BONE NEOPLASMS

• Primary neoplasms of bones are rare.

• Primary Tumor
o The tumor originated in the bone
• Secondary Tumor
o It metastasized from another part of the body
• Most are benign, arising from the synovium.
o Benign
 Most common
 Slow growing, does not cause a lot of symptoms and is not a cause of death
o Malignant
 Very uncommon
 Usually in child or adolescents
 Survival is about 50-80%
• In general; the cause of bone cancer is not really known but they have found that it occurs
in children during rapid skeletal growth. (adolescent growth spurt)
• Also find occurrences in people with conditions that stimulate increase bone metabolism.
Example is Pagets Disease and Hyperparathyroidism
• May be caused by radiation exposure: Environment or treatment from cancer

PATHOPHYSIOLOGY
• Primary tumors cause bone destruction  weakens bone resulting in bone fracture
• Adjacent normal bone responds by altering normal pattern of remodeling
• Bone surfaces change, contours enlarge tumor area
• Malignant bone tumors invade and destroy adjacent bone tissue
• Spinal Metastasis - Spinal Cord Compression
Progress rapidly or slowly
Neurologic deficits (progressive pain, weakness, gait abnormality, paresthesia, paraplegia, urinary
retention, loss of bowel or bladder control) identified early and treatment with decompressive
laminectomy to prevent permanent spinal cord injury

MALIGNANT PRIMARY MUSCULOSKELETAL TUMORS

• Osteosarcoma
• Chondrosarcoma
• Ewings Sarcoma

NURSING DIAGNOSIS
• Knowledge deficit related to disease process, therapeutic regimen
• Pain R/T pathological process, surgery
• R/F injury R/T pathological fx R/T tumor
• Ineffective coping R/T fear of unknown, perception of disease process, inadequate support
system
• Disturbance self esteem R/T loss of body part or alteration role
OSTEOCSARCOMA
• Osteogenic Sarcoma
• Rapidly growing malignant tumor of bone
• Osteoblast cells of bone multiply rapidly
• Found in the active skeletal growth area; tend to occur around the knee joint
• Most common, most often fatal
• Tend to have pathological fractures and that is usually how it is found
• Increased mortality rate because sarcoma often spreads to lungs
o Metastatic
• Most frequently in males 10-25 y/o
o Adolescents and young adults - Bones grow rapidly during these years

CLINICAL MANIFESTATIONS – OSTEOSARCOMA

• Localized Pain - Swelling
• Child may awake at night due to pain
• Unilateral and not related to any activity
• Look at Hx of trauma

Physical Findings
• Bony Tenderness or mild joint stiffness
• Rarely demonstrate instability
• Normal NV Exams
• Limitation of motion
• Weight loss – considered ominous findings
• May be palpable, tender, fixed
• Increased skin temp over mass and venous distention
• Pathological Fractures are common

GENERAL TREATMENT
• Combination chemotherapy pre/post surgery removal
• Resect tumor in bone or possible amputation
• Potent chemo drugs

DIAGNOSTIC TEST / FINDINGS

• Radiography – May notice changes
• Bone Biopsy – Gives diagnosis
• CT and MRI to look for metastasis
• Alkaline Phosphatase – May be elevated

THERAPEUTIC MANAGEMENT
• Surgery
• Amputate Limb or Limb Salvage
o Take out affected area in bone or possible amputation
CHONDROSARCOMA
• Malignant tumor of hyaline cartilage – Usually located in pelvis or femur
• Second most common
• Primarily occurs in young adults 30-5- y/o
• Large, bulky, slow growing that affect adults – men more frequently than women
• Usual Tumor sites:
o Pelvis
o Ribs
o Femur
o Humerus
o Spine
o Scapula
o Tibia

• Metastasis to lung occurs fewer than half

• Tumors well differentiated, large because excision or amputation affected extremity results
in increased survival rates
• Tumors may reoccur

CLINICAL MANIFESTATIONS – CONDROSARCOMA

• Localized Pain - Swelling
• Child may awake at night due to pain
• Unilateral and not related to any activity
• Look at Hx of trauma

Physical Findings
• Bony Tenderness or mild joint stiffness
• Rarely demonstrate instability
• Normal NV Exams
• Limitation of motion
• Weight loss – considered ominous findings
• May be palpable, tender, fixed
• Increased skin temp over mass and venous distention
• Pathological Fractures are common

DIAGNOSTIC TEST / FINDINGS

• Radiography – May notice changes
• Bone Biopsy – Gives diagnosis
• CT and MRI to look for metastasis
• Alkaline Phosphatase – May be elevated

TREATMENT
• Large Block resection or radical surgical amputation
• Chemo is not generally used
• Increased dose of radiation is used
EWING SARCOMA
• Rare – Round cell bone tumor
• Body involvement
• Arises in marrow spaces of bone – small cells
• Principal sites of origin are shafts of long bones (femur, tibia, fibula, humerus, ulnar) trunk bones
(vertebra, scapula, ribs, pelvis) and skull
• Occurs almost exclusively in individuals < 30 y/o with most occurrences between 4-25 y/o
• 10-30 y/o males more common
• Later relapse up to 10 years

CLINICAL MANIFESTATIONS
• Localized Pain - Swelling
• Child may awake at night due to pain
• Unilateral and not related to any activity
• Look at Hx of trauma
Physical Findings
• Bony Tenderness or mild joint stiffness
• Rarely demonstrate instability
• Normal NV Exams
• Limitation of motion
• Weight loss – considered ominous findings
• May be palpable, tender, fixed
• Increased skin temp over mass and venous distention
• Pathological Fractures are common

DIAGNOSTIC TEST / FINDINGS

• Will be more systemic
• WBC – Leukocytosis ELEVATED
• ESR – Erythrocyte Sed Rate will also be ELEVATED
• Radiography
• Surgical Biopsy
• Bone marrow aspiration

THERAPEUTIC MANAGEMENT OF EWING SARCOMA

• Surgical excision with PRE and POST op CHEMO
o Because of the high risk of spreading
• Widely used drug regimen
o Vinsristine Actinomycin D Cyclophosparnide
o Ifosphamide VP-16 Adrinamycin

NURSING CONSIDERATIONS
• Educate family about deletenious effects on irradiated site
o Severely affected growth, function, appearance
• Educate / Prepare regarding various diagnostic tests: Bone aspiration, Surgical Biopsy
o Adequate explanation of treatment regimen
• High-dose radiotherapy  skin reaction of dry or moist desquamation followed by
hyperpigmentation
• Child to wear loose-fitting clothes over irradiated area to minimize additional skin irritation
• Protect area from sunlight, sudden changes in temp – avoid using heating pads or ice
• Use extremity as tolerated