.

Tuberculous spondylitis

This is one of the most common forms of the disease. It affects several vertebrae, most often in the thoracic region.

Once with blood in the tissue of the vertebrae, tubercle bacilli form tubercles in it, which subsequently disintegrate with the formation of caseous ("curdled") necrosis and the formation of a large cavity. The dead areas are separated from the intact ones, that is, sequestration occurs, and the vertebra disintegrates. The spread of inflammation to the surrounding tissues is accompanied by damage to the remaining parts of the vertebrae (arches, processes), the formation of purulent deposits near the spinal column. Dead tissue compresses the spinal cord.

The earliest and most persistent symptom of pathology is back pain. At first, it is in the nature of an indefinite discomfort. Sometimes it intensifies at night, when coughing, sneezing, causing the sick person to suddenly cry out. The distribution of pain along the course of large nerves is specific, which resembles neuralgia, lumbago, sciatica (pain in the limbs), as well as discomfort between the shoulder blades.

Pain syndrome can mimic diseases of the digestive system or kidneys - peptic ulcer, renal colic, inflammation of the appendix. In contrast to these conditions, in tuberculous spondylitis, pain is provoked by stress, movement, and tapping on the back.

As a result of the destruction of the vertebrae, a sharp deformation of the spinal column occurs. This is how the hump is formed. A person with a hump is very likely to have once suffered tuberculosis of the spine. The progression of the disease is accompanied by paralysis and dysfunction of the pelvic organs.

Other specific spondylitis

Damage to the vertebrae can occur in the secondary or tertiary periods of syphilis. It is often accompanied by recurrent meningitis, encephalitis, subarachnoid hemorrhage.

Brucella spondylitis is characterized by undulating fever, joint and muscle pain, excessive sweating, swollen lymph nodes in the neck and groin.

Pathology of the spine can develop with typhoid fever (after a "light period" of well-being) and dysentery.

Spondylitis can be a complication of an acute rheumatic process, combined with the formation of heart disease and oligoarthritis.

Diagnostics

The diagnosis is based on the following data:

• complaints, history of life and illness, general examination data;
• a thorough neurological examination;
• X-ray of the spine;
• computed tomography allows you to see abscesses near the vertebrae, more accurately assess the destruction of the bone;
• magnetic resonance imaging is often prescribed to diagnose purulent streaks and "cold" abscesses characteristic of tuberculous spondylitis;
• radionuclide study, which helps to find all foci of infection;
• the level of leukocytes, ESR, acute phase reactions (C-reactive protein);
• laboratory tests confirming the tuberculosis or other nature of the disease (polymerase chain reaction to identify pathogens);
• study of blood culture taken at the height of fever; at this time, in about a third of cases, it is possible to identify the causative agent of the disease and find out its sensitivity to drugs;
• open or closed biopsy, that is, obtaining the affected tissue for examination using a special needle or during surgery.

Differential diagnosis is carried out with the following diseases:

• urinary tract infection and urolithiasis;
• radicular syndrome in osteochondrosis of the spine;
• ankylosing spondylitis (Bekhterev's disease);
• tumors and metastases in the vertebral body.

Radiography of the spine makes it possible to detect foci of bone destruction only after 4 weeks from the onset of the disease, or even later. For earlier diagnosis, computed tomography is used. The most sensitive method is magnetic resonance, it makes it possible to detect inflammatory changes in the bone, nerves, and spinal cord. Soft tissue at an early stage of the disease. This study is of particular value when contrasting the affected tissue with the help of paramagnetic contrast agents. Abroad, this method is recognized as the "gold standard" for the diagnosis of vertebral osteomyelitis.

Treatment methods for spondylitis

The question of how to treat spondylitis should only be decided by a specialist. Self-treatment of this disease is very dangerous, since incomplete recovery will lead to chronicity of the process and further formation of disability.

The main directions of treatment:

• immobilization for a period of 2 weeks to 3 months;
• antibacterial therapy;
• pathogenetic treatment;
• surgical intervention.

Immobilization involves strict bed rest or the use of special plaster beds for children, and then the use of special rigid corsets.

Antibacterial therapy should be carried out only with a known pathogen and its sensitivity, aiming. Empiric antimicrobial treatment (without regard to susceptibility) is only occasionally allowed early in the acute process.

Antibiotics for spondylitis:

After studying the patient's immune status and the type of pathogen, staphylococcal toxoid, anti-staphylococcal plasma, anti-staphylococcal immunoglobulin, and immunomodulators are prescribed. To reduce intoxication, intravenous administration of solutions, hemosorption, and plasmapheresis are prescribed.

Spondylitis operation

Indications for surgical treatment of spondylitis and osteomyelitis of the spine:

• destruction of the vertebral bodies;
• abscesses of paravertebral tissues;
• disruption of the spinal cord and its roots;
• fistulas with purulent discharge;
• back pain, spinal instability.

The operation is not performed for people with severe cardiovascular and other concomitant diseases that cause a high risk of surgery, as well as for sepsis.

Initially, an operation is usually performed aimed at strengthening the spinal column with the help of metal structures. They are installed from the side of the spinous processes (behind the spine). A few days later, the second stage of the operation is performed.

The essence of surgical treatment of spondylitis is to remove the damaged tissue and replace it with a graft:

• a piece of one's own bone tissue obtained from the iliac wing or a removed rib;
• implants made of a porous material - titanium nickelide;
• carbon or hydroxyapatite implants.

After surgery on the spine, a period of rehabilitation is required.

Rehabilitation and recovery. Exercises

Doctors are of the opinion about the need for early mobility of a patient who has undergone surgery for spondylitis. This improves blood circulation in the tissues, antibiotics become more effective, and stiffness of the intervertebral joints is prevented.

The patient receives antibiotics for at least a month after the operation. Gradually expanding the motor mode. The recovery complex includes physiotherapy exercises, massage, manual therapy, reflexology.

Rehabilitation after surgery for spondylitis is carried out in three stages. At the first stage, the patient "gets used" to the new conditions of life without pain. This phase is carried out in a hospital and takes several days. The patient learns to walk normally and keep balance in the changed conditions. Physical activity is excluded, special attention is paid to correct posture. At this time, the doctor may prescribe a soft corset for several hours a day.

At the second stage, the patient is discharged home. Within a month after the operation, he is recommended to perform a set of exercises that strengthen the muscles of the back. Exercises are performed 2-3 times a week, if pain occurs, they should be stopped. Gradually, the duration of classes increases. It is necessary to avoid sharp bends, turns of the body, exercises on the horizontal bar. Gymnastics is preferable in the supine position, side, stomach, standing on all fours. The doctor should acquaint the patient with the permitted set of exercises in more detail, depending on the type and place of surgical intervention.

The third stage of rehabilitation lasts a lifetime and is aimed at maintaining correct posture and strengthening the body's defenses. Swimming or just slow movements in the pool, balneotherapy, physiotherapy are very useful. After consulting with a doctor, you can receive course treatment in a sanatorium.

Alternative treatment of spondylitis

Spondylitis is an infectious process, without the use of antibiotics or surgery, it is impossible to get rid of it. Self-treatment in this case will lead to disability of the patient.

Treatment of spondylitis with folk remedies can be carried out as an addition to rehabilitation after a successful operation. Here are some folk recipes that help improve blood supply to the spine and back muscles, speed up recovery, and improve posture:

• therapeutic baths with infusions of chamomile, immortelle, oak bark and sage;
• ingestion of a solution of the Altai mummy, which has an immunostimulating and restorative effect;
• after complete recovery, it is useful to go to the bathhouse (not to the steam room), while the patient's companion should gently stroke and steam the patient's back with a birch broom;
• you can apply a plant such as comfrey or larkspur, in the form of an ointment for topical application or tincture for oral administration.

So, spondylitis is an inflammation of the vertebrae, caused mainly by bacteria. The most common forms of the disease are osteomyelitis of the spine and tuberculous spondylitis. The disease is manifested by back pain, dysfunction of the spinal cord, signs of intoxication. For diagnosis, X-ray methods, magnetic resonance imaging, as well as the isolation of the pathogen from the blood or the affected tissue are used. Treatment in many cases is surgical. Almost always, the complex of therapy includes antibiotics, anti-tuberculosis or antifungal drugs. After spinal surgery, it is recommended to use special complexes of therapeutic exercises, as well as some home remedies that have a physiotherapeutic and restorative effect.

Useful articles:

Bone cancer is cancer that occurs in the cells of the bone tissue. When cancer is found in the bones, it has either started there (primary bone cancer) or has spread to the bone. When cancer is found in the bone, most often we are talking about metastases. Therefore, it is often called: metastatic cancer. Less commonly, the disease may begin in the bone as a primary lesion. Primary and metastatic bone cancer are treated differently and have different prognosis. There are types of cancer that can start in the bone but are not considered true bone cancer. These include:

1. Lymphoma is a cancer of the cells responsible for the body's immune response. Lymphoma usually starts in the lymph nodes, but sometimes it starts in the bone marrow.
2. multiple myeloma is another type of immunocyte cancer that originates in the bone marrow. These tumors are not considered bone cancer because they do not arise directly from bone cells.

Risk factors

Approximately 2,300 cases of bone cancer are diagnosed in the US each year. Primary cancer accounts for less than 1% of all cases. Bone cancer is more common among children and adolescents than adults. If cancer is found in the bones of an adult, then it got there, having formed elsewhere.

Risk factors for bone cancer include:

1. Previous exposure to radiation therapy
2. Previous exposure to chemotherapy with an affiliated drug
3. Mutations in a gene known as the retinoblastoma gene (Rb gene), or other genes
4. Associated diseases such as hereditary retinoblastoma, Paget's disease,
5. Li-Fraumeni, Rothmund-Thompson syndrome, tuberous sclerosis, Diamond-Blackfan anemia
6. Implantation of metal plates for the treatment of fractures

Causes of bone cancer

Cancer occurs when normal cell growth and reproduction is disrupted, causing uncontrolled division and growth of idioblasts. Probably, the development of bone cancer is due to a number of hereditary and external factors. So far, no one can name the exact root cause.

Types of bone cancer in children

Osteosarcoma, the most common type of bone cancer, is more common in older children, adolescents, and young adults. Ewing's sarcoma affects children.

Diagnosis of bone cancer

To detect neoplasms in the bones, different methods of visual diagnostics can be used. Early stage bone cancer may not be visible on x-rays. Computed tomography and MRI are more accurate diagnostic methods.

Bone scintigraphy is a diagnostic method that uses radioactive materials to obtain an image of the entire skeleton. It can help locate bone cancer anywhere in the body. This method is used not only to diagnose bone cancer, it also identifies inflamed areas, such as arthritis, fractures or infections.

There are currently no screening tests to detect bone cancer in the early stages.

Although many types of bone cancer have their characteristic manifestations at the time of imaging, a biopsy (tissue sample) must be taken to accurately determine the type of disease and confirm the diagnosis. A biopsy is a procedure for obtaining a sample of tumor tissue, which is examined under a microscope. A tissue sample can be obtained by inserting a needle through the skin into the tumor or by surgery.

Ways to treat bone cancer

Performing a removal operation is the main focus of treatment. The surgical technique can remove most bone cancer without the need for amputation. Sometimes nearby tissue needs to be removed. Therefore, after that, plastic surgery may be needed in order to help increase the functionality of the limb.

Ewing's sarcoma, which does not respond to chemotherapy, requires radiation therapy and a stem cell transplant. In this procedure, the patient's stem cells are taken from the bloodstream. After large doses of chemotherapy drugs destroy the bone marrow, the stem cells are returned to the body through a blood transfusion. Over the next 3-4 weeks, the stem cells produce new blood cells from the bone marrow.

Targeted Therapy These are medicines aimed at treating cancer cells. For example, denosumab (Xgeva) is a monoclinal antibody that blocks the activity of bone cells called osteoclasts. The drug is used in the treatment of large bone tumors that recur after surgery or cannot be removed surgically. Imatinib (Gleevec) is a targeted therapy that can block signals from certain mutated genes that promote tumor growth.

Bone cancer is treated, usually by a surgical oncologist or orthopedic oncologist (for surgical removal of the tumor) and a chemotherapist (for chemotherapy). A radiation oncologist is part of the team if radiation therapy is planned. Palliative care professionals help manage pain.

Pain relief drugs

Pain is relieved by analgesics (pain medications). They can be sold over the counter and by prescription. Mild to moderate pain is treated with drugs such as acetaminophen (Tylenol) or non-steroidal anti-inflammatory drugs containing ibuprofen (Advil, Motrin) and naproxen (Naprelan, Aliv, Naprosyn, Anaprox). However, people taking cancer chemotherapy should avoid non-steroidal anti-inflammatory drugs because of the risk of bleeding.

Prescription drugs are taken for moderate to severe cancer pain. Opioids are strong narcotic painkillers: morphine, oxycodone, hydromorphone, and fentanyl are used to control severe pain. Sometimes a complex of drugs is used in the treatment of cancer pain. Opioid medicines can cause side effects such as drowsiness, constipation, and nausea.

Five-year survival rate

The medical prognosis for patients' survival depends on the type of cancer and how far it has spread. In general, the five-year survival rate for all types of bone cancer in adults and children is about 70%. The five-year survival rate among adults with chondrosarcoma is about 80%.

The five-year survival rate for localized osteosarcoma is 60–80%. If the cancer has spread beyond the bone, the survival rate is 15-30%. Osteosarcoma has a better prognosis if it is in the arm or leg, responds well to chemotherapy, and is completely removed during surgery. Young patients and women also have better prognosis than men and older people.

Ewing's sarcoma has a five-year survival rate of about 70% if detected at a stage where its spread can be limited. If it has gone beyond the boundaries of the bone, the survival rate drops to 15-30%. Factors that give a favorable prognosis for Ewing's sarcoma include small tumor size, age less than 10 years, localization in the arm or leg (rather than in the pelvis or chest wall), and a good response to chemotherapy drugs.

Can bone cancer be prevented?

The exact cause of bone cancer is not fully understood, and there are no changes in lifestyle or habits that can prevent this uncommon disease.

Bone cancer: symptoms and signs

Pain is the most common symptom of cancer. At first, the pain may occur at certain times of the day, often at night, or during physical exertion. Over time, it develops and becomes stronger. Sometimes a person may experience pain for years before seeking medical attention.

At the site of bone cancer formation, a tumor neoplasm, swelling or bump is felt. In places of pathological neoplasms, fractures of the limbs often occur. The reason for this is the weakening of the deep structure of the bone tissue.

Infrequently, symptoms cause pinching or tearing of nerve endings or blood vessels in the affected area. These include numbness, tingling, soreness, or decreased blood flow beyond the tumor, causing cold hands and feet and a weak pulse.

Types of bone cancer

There are several types of bone cancer. To develop an optimal treatment plan, it is very important to know the exact type of disease. Here are some common types of bone cancer:

1. osteosarcoma
2. Chondrosarcoma
3. Ewing's sarcoma
4. Pleomorphic sarcoma
5. fibrosarcoma
6. Chordoma

Osteosarcoma is the most common type of bone cancer. Most often, osteosarcoma develops in older children, adolescents and young people (10-19 years old), and also most often in men. In young people, osteosarcoma tends to develop at the ends of long bones, in areas of active growth, often around the knee, or at the end of the femur or tibia near the knee. The next most common site for bone cancer is the humerus. However, osteosarcoma can develop in any bone. Depending on the appearance of tumor cells under a microscope, there are several different subspecies of osteosarcoma.

Chondrosarcoma is the second most common type of bone cancer. It develops from chondrocytes that attach to or coat the bone. It is more common in people over the age of 40, and less than 5% of cases of this cancer occur in people under the age of 20. Chondrosarcoma can grow quickly and aggressively or slowly. Most often, chondrosarcoma is found in the bones of the pelvis or ilium.

Ewing's sarcoma, sometimes called a tumor of the Ewing's sarcoma family, is an aggressive form of bone cancer that is common in children aged 4–15 years. It can develop in either bone or soft tissue and is thought to originate in undifferentiated neural tissue. Tumors of the Ewing's sarcoma family are more common in men than in women. The most common location for Ewing's sarcoma is the middle part of the long bones of the arms and legs.

Pleomorphic sarcoma This type of cancer was formerly called malignant fibrous histiocytoma. Usually, pleomorphic sarcomas are not cancers of the bone, but of the soft tissues. However, in 5% of cases, it can also form in the bone. Pleomorphic sarcoma occurs in adults and can form anywhere.

Fibrosarcoma is a rare type of bone cancer. Most often it is formed in adults behind the knee.

Chordoma is a very rare type of cancer that usually occurs in people over the age of 30. More often localized in the lower or upper part of the spinal column.

- These are malignant various parts of the human skeleton. The most common form is secondary cancer, when the oncological process is caused by sprouting from neighboring organs.

Primary cancer, when the tumor develops from the bone tissue itself, is much less common. Its varieties are osteoblastoclastoma and parosteal sarcoma, as well as osteogenic. Bone cancer includes malignant tumors of cartilage tissue: chondrosarcoma and fibrosarcoma. As well as cancers outside the bones - lymphoma, Ewing's tumor and angioma.

In the structure of oncological morbidity, bone cancer occupies a small share - only one percent. But due to the symptoms that are not expressed at the initial stages and the tendency to rapid growth, it is one of the most dangerous types of oncology.

Symptoms of bone cancer

The first sign of developing bone cancer is pain that appears when you touch the place under which the tumor is located. At this stage, the neoplasm can already be felt: this is the middle stage of the course of the disease.

Then the pain is felt without pressure. At first weak, sometimes arising from time to time, gradually it becomes stronger. Appears unexpectedly and quickly disappears.

The pain occurs intermittently or is present constantly, in a dull or aching form. It concentrates in the area of ​​the tumor and can radiate to nearby parts of the body: if the shoulder is affected, the arm may hurt. The pain does not go away even after rest, aggravated at night. As a rule, analgesics do not relieve the pain symptom, and the pain intensifies at night or during vigorous activity.

Other common symptoms of bone cancer include limited movement and swelling of the limbs and joints. Bone fractures may occur, even if the fall was very slight.

Abdominal pain and nausea are often noted. This is the result of hypercalcemia: calcium salts from the diseased bone enter the blood vessels and cause unpleasant symptoms. In the further stages of the development of the disease, other common signs of bone cancer are observed - a person loses weight, his temperature rises.

At the next stage of the malignant process, usually two to three months after the onset of pain, regional lymph nodes increase, joints swell, and soft tissue edema develops. The tumor is well palpable - as a rule, it is a fixed area against the background of moving soft tissues. In the affected area itself, an increased temperature of the skin may be observed. The skin in this place becomes pale, thinner. If the size of the tumor is significant, a vascular, marble pattern is noticeable.

Weakness appears later. A person begins to quickly get tired, becomes lethargic, he is often haunted by drowsiness. If the cancer metastasizes to the lungs, breathing problems are observed.

The main symptoms of bone cancer:

limitation of joint mobility;

an increase in regional lymph nodes;

swelling of the limbs and joints;

Bone marrow transplantation can also provoke malignant processes in bone tissues.

A predisposition to the development of malignant neoplasms is observed in people with certain hereditary pathologies. Thus, Li-Fraumeni syndrome is determined in the anamnesis of some patients diagnosed with breast cancer, brain cancer, and sarcoma. Genetic diseases that can affect the appearance of cancer today include Rothmund-Thomson and Li-Fraumeni syndromes, Paget's disease, and the presence of the RB1 gene.

According to doctors, the cause of the development of oncological neoplasms can be DNA mutations, as a result of which oncogenes are “launched” or genes that prevent tumor growth are suppressed. Some of these mutations are inherited from parents. But most tumors are associated with mutations acquired by a person already during his own life.

The risk of developing bone cancer is slightly higher in smokers and those who have chronic diseases of the skeletal system.

Main causes of bone cancer:

injuries of bones and joints;

radioactive radiation;

hereditary predisposition;

DNA mutations;

bone marrow transplant operations;

chronic diseases of the skeletal system.

Stages of bone cancer

At the first stage bone cancer is limited to the affected bone. In stage IA, the tumor is eight centimeters in diameter. In stage IB, it becomes larger and spreads to other parts of the bone.

The second stage of the disease is characterized by malignancy of neoplasm cells. But it still does not go beyond the boundaries of the bone.

At the third stage the tumor captures several sections of the affected bone, its cells no longer differentiate.

Sign of the fourth stage- “intervention” of cancer in tissues adjacent to the bone: the formation of metastases. Most often in the lungs. Later - to regional lymph nodes, as well as to other organs of the body.

The rate of transition of the disease from one stage to another depends, first of all, on the type of malignant tumor. Some types of neoplasms are very aggressive and progress quickly. Others develop slowly.

One of the fastest growing types of bone cancer is osteosarcoma. He is also the most common. Typically seen in men. It is located on the long bones of the legs and arms, near the joints. An x-ray shows a change in the structure of the bone.

Another type of bone cancer, chondrosarcoma, can grow at different rates, either quickly or slowly. It occurs mainly in people over forty years of age. And it is usually located on the bones of the thighs and pelvis. Metastases in such a tumor can "migrate" to the lymph nodes and lung tissues.

One of the rarest types of bone cancer is chordoma. It affects in most cases people over the age of thirty years. Localization - the spine: either its upper or lower section.

Bone cancer with metastases, prognosis

Most patients get an appointment with an oncologist when the bone cancer has already gone far. As a rule, metastases are diagnosed at this stage. Therefore, the complex treatment of malignant tumors of the skeletal system usually includes the entire set of anti-cancer techniques. In the later stages of the disease, it is often necessary to resort to amputation of the limb.

The effectiveness of treatment in oncology is measured by the survival rate: the time that a person lives from the moment of diagnosis. With bone cancer, the five-year milestone reaches seventy percent of patients. Both children and adults. The most common bone tumor in adult patients is chondrosarcoma, with eighty percent of patients living with it for more than five years.

The cause of death in this form of oncology is usually not the bone cancer itself, but osteogenic tumors in other places of the body caused by metastases from the bone focus.

The key condition for effective treatment of bone cancer is the earliest possible diagnosis. A timely X-ray or MRI can detect a malignant process in the initial stages and provide a high chance of a patient's recovery.

Tactics of treatment in each case is selected individually. The main methods: surgery, radiation therapy, chemotherapy, are used either in combination or separately from each other.

When choosing methods and their combination, the oncologist focuses on several factors: the localization of the tumor, the degree of its aggressiveness, the presence or absence of metastases in nearby or distant tissues.

Surgery

Surgery is performed in the vast majority of cases. Its goal is to remove the tumor and healthy bone tissue adjacent to it. If earlier the affected limb was often amputated, today more gentle methods are used when only a malignant neoplasm is removed. The damaged area is repaired with bone cement or bone graft from another part of the body. Bone bank tissue may be used. If a large area of ​​bone has been removed, a metal implant is implanted. Some models of implants are able to "grow" with the body of a child or teenager.

Before surgery, chemotherapy may be prescribed: the introduction of drugs to stop the growth of malignant cells. This reduces the size of the tumor and facilitates the operation. After the tumor is surgically removed, chemotherapy is used to kill any cancer cells that may still be in the body.

Radiation therapy

Radiation therapy also aims to kill malignant cells. High-energy x-rays affect only the area of ​​tumor localization. Long-term treatment: every day, several days or months.

Low Intensity Electro Resonance Therapy

Among the modern methods of treating bone cancer, the NIERT method (Low Intensity Electro Resonance Therapy) can be noted. In conjunction with autohemochemotherapy and taking calcium preparations, it is used to treat metastases of various sizes in bone tissues. Conducting several courses, experts say, gives a good analgesic effect, partial regression of metastases is achieved (in 75% of cases).

Rapid Arc

Rapid Arc is positioned as the latest development in the field of cancer treatment. This is radiation therapy that uses visual control and changes in the intensity of radiation. The technology uses high-precision linear accelerators and computed tomography. The device moves around the patient, "attacking" the tumor from a variety of angles. Irradiation is ten times more powerful than that of devices of older generations. Treatment time is reduced by up to eighty percent.

cyber knife

CyberKnife is considered an innovation in the surgical treatment of malignant neoplasms. Affected tissues are removed using stereotactic radiosurgery. This complex device combines the latest advances in robotics, radiation surgery and computer technology. The operation takes place without pain and blood, and the intervention in the patient's body is minimal.

Brachytherapy

In brachytherapy, a radioactive source is implanted inside the tumor. This limits the area of ​​radiation exposure and protects healthy tissue.

Proton beam therapy

A promising area in the radiological treatment of cancer is proton beam therapy. Malignant cells are exposed to beams of charged particles moving at great speed: heavy carbon ions and hydrogen protons. The method is more accurate than existing methods of cancer treatment.

Education: completed residency at the Russian Scientific Cancer Center named after N.N. N. N. Blokhin” and received a diploma in the specialty “Oncologist”

Bone cancer (or bone cancer, or bone tumor) is a general term used to address neoplasms of a benign (with the possibility of degeneration) and malignant type. Bone cancer, which presents differently depending on the type of cancer, may present with minor symptoms in the early stages and is therefore often ignored by patients. It is noteworthy that bone oncopathology itself is diagnosed quite rarely (about 1% of tumors), however, due to the formation of a tumor in a particular organ or system, and metastasis to the bones, certain types of cancer belong specifically to bone cancer.

general description

Bone cancer is one of the most rarely diagnosed types of cancer. Basically, this disease affects children and adolescents, much less often bone cancer is diagnosed in older people. Bone damage mainly occurs due to metastasis from cancer in other areas (with cancer of the breast, lungs, etc.). Depending on this, the disease is designated as primary or secondary. Primary bone cancer develops on its own. Secondary bone cancer (or, as it is also called, metastatic bone cancer) develops in the previously indicated variant, that is, in cases where cancer cells from other areas enter the bone tissue.

We remind our readers what metastasis is. Metastasis refers to a process in which secondary foci of tumor growth begin to form, that is, metastases. Metastases begin to form due to the spread of cells that contribute to this to other areas and tissues from the area of ​​\u200b\u200bthe primary (main) location of the tumor. It is on the basis of such a process as metastasis that there are reasons to indicate the malignant nature of the tumor disease. At the same time, metastasis excludes the possibility of curing an existing tumor without removing the metastases themselves. Often, it is precisely because of the damage to a number of internal organs (brain, liver, etc.) caused by metastases that tumors become incurable.

The disease, which we will focus on today, develops when bone cells begin to divide uncontrollably and randomly. Cancer cells grow directly in the bone tissue. With the continuation of uncontrolled division, that is, when there is no need for new cells, but they still continue to divide, an outgrowth is formed - this is a tumor. Also, neoplasm cells can grow into tissues located in their immediate vicinity, as well as spread to other parts of the body. This picture corresponds to a malignant tumor formation, but if the tumor is benign, then such a spread to other organs does not occur.

Depending on the characteristics of the lesion, the corresponding types of bone cancer are distinguished, we will consider them below.

Bone cancer: types and features

As we have already indicated, bone tumors can be benign and malignant. In listing the options, we will not dwell on their characteristic symptoms, but only highlight their inherent features for a general idea.

Benign tumors include:

• In this case, the tumor, as already indicated, is benign. It is characterized by a favorable course, it grows very slowly, is not predisposed to malignancy, does not grow into nearby tissues, and is not prone to metastasis. It is mainly diagnosed in children and young people (general age group - patients 5-20 years of age). Osteomas have certain types of forms, their difference is the area of ​​localization and structure. In particular, these are hyperplastic osteomas formed on the basis of bone tissues (osteoid osteomas, osteomas), as well as heteroplastic osteomas formed on the basis of connective tissue(osteophytes). Tumors are mainly localized from the side of the outer bone surface with localization in the area of ​​the flat bones of the skull, on the humerus, femur and tibia, on the walls of the frontal, ethmoid, maxillary and sphenoid sinuses. The vertebral bodies may also be affected. As a rule, osteomas are single in nature of manifestation, however, exceptions are allowed. As such, it is considered Gardner's disease accompanied by the formation of multiple tumor formations, as well as congenital osteomas with damage to the bones of the skull. The latter develop due to a violation in the development of mesenchymal tissues, appear in combination with a number of other defects. Osteomas themselves are not painful, their presence is not accompanied by any symptoms, however, until nearby anatomical formations begin to be squeezed, this can already cause the manifestation of a wide variety of symptoms, ranging from visual impairment to the development of epileptic seizures. Treatment of osteomas is performed only by surgical intervention.
• Osteoid osteoma (aka osteoid osteoma). Such a neoplasm is mostly single, its diameter does not exceed 1 centimeter. Its contours are clear, the area of ​​localization is possible in any of the bones of the skeleton (exceptions are the sternum and bones of the skull). Based on statistics for this type of tumor, they are diagnosed on average in 11% of cases of benign tumor formation. In most cases, the femur is affected, followed by the tibia, and finally the humerus, according to the frequency of detection of osteomas. Difficulties in diagnosis arise due to the small size of the tumor formation, as well as due to the absence of specific symptoms. Because of this, often the treatment of osteoid osteoma is carried out on the basis of an incorrect diagnosis, and, accordingly, unsuccessfully. The only method of treatment is surgical intervention, its volume is determined based on the area of ​​localization and on the specific type of tumor process. Such formation after removal, as a rule, is not subject to recurrence.
• Osteochondroma (aka - ectostosis). In this case, we are talking about a tumor formation, which manifests itself as an outgrowth based on bone tissue, which is, as it were, covered with a “cap”, this time based on cartilage tissue. Osteochondroma has the appearance of a colorless mass in its structure. It is mainly detected in patients aged 10-25 years. A neoplasm of a similar type, which can be designated as an osteophyte, has nothing in common with the considered tumor formation in terms of pathogenesis (features of the course of the disease, what happens during it). Osteophytes are formed near the affected joint in a disease such as osteoarthritis. In other words, it is wrong to attach an osteophyte to osteochondroma, they are not synonyms. As for the areas of localization, the picture here can be different, although in about half of the cases, damage to the lower femur, damage to the upper tibia, and damage to the upper humerus are diagnosed. Detection is allowed in other bones, except for the defeat of the facial bones of the skull. The feet, hands and spine, meanwhile, are rarely affected. The diameter of the tumor can reach 14 centimeters, with the maximum period of observation of patients, there were no cases of malignancy of the process, the probability of such a variant, meanwhile, is 1-2%. Recurrence is also possible, mainly observed during the first 26 months after surgical removal of the tumor. A similar option is possible with incomplete removal of the tumor or with incomplete removal of its cap. Treatment of osteochondroma is carried out only with a radical effect, that is, with surgical removal of the tumor.
• Chondroma. Chondroma can also be referred to as a cartilage tumor or cartilage, which, as you can understand, determines the structural features of such a tumor - it consists of cartilage tissue. Based on the localization of the bone, enchondroma and ecchondroma are distinguished. Enchondroma is formed directly in the bone, which is accompanied by a practical bursting of the latter with the growth of the tumor. Echondroma grows from the bone, towards the soft tissues, that is, beyond the limits of the bone to which it refers. Chondromas in their localization often affect the bones of the feet and hands, somewhat less often flat and long tubular bones are affected. Symptoms are scarce, pain, as one of the symptoms, appears mainly as a result of injuries or as a result of pathological fractures due to the growth of the presence of a tumor process in the bone (which is important when localized in the region of the distal extremities). Treatment of chondromas requires surgical intervention, in which the tumor is removed and the defect is repaired. Malignancy of the process occurs mainly with large tumors concentrated in the pelvic bones and in long tubular bones. In general, the prognosis is favorable.
• Chondromyxoid fibroma. This type of tumor formation is quite rare, it is benign. Basically, long tubular bones are subject to damage with it, although damage to other bones of the skeleton is not excluded. As a rule, the course of the disease is characterized as favorable, although the possibility of recurrence and even malignancy is allowed. The manifestation of chondromyxoid chondroma is accompanied by the occurrence of increasing pain sensations, which are noted where, in fact, the tumor appeared. In a severe variant of the course, muscle atrophy may develop in the area of ​​the affected limb, and the mobility of the joint located in close proximity to the tumor may also be limited. Quite often the tumor is found in a tibia, in a calcaneus. It can affect the pelvic, shoulder bones, ribs, skull bones, sternum, vertebrae. The most aggressive tumor growth is in the spinal cord. Chondromyxoid fibroma, the symptoms of which are detected with the same frequency in both men and women, develops in patients of any age. In particular, severe symptoms and the most rapid growth of the tumor are detected in children. In about 15% of cases, the course is characterized by the absence of symptoms as such, while the detection of the tumor occurs by chance, during an X-ray examination in the direction of an orthopedist or traumatologist.
• Chondroblastoma. This type of tumor formation is similarly benign, however, there are certain deviations for this statement. To begin with, let us denote that such a tumor is formed due to cartilaginous tissue, concentrating in the epiphyseal region of tubular long bones. The distal epiphysis of the femur is in the first place in terms of the part of the lesion, the proximal epiphysis with the lesion of the tibia is in the second place, and, finally, the proximal epiphysis with the lesion of the humerus is in the third place. Somewhat less often, chondroblastomas are detected in the proximal epiphysis of the femur, in the bones of the foot and pelvis. In practice, there are also cases of chondroblastomas appearing on the side of the ribs, sternum, spine, scapula, collarbone, patella, wrist bones, phalanges of the fingers, as well as in the cranial vault and lower jaw. Most often, this disease is diagnosed after the age of 20 years, somewhat less often - in adulthood and in the elderly. For various age groups, there are data on chondroblastoma, indicating that it is diagnosed on average in 1-4% of cases of possible benign tumor formations. There is also a predisposition of men to this type of tumor - they are diagnosed on average 2 times more often than, respectively, in women. It should be noted that chondroblastoma can be not only benign, but also malignant. In this case, benign chondroblastoma can manifest itself either in a typical form or in a mixed form. There are also some varieties of both types of tumors. So, benign chondroblastomas can manifest themselves in the following varieties: cystic chondroblastoma, chondromic chondroblastoma, chondroblastoma with chondromyxoid fibroma or osteoblastoclastoma. In turn, malignant chondroblastomas can manifest themselves in such varieties: clear cell chondrosarcoma, primary malignant chondroblastoma or malignant chondroblastoma (in the latter version, it can also be transformed into chondrosarcoma or osteogenic chondroblastic sarcoma). Malignant forms of chondroblastoma are diagnosed in approximately 7% of cases of chondroblastoma in general (that is, including benign ones). Malignancy mainly occurs against the background of several previous relapses of the benign form of the disease, which, in particular, is due to its incomplete surgical removal.
• Giant cell tumor (also known as osteoblastoclastoma or osteoclastoma). Such a bone tumor is diagnosed most often. There are no special differences in the predisposition of men or women to this disease, therefore it can be added that both sexes are equally susceptible to it. There is also a hereditary predisposition. With regard to age predisposition, in general, the disease can be detected from 1 year to 70 years, however, in more than half of the cases of detection of giant cell tumors, the age of 20-30 years can be designated as the peak of age-related incidence. At the same time, it can be added that in children under twelve years of age, the tumor is detected extremely rarely. Basically, the tumor formation is solitary, in some cases its double concentration is detected, and mainly in the bones located near. More often, long tubular bones are affected, which is relevant in an average of 74% of cases, small and flat bones are affected less frequently. Localization of the tumor in long tubular bones is noted in the epimetaphyseal region. It does not grow into the epiphyseal and articular cartilage. In 0.2% of cases, which is quite rare, the localization is diaphyseal. A benign tumor can transform into a malignant one, in addition, osteoblastoclastoma can be primary malignant. Malignant osteoblastoclastomas are localized similarly to benign tumor formations of this type. Bone tissue is subject to destructive processes. The composition of the tumor includes giant multinucleated cells, as well as unicellular formations, while giant cells play a less significant role in the development of tumor formation in comparison with unicellular ones. The cellular origin of the tumor formation is generally unknown. The clinical course is characterized by its own slowness, the pain manifests itself late and is of a moderate nature. Swelling of the bone and its deformation are observed in the later stages of the course of the disease. The process of metastasis is accompanied by spread both to the surrounding veins and to distant veins, for example, to the lungs. Here they retain a benign structure, however, they have the ability to produce bone tissue. Osteoclastoma forms in areas that are referred to as bone growth zones. In particular, this is the neck and head of the femur, the greater or lesser trochanter of the femur. The tumor can completely affect the articular end of the bone, thereby contributing to its swelling or destruction of the cortical layer, after which it goes beyond the affected bone. In some cases, the destruction of the bone by the tumor occurs in an uneven way, the clinical and radiological features when examining it indicate either its cellular-trabecular structure or the complete disappearance of the bone under the influence of the growth of the tumor process - in this case we are talking about the lytic form. Remarkably, the lytic form develops in pregnant women, and the process of tumor development is so rapid and vivid in its clinical picture that this form is diagnosed as malignant. Treatment in this case involves termination of pregnancy, although in practice there have been cases of detection of a tumor in the final months of pregnancy, and therefore treatment began after childbirth. If previously this tumor was considered benign, now the prevailing idea about it has been revised, taking into account its possible primary malignant nature and tendency to malignancy. A number of questions on it, in addition, remain unclear.
• Angioma. In this case, we are talking about a generalized definition for a group of vascular tumors that form on the basis of lymphatic or blood vessels. The localization of such neoplasms can be superficial (mucous membranes or skin are affected), in addition, they can be located in the internal organs and muscles. The accompanying manifestations of their existence are bleeding, they, in turn, can manifest themselves in varying degrees of their own intensity. Removal of such neoplasms is carried out by various methods (X-ray therapy, sclerotherapy, cryotherapy), and surgical intervention is also a possible measure. Various organs and tissues are subject to damage, while angiomas can be either single or multiple. Sizes may also vary. If a case of hemangioma (an anomaly with damage to the blood vessels) is considered, then the neoplasms have a blue-red color, and if lymphangiomas (an anomaly with damage to the lymphatic vessels), then such neoplasms are colorless. Basically, angiomas are found in children - they account for about 80% of cases of congenital forms of neoplasms. It should also indicate a predisposition to progression, and sometimes to a very rapid one. Angiomas are mainly found in the region of the upper half of the trunk, on the neck and on the head. The eye sockets, eyelids, lungs, pharynx, external genital organs, bones, liver, etc. are somewhat less commonly affected. Basically, angiomas are congenital, and their increase is due to the growth of blood vessels in the tumor itself. These vessels grow into the tissues surrounding them, thereby destroying them, which is similar to the growth of tumor malignant neoplasms.
• Myxoma. Myxoma is an intracavitary tumor that affects the heart. This tumor is benign, and of all varieties of this type of tumors, it is detected in 50% of cases in adult patients, in 15% in pediatric patients. At the same time, in 75% of cases, the localization of the tumor formation falls on the left atrium, in 20% of cases - on the right. A small proportion of cases occur in the valvular apparatus or in the ventricles. The main age of patients is 40-60 years. Most often, myxoma of the heart is diagnosed in women than in men. The tumor itself is formed on the basis of connective tissue, it also contains a significant amount of mucus. In addition to damage to the heart, myxoma can also be detected on the extremities, in the area of ​​intermuscular tissue, fascia and aponeuroses. Somewhat less commonly, the nerve trunks and bladder are affected.
• Fibroma. Fibroma is a benign mature tumor based on connective tissue. It can form in any part of the body. May be diffuse or limited. The course of the disease and its signs directly depend on where the fibroma is located, as well as on the characteristics of the growth rate. The possibility of transformation from a benign formation to a malignant formation is allowed. Fibroma is treated surgically.
• Eosinophilic granuloma. This disease is designated as a pathology of an unclear nature, the course of which is characterized by the formation of granulomas (infiltrates) in the bones, while a feature of the granulomas is the presence of a significant number of eosinophilic leukocytes in them. Some authors believe that the disease has an infectious-allergic nature, some - that it is associated with trauma, some - with helminthic tissue invasion. The disease is diagnosed quite rarely, and mainly in preschool children. The main symptom of the disease in question is that it forms single or multiple tumor foci that affect the tubular and flat bones. Most often, the vertebrae, femurs, bones of the cranial vault and pelvic bones are affected.

Malignant tumors include:

• This type of tumor is malignant, with it the bone skeleton is subject to damage, mainly the lower part of the long tubular bones, the collarbone, spine, pelvis, ribs, and shoulder blade. Ewing's sarcoma ranks second in the frequency of diagnosis in children; in general, it occurs in children under 5 years of age, as well as in adults from 30 years of age. The main peak of incidence in this case is the age from 10 to 15 years. The causes of Ewing's sarcoma are currently still unknown, but 40% of cases of this disease have been associated with previous trauma. In rare cases, Ewing's sarcoma develops as an extraosseous pathology, which is accompanied by soft tissue damage, but, as already noted, bones are mainly affected. The disease can be localized and metastatic in developmental stages. The localized stage of Ewing's sarcoma determines for it the possibility of spreading from the primary lesion to soft tissues in close proximity to it, while distant metastasis is not observed. As for the metastatic stage, here the tumor can spread to other parts of the patient's body (bone marrow, bones, lungs, liver, central nervous system, etc.). In general, Ewing's sarcoma is the most aggressive of malignant tumor formations. Remarkably, in approximately 90% of cases when any therapy measures are started, metastasis is already actual for patients (the main areas are bones, lungs and bone marrow).
• Osteogenic sarcoma. Osteogenic sarcoma is a tumor whose malignant cells are formed at the expense of bone tissue, while they also produce this tissue. Osteogenic sarcoma can be sclerotic (osteoplastic), osteolytic, or mixed, which is determined radiographically. As is clear, such a sarcoma occurs directly due to bone elements, and it is also characterized by rapid progression and early metastasis. Osteogenic sarcoma is detected at any age, however, in approximately 65% ​​of cases, the peak incidence occurs between the ages of 10 and 30 years. It is also noted that basically the sarcoma develops by the end of puberty. As for sexual predisposition, it is also relevant here: men get sick almost twice as often as women. The predominant environment for the localization of osteogenic sarcomas are long tubular bones, and in about 1 out of 5 cases of osteogenic sarcomas, their localization falls on short or flat bones. Up to 6 times more often the bones of the lower extremities are affected in comparison with the bones of the upper extremities, while about 80% of the total number of tumors affecting the lower extremities are concentrated in the knee joint. The hip, humerus, tibia, fibula, pelvis, ulna, and shoulder girdle are also often affected. In the radius, where a giant cell tumor appears quite often, in rare cases it is accompanied by the growth of osteogenic sarcoma. Osteogenic sarcoma almost never grows from the patella. The skull is affected mainly in children, in addition, such a lesion is also relevant for elderly patients, but here it already acts as a complication of osteodystrophy. The development of the tumor in some cases is associated with the rapid growth of the bone. In children who are diagnosed with osteogenic sarcoma, in most cases, growth is higher (if equal to the general age norm), while the disease itself affects those parts of the skeleton that grow the fastest. Basically, there is also a connection with trauma as a predisposing factor to the development of sarcoma, but trauma is more of a factor that allows it to be detected almost randomly during an X-ray examination.
• parosteal sarcoma. This type of sarcoma is one of the varieties of osteosarcoma. The frequency of its detection averages 4% of the total number of osteosarcomas, that is, the tumor is quite rare. It develops directly on the bone surface, its feature is a longer and, at the same time, less malignant course. A typical localization environment is the region of the knee joint (posterior surface of the femur or tibia), it accounts for about 70% of cases of this type of sarcoma. In rare cases, the skull, bones of the pelvis and spine, scapula, bones of the foot and hand are affected (literally isolated cases). This tumor has a bone consistency, it is concentrated outside the bone, however, it is associated with the underlying bone and with the periosteum. In frequent cases, it is, as it were, in a capsule, which, however, does not exclude the possibility of its germination into nearby muscles.
• Chondrosarcoma. This tumor is one of the most common tumor pathologies affecting the skeleton. It is based on cartilage. Basically, chondrosarcoma develops in flat bones, although it is also possible to detect such a tumor in tubular bones. There are several scenarios under which such tumors can progress. So, it can be a relatively favorable scenario of progression, in which the growth of the tumor formation is slowed down, and metastasis occurs at late stages, or an unfavorable one, in which tumor growth is rapid and metastasis begins early. These are two basic options for which certain deviations are possible when considering the overall picture of the disease in each case. Treatment of chondrosarcoma consists of surgical intervention, the prognosis is determined by the specific variant of the course of the disease, as well as the possibilities of a relatively radical effect on the tumor. Basically, the shoulder girdle, pelvic bones, femurs and humerus bones, and ribs suffer from this tumor. On average, in 60% of cases, the disease is diagnosed in patients of the middle and elderly age group (age from 40 to 60 years). Meanwhile, this does not exclude the possibility of detecting chondrosarcoma in patients of other ages. Thus, statistics indicate that the earliest case of this pathology was recorded at the age of 6, while the latest - at 90. Regarding gender predisposition, it can be noted that men are twice as likely to experience this disease compared to women. Chondrosarcoma can correspond to several degrees of malignancy of the process. So, 1 degree The malignancy of chondrosarcoma is accompanied by the predominant presence of chondroid tissue in the tumor, the latter, in turn, contains chondrocytes, which contain small dense nuclei. In a small amount, there are still multinucleated cells, there are no mitotic figures. For 2 degrees predominantly myxoid intercellular substance is characteristic, the number of cells is greater than within the 1st degree. The accumulation of cells occurs along the periphery of the lobules. The nuclei are enlarged, mitotic figures are present in a single amount, there are areas of destruction, that is, areas of necrosis. And finally 3 degree, it is characterized by the myxoid composition of the intercellular substance, the arrangement of cells in it occurs in strands or groups. The presence of stellate or irregularly shaped cells in a significant volume is determined. There are a lot of multinucleated cells, and a lot of cells with enlarged nuclei. There are mitotic figures, areas of necrosis are extensive. If we do not go into a detailed consideration of such changes, but start only from knowing the degree of chondrosarcomas, then we can indicate that the higher the degree, the higher the likelihood of early metastasis, as well as the development of a relapse of the disease after surgical removal of the tumor formation.
• Chordoma. This type of neoplasm can be referred to as both a benign tumor and a malignant tumor. Meanwhile, the benign nature of such a neoplasm is controversial. Given the fact that the growth of the tumor formation is slow, and metastasis is rarely observed outside of it, it is considered precisely as benign. However, due to the fact that the tumor is located in a specific area, it is its location that causes the development of complications. The tumor itself can subsequently recur, that is, resume its development after a seemingly complete recovery of the patient. It is for this reason, in accordance with the principles on which the international classification of neoplasms is based, that it is more correct to classify it as a malignant tumor. Chordoma is rarely diagnosed (in about 1% of cases of tumor formations affecting bone structures), it is formed on the basis of the remains of the embryonic chord. The chordoma of the sacrum is predominantly detected, in this case - in patients 40-60 years old, more often in men. If the tumor is diagnosed in young people, then it is usually a tumor at the base of the skull. It is these areas that are the main ones in the defeat of the chordoma. Tumors are divided into the following forms: chondroid chordoma, undifferentiated chordoma and normal chordoma. The chondroid chordoma is characterized by the least aggressiveness. The undifferentiated is prone to metastasis and is the most aggressive of these forms. Sometimes it is difficult to determine the specific type of tumor, in this case it is often believed that chondrosarcoma has formed (due to the common localization and structure). Here we are talking about an undifferentiated tumor, and, of course, the need to differentiate a specific neoplasm. If we are really talking about chondrosarcoma, and not about chordoma, then there are grounds for a favorable prognosis for it. The fact is that chondrosarcoma is more sensitive to treatment using radiation therapy, which is the basis for such statements. Treatment of chordoma requires surgical intervention, its volumes are determined individually, depending on the nature of the pathological process.

Bone Cancer: Risk Factors

Despite the fact that at the moment it has not been possible to determine the unambiguous cause of bone cancer, this does not exclude the identification of some factors that are predisposing to the development of this disease. In particular, these are:

• the presence of such a benign disease that affects the bones, such as Paget's disease;
• heredity (the presence of the closest blood relatives of this disease in the past);
• exposure;
• trauma to the bones (again, trauma cannot be considered as a factor contributing to the development of cancer, however, it is with trauma, as already indicated, that the disease is detected).

Certain predisposing factors can be identified for some individual types of bone cancer.

• osteosarcoma: male, age from 10 to 30 years, bone marrow transplantation, retinoblastoma (eye cancer, a fairly rare disease), the presence of hereditary cancer syndromes.
• Chondrosarcoma: exostoses in a significant amount (a disease of a hereditary type, as a result of which the bones are affected by characteristic bumps), age from 20 years.

In other types of cancer, a sufficient factor for the development of cancer is compliance with a certain age group, which, meanwhile, cannot be unambiguously determined due to the variability of variants.

Bone cancer: symptoms

The clinical manifestation of the disease is based on the following symptoms:

• Pain. Pain, as you can understand, if it appears, then in the place where the tumor has formed. The pain can be constant, its intensification occurs during loads and movements, at night (the period of muscle relaxation).
• Puffiness. Puffiness similarly occurs in the area where the tumor is located, in particular, the swelling surrounds it. It is noticeable during the late stage of the course of the disease, that is, when the tumor has already reached a significant size. In some cases, edema may not be detected during examination and palpation.
• Difficulty of movements. Being in close proximity to the affected joint, the tumor, as it grows, leads to certain difficulties in its work. The movement of the limb because of this may be limited. If the joints of the legs have been affected, then this can cause numbness of the limbs, tingling in them, and lameness.
• Deformity of the affected limb or body.
• Weight loss, sweating, fever, lethargy are symptoms of a general "failure" of the body, both against the background of oncological diseases and against the background of diseases of any other type.

The listed symptoms, as you can see, are relevant for many diseases, and this applies not only to the last point. Meanwhile, if the duration of the manifestation of such a symptom as pain in the limbs is more than two weeks, it is necessary to consult a doctor for a comprehensive examination to identify a specific cause.

Cancer of the bones of the legs and pelvis

Quite rarely in practice there are primary tumors with damage to the bone tissue of the pelvic bones. With the same frequency in this case, osteosarcomas and chondrosarcomas are detected. Sarcoma of the hip joint is diagnosed even less frequently. Like many types of cancer, these pathologies are more often diagnosed in men (in comparison with women).

Let us dwell on the symptoms inherent in such a disease as cancer of the pelvic bones:

• Blunt pain, arising in the pelvis and buttock, in some cases, such pain may be accompanied by a short-term increase in overall body temperature.
• Increasing pain sensations noted in particular during physical exertion and while walking, the symptom is relevant with the gradual progression of tumor pathology.
• protrusion, swelling, also detected in the future, with the progression of the disease when the tumor acquires a significant size. The skin in the affected area becomes noticeably thinner, which makes it possible to notice the vascular pattern.
• Spreading the pain to the spine, perineum, groin, thigh, etc. This symptom is relevant for the later stages of the pathological process, when nerves and blood vessels are compressed by a tumor formation.
• Limited mobility of the affected joint.

The next part of the symptoms, on which we will dwell, corresponds to such a type of disease as leg cancer, its symptoms are diagnosed with the same frequency in both sexes, that is, in men and women.

• Pain in the legs, increased pain during exercise;
• Limited mobility of the affected limb;
• The appearance of edema on the skin, protrusions;
• Deformity of the affected limb;
• General symptoms of malaise (fever, lethargy, weight loss, weakness, etc.).

Also, regardless of the type of cancer, such a symptom as bone fractures can be identified, which is more relevant for the later stages of cancer, when the tumor leads to significant damage to the joint to which it is directly related.

Diagnosis and treatment

Often, as we have already highlighted in the article, cancer is detected by chance, with no symptoms and during an X-ray examination, for example, for the presence of an injury. In the future, the doctor may prescribe a number of examinations, among them the following can be distinguished:

• a blood test (allows you to determine the level of actual alkaline enzyme phosphatase; if it is elevated, then there is reason to assume a bone tumor, which, however, is also relevant within the growth period of a completely healthy child);
• x-ray examination;
• scanning of the bones of the skeleton (in this case, it means such a test with which you can determine where the tumor is located; for its implementation, a radioactive substance is introduced into the bloodstream, absorbed by the bone tissue, after which, using a special scanner, the features of its impact are monitored);
• CT, MRI;
• bone marrow biopsy.

As for such a question as the treatment of cancer, it is applied differently in each case of this disease, its principles are determined precisely on the basis of the variety, as well as on the basis of the stage of cancer, the area of ​​localization of the tumor formation, the patient's health status, the presence of metastases and other criteria. Basically, surgical removal of the tumor is indicated, although such methods of treatment as radiation therapy and chemotherapy can be used - basically in treatment they are an addition to surgery.

If you have symptoms that may indicate cancer, you should contact an orthopedist or an oncologist.

Bones in modern medical practice are relatively rare. Such diseases are diagnosed only in 1% of cases of cancerous lesions of the body. But many people are interested in questions about why such a disease occurs, and what is the main symptom of bone cancer. After all, the sooner the diagnosis is made and treatment is started, the higher the chances of a successful recovery.

Cancers of the skeleton and their causes

Unfortunately, the causes of primary malignant degeneration of bone and cartilage cells are still under investigation today. However, there is evidence that genetic inheritance matters in this case. In particular, such as Li-Fauman and Rothmund-Thomson syndromes increase the risk of bone damage.

On the other hand, oncological diseases can develop under the influence of external factors. In about 40% of cases, cancerous lesions of the skeleton develop after injuries and bone fractures. Exposure to radioactive radiation on the body, as well as poisoning with strontium and radium compounds, leads to malignant degeneration. Some people have developed cancer after a bone marrow transplant.

Classification of bone cancers

In oncological diseases of the skeleton, the tumor develops either from bone or cartilage structures. In addition, the disease can be both primary and secondary. Primary cancer is most often diagnosed at a young and even childhood age. Secondary tumors are metastases formed by the migration of malignant cells from other sites of damage to the body. possible with hemangioma, lipoma, reticulosarcoma, fibrosarcoma, etc.

In addition, bone tumors can be both benign and malignant (this is important, since the main symptom of bone cancer will depend on the nature of the neoplasm):

1. A benign tumor has clear boundaries and most often the correct shape. Such a neoplasm is considered relatively safe, since it does not give metastases, although in some cases cells can be reborn. The processes of cell division and tumor growth are slow. Such diseases include osteoma and chondroma.
2. Malignant neoplasms are characterized by rapid and aggressive growth. The tumor has no clear boundaries and easily grows into the surrounding tissues. Such diseases are often accompanied by metastasis and end in the death of the patient.

bones and their symptoms

It is worth noting that most often such a disease is diagnosed at a young age (20-30 years), and men are more susceptible to it than women. As already mentioned, benign neoplasms are less dangerous, but this does not mean that treatment is not required here. So what is the first bones?

In fact, the initial stages of the disease in most cases are asymptomatic. Only in the later stages can some external signs appear. In particular, sometimes an uncharacteristic seal can be felt on the bone, which is perfectly felt through the skin. But pain rarely appears - the only exceptions are those cases when the neoplasm greatly increases in size, squeezing the nerve fibers or blood vessels.

Sometimes the tumor grows so much that it is visible to the naked eye. But, importantly, the skin over the neoplasm does not change.

What are the symptoms of bone cancer?

The appearance of a malignant tumor is characterized by a more aggressive course, and therefore the clinical picture is more pronounced here. Pain is the main symptom of bone cancer. Patients often complain of pulling and aching pains, which can either be localized in the affected area or spread to other parts of the body (for example, if the shoulder is affected, pain can occur in the arm).

The intensive growth of a malignant neoplasm and the spread of metastases leads to depletion of the body, the onset of weakness, and a sharp decrease in weight. As in the previous case, the tumor can sometimes be felt through the skin, but it does not have clear boundaries. The skin over the affected area of ​​the skeleton becomes pale and thin, and the translucent venous mesh gives the tissues a marble pattern.

Leg bone cancer: symptoms and features

Approximately 60% of patients with bone cancer are diagnosed with an osteogenic malignant tumor, which most often affects the tubular bones of the leg. A similar disease is diagnosed in adolescents and young people aged 10 to 25 years. In particular, such a neoplasm develops during a period of intensive growth and puberty, and boys are more prone to this disease.

As a rule, the tumor forms in the growth zone, for example, near the knee or at the lower end of the femur. Constant pain that gets worse when walking, temporary lameness, weakness, and sudden weight loss are the main symptoms of leg bone cancer. In the absence of treatment, metastasis occurs, and the lungs are primarily affected.

Pelvic bone cancer: symptoms and description of the disease

The pelvic bones are most commonly affected by Jung's. This disease is characterized by a malignant course, the rapid growth of the tumor and the spread of malignant cells throughout the body. As a rule, young people at the age of 20 years are more susceptible to the disease, although its occurrence is also possible in old age.

The disease is accompanied by characteristic symptoms. Cancer of the pelvic bones is accompanied by pain in the pelvis and thigh, which often spread to the entire lower limb. Soreness greatly complicates movement, so you can see that when walking a sick person is very lame.

Cancer treatment methods

There are many methods used to treat skeletal cancers. The choice of therapy here depends on the nature and size of the tumor, as well as its localization and the presence of metastases. A good effect can be achieved using radiation and chemotherapy. Ionizing rays, as well as chemical aggressive substances, have a negative effect on malignant tumor cells, eliminating not only the primary formation, but also its metastases.

In more severe cases, surgery is required. Surgical treatment is reduced to the removal of the affected parts of the bone and replacing them with metal implants. Naturally, further after the removal of the tumor, an additional course of chemistry or radiation therapy is required to neutralize the malignant structures remaining in the body.

What are the prognosis for patients with bone cancer?

Many patients are interested in the question of how long they live with bone cancer. There is no unequivocal answer to this question, since everything here depends on the nature of the disease, the stage of its development, the presence of metastases and the quality of the therapy performed. As a rule, benign neoplasms can be cured relatively quickly. Diseases of a malignant nature are much more difficult to treat. Nevertheless, with properly administered therapy, it is possible to achieve a stage of long-term remission (about five years). If the patient went to the doctor at the last stage of the disease, when the tumor had already managed to metastasize to the vital organs, the prognosis is not so favorable.