Bone Tumors

Definition:
Primary cancers in the bone is called as sarcoma.
Sarcomas arises in cartilage, muscle fibers, fatty
tissues and necrotic tissue
 Causes of bone tumors:
• metastasis from organs like breast, prostate,
GI, Lungs, Kidneys, ovary & thyroid
• Chromosomal mutation (gene abnormality)
• Genetic predisposition
• Exposure to radiation
• Chemicals like benzene etc.
 Types of bone tumors:
Benign:
• Osteo chondroma: occurs in metaphysis portion of the bone
like pelvis, scapula, leg
• Osteoclastoma: arises in the cancellous end
• Endochroma: Occurs in hand & foot bone
Mallignant:
• Osteogenic sarcoma: occurs in bones of arms, legs & pelvis.
• Chondrosarcoma: occurs in cartillageous cells of the bones.
• Ewing’s Sarcoma: occurs in the medullary cavity of large
bones like femur & humerus.
• Chondroma: Occurs in the base of the skull
 Pathophysiology
Metastasis from other sites

Osteolytic response of
the bone osteoblastic response
of the bone
Weakening of bone assymetric growth of
bone
Pathologic fractures Alteration of bone structure

Bone remodelling
 Clinical Manifestations
• Severe pain in the area involved in tumor
• Disability
• Weight loss
• Malaise
• Fever
• Gait changes
• Pathologic fractures
• Irritation of joints
• Exercise difficulties
 Diagnostic findings
• X-Ray- shows osteoblastic and osteolytic changes in the bone
• CT scan/MRI- to identify the extent of bone metastasis
• Nuclear imaging- to locate bone tumors
• Possitron Emission Tomography- to identify metastasis
• Sr. Alkaline phosphatase: (40-270 mg/dl) elevated due to
osteoclastic activity
• Sr. Calcium (9-11 mg/dl)- elevated due to osteoclastic activity
• Surgical biopsy of the bone tissue- sent for histopathological
examination to differentiate the type of tumors.
 Treatment
• Chemotherapy agents like methotrexate,
doxorubicin, bleomycin, ifosfamide, cisplatin
• Pain management- morphine
• Radiation therapy
 Surgical Management

• Limb salvage procedures: this is done by removing

the bone and the adjacent tissue
• Arthroplasty: removal of the affected bone and bone
grafting (replacement of the donor bone ) is done.
• Open reduction & stabilisation: this is done in case of
fractures to stabilise the bone with rods or plates
• Amputation: this is done to remove the affected
bone in case of bone remodelling
 Nursing Management
• Impaired physical mobility related to
osteoblastic activity of the bone:
– Assess the affected area for the patients ability to
perform activity
– Provide extra pillows to support the affected site.
– Do passive and active range of motion &
exercxises
– Advice the patient on the need for chemotherapy
and radiation therapy.
• Pain (joints) related to bone remodelling as
evidenced by patients verbalisation and facial
expression
– Assess the extent, severity and duration of pain
– Provide comfortable supine position and extra pillows to
the legs
– Allow adequate rest periods in between activity
– Administer analgesics like morphine as prescribed by
doctor.
Risk for fractures related to osteoclastic activity of the
bone
-assess the bone by taking X-ray to identify the
weakened area in the bone
-advice the patient to use clutches while walking
-advice the patient to avoid walking in slippery floors.
- advice the patient family members to be with the
patient
• Deficient self care related to pain in the bone due to
osteoblastic activity of the bone:
– Assess the patient’s ability to do self care
– Advice the patient to take adequate periods of rest
– Advice the patient to do active and passive exercises
– Do all the care at the bedside of the patient
– Teach the patient on the need for treatment like
chemotherapy and radiation therapy