Bone Tumors: Diagnosis & Treatment by Robert J. Snyder, MD

Bone tumors are quite rare. Although this problem is not seen in very many patients, I want to educate you on what exactly a bone tumor is and answer other questions you may have.
So what is a bone tumor? A bone tumor is an abnormal collection of cells confined to within the bone or arising from the outer layer of the bone. In many instances, a patient may not even know they have a bone tumor. The cause of most primary bone tumors is unknown. Some of the most common presenting symptoms of a bone tumor are dull and aching pains in a specific area of the body, painful swelling, tender joints and a pathologic bone fractures. Some individuals experience no symptoms at all and the tumors are discovered on routine X-rays or MRI scans. There are two types of bone tumors: benign and malignant.
Benign Tumors
The majority of bone tumors are benign, which means it is non-cancerous and cannot spread to other parts of the body. Benign tumors are typically not life-threatening, but can still weaken the bones and cause fractures or symptoms related to their size and growth. The most common type of benign tumor is an Osteochondroma, which accounts for 35 to 40 percent of all benign bone tumors. Osteochondromas are typically found at the growing ends of long bones such as the arms or legs. These are usually discovered on an x-ray taken for another reason.
Malignant Tumors
Malignant tumors, those that are cancerous, are more serious. A cancer that originated in the bones is a primary bone cancer, while cancer that starts in another part of the body and spreads to the bones is called secondary cancer or a metastatic tumor. Multiple Myeloma and Osteosarcoma are the two most common types of cancers caused by primary bone tumors. Multiple myeloma is typically seen in older patients and can present with back or shoulder pain while osteosarcoma is seen in adolescents and presents as pain and swelling about a joint typically the knee.
Diagnosis
Diagnosis begins with the physical exam. The area of the suspected tumor is examined for tenderness or abnormalities in range of motion. Blood tests can be useful to locate certain proteins that may indicate the presence of a tumor. X-rays will help localize and diagnose a bone tumor. Every bone tumor has certain distinct X-ray characteristics although these can overlap to a certain degree. An MRI (Magnetic Resonance Imaging) test will also give me a more detailed look at the affected area.
In some cases, I will perform a biopsy on the patient, which involves removing a sample of tissue from the tumor. There are two types of biopsies that can be done, needle and incisional. A needle biopsy will involve inserting a needle in at the site of the tumor to remove a small amount of fluid or tissue from the mass. An incisional biopsy removes tissue by cutting an incision in the skin to reach the tumor. The biopsied tissue can be studied in the lab using a variety of techniques to arrive at a definitive diagnosis.
Treatment
There are multiple treatments for bone tumors. Some tumors may not require any treatment other than periodic check-ups and x-rays. A few benign bone tumors have the potential to transform to a malignant tumor. These are sometimes surgically removed. Other benign tumors that by their size may weaken a bone to cause a fracture are often removed early.
Treatment for a malignant tumor will depend on what type of cancer the patient has and if it has spread or not. Options such as surgery, chemotherapy and radiation are used and often done simultaneously supervised by an oncologist. Surgery on primary malignant bone tumors is typically performed by orthopedic surgeons who have advanced training in surgical oncology and usually operate out of large medical centers. When performing surgery on a patient with a malignant bone tumor, the orthopedic specialist’s goal is to not only remove the tumor, but any surrounding tissue that the cancer cells could have spread to.
In some cases, limb salvage surgery is being performed to remove the tumor usually in the younger patient when the alternative is amputation. The risky aspect of this type of procedure is not only removing the tumor, but saving the vital surrounding tissues and nerves. A wide excision is done, which removes the tumor as well as some surrounding tissue that could potentially be affected. The lost bone is then replaced with a bone graft or an endoprosthesis, which both contain replacement material for the affected part of the body. This type of surgery requires extensive rehabilitation and is usually combined with radiation and chemotherapy.
Sometimes it is not always possible to remove a tumor without harming the surrounding normal vital structures which could result in extreme pain for the patient or even require removing that part of the limb. Tumors in other areas such as the lungs or brain require even more extensive surgery, and may be too dangerous to remove. Chemotherapy and radiation can be used to treat malignant tumors in these sensitive areas of the body.
Robert J. Snyder, MD is an Orthopaedic Surgeon who practices at Orthopaedic & Spine Center in Newport News, VA. Voted a “Hampton Roads Top Doc” for 2012 and 2013 by his peers, Dr. Snyder specializes in Joint Replacement of the Knee and Hip, Sports Medicine and General Orthopaedics. For more information on Dr. Snyder or OSC, call 757-596-1900 or go to www.osc-ortho.com.