2 BONE CANCER Bone cancer is an uncommon cancer that begins in a bone. most commonly affects the long bones that make up the arms and legs20 % of pediatric bone tumors are malignant.66% of adult bone tumors are malignant, most commonly mets.The most common type of bone cancer in adults is metastatic cancer from other organs
4 BONE CANCER PRIMARY : cancer arising from the bone itself. SECONDARY : i.e. metastasis
5 PRIMARY BONE CANCER RISK FACTORS: Radiotherapy & chemotherapy Paget's diseaseFamily Hx : hereditary retinoblastomaPaget's disease; frequently familial, of older persons in which bone resorption and formation are both increased,rarely diagnosed in people less than 40 years of age.
6 Signs & symptoms Bone pain that often is nocturnal Swelling & tenderness near the affected areaPathological fracturesFatigueUnintended weight lossFeverNight sweats
7 OSTEOSARCOMA The most common primary bone malignancy Incidence: 2.8 per millionAge years (the 8th most common form of childhood cancer)M >FThe most common sites are;Distal femur 52%Proximal tibia 20%Proximal humerus 9%
8 OSTEOSARCOMA (continued) Usually the lesions are metaphysealStrong genetic predisposition (chr. 13)Metastatic spread usually is pulmonary
9 Diagnosis Radiological studies : 1. X-Ray 2. CT-scan 3. bone scan & MRI.Bone biopsy.Bone biopsy.the only definitive method to determine whether a tumor is malignant or benign.
10 X-ray findings 1.Lesion 2.Cortical destruction 3.Extension to the marrow or soft tissue4.Codman’s triangle5.Sunburst Effect
16 PrognosisAggressive tumor & The prognosis depends on the stage not the grade.Without mets the 5-year survival is 70%If mets present the 5- year survival is 25%
17 Ewing’s sarcoma Identified in 1921 by James Ewing The second most common bone malignancy in pediatrics.Incidence : 0.6 per millionM>FAge yearsThe usual sites are : pelvis , long bones of the limbs & ribs , but most commonly around the knee joint.
21 Frontal radiograph and lateral radiographs of the femur New bone formation may extend along the shaft, forming fusiform layers of bone surrounding the lesion, giving rise to an "Onion-peel" appearance.(white arrows).There is sunburst periosteal reaction (red circle)osteolytic lesion (blue circle)