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Kufe DW, Pollock RE, Weichselbaum RR, et al., editors. Holland-Frei Cancer Medicine. 6th edition. Hamilton (ON): BC Decker; 2003.
Holland-Frei Cancer Medicine. 6th edition.
Show detailsPrimary bone tumors are uncommon. Approximately 2,400 malignant neoplasms of the bones and joints are diagnosed annually in the United States, accounting for 0.18% of all cancer cases. An estimated 1,300 patients die from these cancers each year, representing 0.24% of all deaths from Cancer. Osteomyelitis in children, trauma in midlife, and metastatic carcinoma are considerably more common and are often confused for primary skeletal neoplasia. On the other hand, primary bone tumors are not so rare as to be unimportant and, at least, some knowledge of them is essential for an oncologist.
Bone tumors can be benign or malignant. The behavior of benign bone tumors can vary considerably from being self-limited and healing spontaneously (eg, unicameral bone cyst, nonossifying fibroma, osteoid osteoma), to inactive but persistent (eg, enchondroma, osteochondroma), to minimally locally aggressive (eg, aneurysmal bone cyst, chondroblastoma, chondromyxofibroma), to very locally aggressive (eg, giant cell tumor of bone, osteoblastoma). The treatment of benign bone tumors depends on their growth behavior. Often the behavior of an individual tumor in a specific patient will need to be determined before the proper treatment is chosen. Most primary malignant bone tumors should be surgically resected. Myeloma and lymphoma of bone are exceptions. These two conditions will be mentioned briefly in this chapter but are dealt with in more detail elsewhere in the text. Patients with a primary malignant bone tumor that has a high prevalence of micrometastatic disease at presentation (eg, classic osteosarcoma, Ewing sarcoma) should be treated with adjuvant chemotherapy. During the past decade adjuvant chemotherapy has been given both before, so-called neoadjuvant chemotherapy and after surgery. Irradiation for bone tumors is routine for myeloma and lymphoma but otherwise is a secondary treatment option used when an adequate surgical resection would produce unacceptable morbidity or is not technically possible.
Bone tumors arise from the mesenchymal cells normally present in the skeleton. The classification of these tumors is defined by the assumed cell of origin based on the histologic examination. Often it is the matrix of the tumor that indicates the cell type. Therefore, tumors that have a matrix of bone have “osteo” in their name and are believed to have arisen from cells in the osteoblast cell line (eg, osteoid osteoma, osteoblastoma, osteosarcoma). Those with a cartilage matrix have “chondro” in their name and are believed to have arisen from cells in the chondroblast cell line (eg, enchondroma, osteochondroma, chondroblastoma, chondrosarcoma). In addition to these two obvious tumor groupings there are tumors with a fibrous matrix (eg, nonossifying fibroma, fibrosarcoma, malignant fibrous histiocytoma), a vascular origin (eg, hemangioma, hemangioendothelioma, hemangiopericytoma), and those without a particular matrix (eg, unicameral bone cyst, aneurysmal bone cyst, giant cell tumor of bone, Ewing sarcoma). Those bone tumors that arise from the marrow elements (eg, Langerhans cell histiocytosis, myeloma, lymphoma) are usually not considered classic primary bone tumors and their behavior is sufficiently different that their consideration with primary bone tumors is not necessary. They are included in the differential diagnosis with the more classic primary bone tumors, however, and must be considered in any discussion of bone tumors.
This chapter will offer the reader an introductory understanding of the common bone tumors and their current treatments.
Contents
- Staging
- Biopsy
- Surgery
- Chemotherapy
- Radiation therapy
- Specific bone tumors
- References
- Bone Tumors - Holland-Frei Cancer MedicineBone Tumors - Holland-Frei Cancer Medicine
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