bubble_chart Overview

Bone tumors are not merely lumps that grow on the "bone." They include masses and tumor-like lesions occurring in all the accessory tissues of the skeleton, such as bone marrow, periosteum, cartilage, blood vessels, muscles, nerve fibers, and fat. For example, conditions like "fibrous dysplasia" and "bone cysts" are not true tumors, but their manifestations and treatments resemble those of bone tumors, leading them to be termed tumor-like lesions. Bone tumors can be classified as benign or malignant, but sometimes there is no clear boundary between the two. Even within the same tumor, benign and malignant histological features may coexist. To further clarify the diagnosis, microscopic pathological findings must be combined with clinical context and X-ray manifestations for comprehensive analysis, as all three are indispensable. The incidence of bone tumors in the population is approximately 0.01%. Among bone tumors: benign cases account for 50%, malignant for 40%, and tumor-like lesions for about 10%. Common benign bone tumors include giant cell tumor of bone, osteochondroma, and chondroma; malignant bone tumors are more frequently osteosarcoma, chondrosarcoma, and fibrosarcoma. Since bone tissue originates from mesodermal tissue, malignant tumors occurring in bone tissue are referred to by doctors as "sarcomas" and cannot be termed "bone cancer." Bone tumors most commonly occur in the femur and tibia, such as osteosarcoma, giant cell tumor of bone, and osteochondroma. Tumors of the trunk are less common, such as metastatic tumors, multiple myeloma, and chondrosarcoma. Chordomas are specific to the spine, particularly the sacrum, while chondromas often occur in the bones of the hands and feet.

Bone tumors are more prevalent in males, especially conditions like multiple myeloma and chordoma, with a male-to-female ratio of approximately 1.5:1. In terms of age distribution, there are two peak periods: the first peak is between 10-20 years old, and the second peak occurs in adulthood, primarily involving metastatic bone tumors. Half of primary malignant bone tumor cases occur in individuals aged 10-20, with osteosarcoma patients accounting for two-thirds of this age group, indicating that malignant bone tumors are more common in adolescents and pose significant harm. Generally, the younger the age, the higher the malignancy of the bone tumor. Due to the lack of major breakthroughs in treatment, the prognosis remains poor.

bubble_chart Diagnosis

1. Pain: The main manifestation of bone tumors, but the severity varies. Some experience only mild soreness or discomfort; some recall past mild pain only after discovering the tumor; others mistake it for wind-dampness-like pain, unrelated to treatment, and it persists even at rest; some suffer severe pain, presenting as continuous dull pain or stabbing pain, requiring painkillers. Benign tumors cause mild pain and progress slowly. Malignant tumors cause intense pain, which is progressive and affects eating and sleep.
2. Mass: In the early stages, the tumor is located within the bone. As the tumor grows, bone expansion becomes increasingly evident. Once the tumor breaks through the bone, it forms a soft tissue mass. The mass often appears simultaneously with pain, though sometimes it is the first noticeable symptom. Since the tumor originates from the bone, it is immobile. Benign bone tumors grow slowly, remain small, and the overlying and surrounding skin appears normal. Malignant bone tumors grow rapidly, with reddened, warm skin and engorged subcutaneous veins.
3. Loss of function: Pain or the mass may impair movement of the affected limb. For example, tumors in the upper humerus can restrict shoulder joint mobility, while spinal tumors may limit spinal movement, causing stiffness or scoliosis.
4. Deformity: Tumor growth causes bone expansion and distortion, weakening structural integrity. Continued weight-bearing gradually leads to bending deformities, such as coxa vara or genu varum/valgum. Severe multiple osteochondroma can stunt growth and cause deformities in developing children.
5. Nerve compression: Craniofacial tumors may compress cranial nerves; tumors near the first rib can compress the brachial plexus; spinal tumors may lead to limb paralysis.
6. Pathological fracture: Tumor growth within the bone makes it susceptible to fractures from minor trauma or daily activities. Often, the bone tumor is discovered only after a fracture occurs.

bubble_chart Treatment Measures

For bone tumors, as with other tumors, efforts should be made to achieve early detection and early diagnosis to facilitate timely treatment. Currently, the primary treatment for bone tumors remains surgery, supplemented by radiotherapy, interventional therapy, chemotherapy, traditional Chinese medicine, and immunotherapy. For benign bone tumors and tumor-like lesions, surgery is the main approach, with attention paid to preserving limb function. Some bone tumors begin as benign but have the potential for malignant transformation. For example, simple curettage and bone grafting often lead to recurrence and may induce malignancy, as seen in Grade I giant cell tumors of bone, which also carry a risk of malignant transformation. Therefore, in principle, giant cell tumors of bone should be treated with segmental resection. For malignant bone tumors, the priority is saving lives while striving to preserve function. Treatment should involve a comprehensive approach, including surgery, radiotherapy, chemotherapy, interventional therapy, traditional Chinese medicine, and immunotherapy. In the past, malignant bone tumors in the limbs often required amputation, but the current trend favors limb-sparing surgery. Limb bone tumors have independent arteries and veins, allowing for regional arterial and venous perfusion chemotherapy via interventional methods, which offers higher efficacy and fewer side effects compared to systemic chemotherapy.

bubble_chart Prognosis

Many bone tumors, like other tumors, show no abnormal symptoms in their early stages, and the affected individuals are completely unaware, making early detection very difficult. This requires everyone to remain vigilant, and parents should regularly observe and inquire about their children's development. When adolescents suddenly experience unexplained pain around the knee joint, they should promptly visit a specialized hospital for an X-ray to rule out bone tumors. Do not let inexperienced doctors treat it as Bi disease and delay the condition. When adolescents exhibit symptoms of acute osteomyelitis such as fever, limb pain, and leukocytosis, the possibility of Ewing's fleshy tumor and osteosarcoma should be excluded. If swelling, lumps, pain, or tenderness occur in the limbs, especially near the joints, the possibility of synovial fleshy tumor should be considered first. Do not hastily attribute it to arthritis or fibroma; instead, further biopsy should be performed for a definitive diagnosis. Elderly individuals experiencing back pain or limb pain with progressive worsening should be alert to the possibility of metastatic bone tumors. For benign bone tumors that have been clearly diagnosed, if the growth rate accelerates or pain intensifies, prompt medical attention is needed to rule out malignant transformation. For patients highly suspected of having malignant bone tumors but not confirmed by ordinary X-rays, further examinations such as radionuclide bone scanning (ECT), computed tomography (CT), and magnetic resonance imaging (MRI) should be conducted. These methods can detect the condition 3-6 months earlier than ordinary X-ray diagnosis.