bubble_chart Overview

Introduction to Bone Cancer (Bone Cancer-Related Information) Like other organs, the skeletal system can develop tumors originating from any tissue component or metastases from other organs. Tumors affecting the bones may arise from bone cells, hematopoietic components of the bone, cartilage, as well as fibrous or synovial membrane components. Other tumors may originate from the musculoskeletal system's muscles, nerves, blood vessels, and adipose tissue.

bubble_chart Etiology

The disease cause of bone tumors remains unclear to this day. In the past, it was believed that injuries, especially chronic minor injuries, and chronic infections could all lead to bone tumors. In recent years, experimental studies have been conducted. For example, Fujinaga used Harvey and Moloney's fleshy tumor virus to create a large number of mouse osteosarcoma models. Finkel used different types of isotopes and viruses to produce osteosarcoma animal models. Others have used radioactive substances such as radium and strontium to create osteosarcoma animal models. These disease causes have been confirmed by many scholars. The age of onset for bone tumors is 15–24 years for males and 5–14 years for females, which may be related to the timing and duration of bone growth and endocrine development in different genders.

The pathological types of bone cancer include multiple myeloma, osteogenic fleshy tumor, chondrosarcoma, fibrous fleshy tumor, and Ewing's fleshy tumor. However, the most common malignant bone tumor lesions are cancers that have metastasized to the bones, particularly in the spine and pelvis.

bubble_chart Clinical Manifestations

1. General symptoms are similar to those of other cancer patients, including decreased appetite, weight loss, fever, etc.
2. Pain in the affected area, with localized lumps and swelling in the joints and limbs.
3. Movement of the affected joints and limbs is restricted.
4. Ulceration of the skin in the affected area.
5. Numbness in the distal part of the affected limb due to compression of nerves and blood vessels.
6. Pathological fracture or deformity may occur.
7. The most typical symptom of bone cancer is bone pain, especially if the pain is more noticeable at night than during the day, which requires special attention.

bubble_chart Diagnosis

The diagnosis of bone tumors primarily involves distinguishing between benign, low-grade malignant, and highly malignant types, which is closely related to the patient's age, gender, and the location of the tumor. Therefore, early and accurate diagnosis, as well as optimal treatment outcomes, rely on the collaboration of four key parties: the patient, the orthopedic surgeon, the radiologist, and the pathologist.

Tumors arising from various tissues within the skeletal system, such as bone, cartilage, fibrous tissue, adipose tissue, hematopoietic system, nerve tissue, and undifferentiated reticuloendothelial structures, are classified as primary bone tumors. Metastatic tumors formed in bone tissue through direct infiltration, hematogenous spread, or lymphatic system metastasis are considered secondary bone tumors. In addition to the distinction between benign and malignant bone tumors, there are also lesions within bone tissue whose nature as true bone tumors remains uncertain, such as fibrous dysplasia of bone, solitary bone cysts, eosinophilic granuloma of bone, and bone lipid metabolism disorders. These are referred to as tumor-like lesions (bone tumor-like lesions).

A detailed medical history, physical examination, laboratory tests, and X-ray imaging can provide valuable diagnostic evidence. For example, the age of onset in the medical history has certain diagnostic reference value. The location of the lesion observed during physical examination and on X-ray images also holds diagnostic significance.

X-ray manifestations are highly variable, so they should not be relied upon solely for diagnosis.

Although histopathological examination is a decisive diagnostic method, it is not absolutely reliable. Misdiagnosis can occur due to various factors, such as significant morphological differences in tumor tissue during different stages of development, inadequate or non-representative sampling, and technical shortcomings in specimen preparation, all of which can complicate pathological diagnosis.

Therefore, most scholars agree with Jaffe's proposed tripartite approach—combining clinical, radiological, and pathological perspectives—as highly accurate. A definitive diagnosis can only be made through careful and collaborative discussion among physicians from these three disciplines.

bubble_chart Treatment Measures

Tumor resection or curettage with simultaneous bone grafting can cure the patient. For those with spinal involvement, decompression plus radiotherapy is sometimes required. Postoperative recurrence occasionally necessitates a second surgery. The tumor may exhibit local invasiveness, potentially transforming into osteosarcoma and metastasizing to the lungs.

Despite the availability of chemotherapy, amputation remains an urgent treatment measure in osteosarcoma management. Advances in effective chemotherapeutic agents will lead to reforms in long-standing treatment protocols, particularly changes in the timing and level of amputation, as well as modifications to radiation sites and dose considerations.

The United States currently employs selective amputation methods. In British literature, approximately one-third of patients undergo amputation initially, while the majority are treated using the Cade method—where amputation is reserved for those with survival prospects, specifically patients showing no lung metastases within six months after radiotherapy (radiation dose of 80Gy). Historical statistics indicate similar survival rates between primary and secondary amputations. Some argue that early amputation and tumor removal carry risks of local recurrence, whereas the Cade method avoids unnecessary amputations in patients facing imminent death. However, making such determinations is often challenging.

In recent years, the debate between amputation and limb-preserving surgery has intensified. Most studies suggest comparable two-year survival rates for both approaches, making limb-preserving procedures preferable for patients despite their high cost.

bubble_chart Prognosis

The outcome of bone cancer treatment is related to factors such as cell morphology, differentiation, and the host effects of each tumor.

If the bone cancer is located in the limb bones, the treatment results should be better than those in the trunk bones, as it is easier to detect, has slower metastasis, and is more treatable.

Due to medical advancements and the collaboration among patients, surgeons, radiologists, and pathologists, the five-year survival rate for treated malignant bone cancer has improved from 15-20% to 60-70%.

For unexplained bone pain, possible causes should be investigated promptly, and the possibility of bone cancer should not be overlooked. If detected and treated early, losing a hand or leg to amputation is not regrettable—losing a precious life is what truly matters. Moreover, with the continuous advancement of prosthetic and rehabilitation technology, prosthetics can still accompany you in leading a happy life.