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BONE SARCOMAS.pptx
- 1. BONE SARCOMAS VINAYAK HARIKUMAR RACHEL ISAAC REHANA RAHMAN AQEEL JAFAR JESHMA REJI ANNA VINCENT GOMEZ NISHAL NAZEER
- 2. INTRODUCTION • Cancer can start in any part of any bone. Cancer begins when healthy cells in the bone change and grow out of control, forming a mass called a tumor. A bone tumor can be cancerous or benign. • Malignant bone tumors can be classified as primary (arising from abnormal bone or cartilage cells) or secondary (bone metastases of other tumors). The most common primary bone tumors are osteosarcomas, Ewing sarcomas, and chondrosarcomas. These tumors differ with regard to primary localization, radiographic characteristics, and the patient age at which they usually develop.
- 6. Ewing sarcoma • Highly malignant bone tumor arising from neuroectodermal cells • Some sources suggest that Ewing sarcoma originates from mesenchymal stem cells • Etiology: translocations of the EWSR1 gene (chromosome 22) • Epidemiology • peak at 10–20 years • ♂ > ♀ • primarily affects white individuals • Localization • Primary tumor: often diaphyses of long bones (particularly femur, tibia, fibula, and humerus) and bones of the pelvis
- 7. Diagnostics • Conventional X-ray • Lytic bone lesions • Onion skin appearance of the periosteum • Biopsy • Anaplastic small-blue-round- cell malignancy • Tumor cells resemble lymphocytes. • Differential diagnoses include lymphoma and chronic osteomyelitis. • Chromosomal translocation t(11;22); fusion protein EWS-FLI1
- 9. Osteosarcoma • Definition: malignant, osteoid, and bone-forming tumor arising from mesenchymal stem cells (osteoblasts) • Etiology • Secondary osteosarcoma: Paget disease of bone, radiation injury, bone infarction • Increased incidence in individuals with retinoblastoma and Li-Fraumeni syndrome • Epidemiology • Primary osteosarcoma: in puberty/adolescence (peak incidence age 10-30 years) • Secondary osteosarcoma: advanced age • Sex: ♂ > ♀ • Most common primary bone malignancy • Localization • Primary tumor: metaphyses of long bones (particularly distal femur and proximal tibia)
- 11. Diagnostics • Imaging • Conventional x-ray • Sunburst appearance of lytic bone lesions and/or Codma n triangles • Biopsy • Pleomorphic, malignant osteoblasts th at produce osteoid
- 13. Chondrosarcoma • Definition: a malignant tumor arising from mesenchymal cells that produce cartilage • Epidemiology • Age: usually > 50 years • Localization: most common in the medullary cavity of the pelvis, ribs, proximal femur, and proximal humerus
- 14. Diagnostics • Conventional X-ray or CT • Osteolysis with a moth- eaten appearance • Intralesional calcifications (rings and arcs calcification, popcorn calcification) • Endosteal scalloping; and cortical breach with infiltration of soft tissue • Biopsy • Malignant chondrocytes
- 16. Secondary malignancies of the bone (bone metastasis) • Etiology: lung, breast(common), and prostate cancer • Epidemiology • More common than primary bone tumors • Classification: based on radiological findings • Osteoblastic metastasis • increase in radiographic density • prostate cancer, small cell lung cancer • Osteolytic metastasis • decrease in radiographic density • multiple myeloma • Mixed metastasis: e.g., breast cancer, gastrointestinal cancer
- 17. Diagnosis of secondary bone cancer • Blood tests • You will have a full blood count and your calcium levels will be checked. • X-rays • X-ray scans will be taken of your chest and bones to check for bone damage, the formation of new bone or fractures. • Bone scan • You will have a small amount of radioactive dye injected into a vein that will show any abnormal changes using a scanning machine. • CT or MRI scans • Scans, including three-dimensional imagery, create pictures of your body that help to highlight any bone abnormality. The scans generally take between 30 and 90 minutes. • PET scan • In a positron emission tomography (PET) scan, you will have a small amount of radioactive glucose injected into the body, which highlights any cancerous areas. • Bone biopsy • A biopsy is when some cells and tissues are removed for examination under a microscope.
- 18. Treatment • Secondary bone cancer can’t be cured, but treatment can reduce symptoms and improve quality of life. In some cases, treatment can keep secondary bone cancer under control for many years. • Your treatment options will depend on: • the type of primary cancer, if it is known • the treatment you have already had • how many bones are affected by cancer • whether the cancer has spread to other parts of the body • your symptoms and general health.
- 19. • Hormone therapy • Hormone or endocrine therapy may be used to treat prostate or breast cancer that has spread to the bone. Hormone therapy aims to lower the levels of hormones in the body or to stop hormones reaching cancer cells that need hormones to grow. It can be given as tablets or by injection. • Chemotherapy • Chemotherapy uses drugs to kill cancer cells or slow their growth. The drugs are usually given via an injection into the vein (intravenously) over several hours. Targeted therapy • Targeted therapy uses drugs that attack specific features of cancer cells to stop the cancer growing and spreading. Targeted therapy can only be used to treat cancers that grow in response to certain proteins in our cells. TImmunotherapy • Immunotherapy aims to stimulate the body’s own immune system to attack the cancer most often by using checkpoint inhibitor drugs. Some cancers create ‘checkpoints’ which block the immune system so the checkpoint inhibitors allow the immune system to bypass these checkpoints.
- 20. Surgery • As cancer can weaken a bone and cause fracture, surgery may be used to insert metal rods, plates, screws, wires or pins. You may also have surgery if the cancer is pressing on the spinal cord. • If pathologic fractures have occurred or are likely: stabilize and restore function
- 21. PROGNOSIS • Ewing sarcoma- • Extremely aggressive, early metastases • Usually responsive to chemotherapy • Osteosarcoma- • Aggressive course • Primary osteosarcoma: five-year survival rate of ∼ 70% (usually responsive to treatment) • Secondary osteosarcoma: poor prognosis (less responsive to treatment) • Chondrosarcoma. Almost 70 out of 100 people (almost 70%) survive their cancer for 5 years or more after they are diagnosed. Survival is better for people with chondrosarcoma starting in the arms or legs than for those with chondrosarcoma in the spine (vertebral) and hip (pelvic) bones. • Malignant giant cell tumors of bone--The five-year relative survival rate for a regional malignant giant cell tumor of bone is 74 percent. Patients with distant metastatic giant cell bone tumors have a five- year relative survival rate of 42 percent.
- 22. MCQs • 1.Which of the following is a common primary malignant bone tumor that predominantly affects adolescents and young adults? • A) Osteoarthritis • B) Osteoporosis • C) Ewing sarcoma • D) Rheumatoid arthritis • 2.Which of the following statements is true regarding osteosarcoma? • A) It is a benign tumor of the bone. • B) It primarily affects the soft tissues surrounding the bones. • C) It is most commonly seen in older adults. • D) Osteosarcoma is a malignant tumor arising from bone tissue.
- 23. • 3.Which of the following is a malignant tumor arising from cartilage cells? • A) Osteosarcoma • B) Chondrosarcoma • C) Ewing's sarcoma • D) Liposarcoma • 4.What is the primary source of most secondary bone tumors? • a) Lung • b) Breast • c) Colon • d) Prostate
- 24. • Mr. Johnson, a 45-year-old male, presents to the orthopedic clinic with a gradually increasing pain in his right hip for the past few months. He denies any recent trauma but reports a dull ache that worsens at night. Physical examination reveals limited range of motion in the right hip, and there is tenderness upon palpation over the greater trochanter. An X-ray of the hip is obtained, showing a well-defined lytic lesion with Intralesional calcifications. • Question: Based on the clinical presentation and imaging findings, what is the most likely diagnosis? • a) Osteosarcoma b) Ewing sarcoma c) Chondrosarcoma d) Fibrosarcoma