1. Adult Medical-Surgical Nursing Musculo-skeletal Module: Bone Tumours

2. Bone Tumours: Classification  Benign  Malignant primary (rare)  Metastases

3.  Benign Bone Tumours

4. Benign Bone Tumours  Osteochondroma: a projection at the end of a long bone (arising at the knee or shoulder)  Enchondroma: hyaline cartilage found in hand, femur, tibia, humerus  Rhabdomyoma (muscle); fibroma (fibrous)  Osteoclastoma (giant cell tumour): may become malignant  Bone cyst

5. Benign Tumours: Pathophysiology  Benign bone tumours have a symmetric controlled growth pattern  Increase pressure on the adjacent bone tissue causing pain and deformity  Occur spontaneously within localised bone tissue  Do not spread to other tissues as malignant tumours (but some benign tumours may become malignant)

6.  Malignant Bone Tumours

7. Primary Malignant Bone Tumours  Sarcoma (malignant growth of connective tissue):  Osteosarcoma is most common (metastasises to lungs)  Chondrosarcoma (hyaline cartilage): slow-growing in adults (femur, humerus, spine, scapula, tibia)  Multiple myeloma (bone marrow)

8. Bone Metastases  Bone metastases are more common than a primary tumour  Malignancy spreads from kidneys, prostate, lung, breast, ovary, thyroid  Metastases found in skull, spine, pelvis, femur, humerus  Often more than one site

9. Malignant Bone Tumours: Pathophysiology  Whether primary or metastatic, malignant tumour cells:  Cause localised bone destruction  May cause reactive bone overgrowth  Invade and destroy adjacent bone tissue  Weaken bone structure  May lead to pathological fracture

10.  Bone Tumours:  Clinical Manifestations

11. Bone Tumours: Clinical Manifestations  Pain: mild or severe  May be disability  May be visible/ palpable bony growth  If spinal tumour, spinal cord compression may occur → neuropathy (paraplegia)  If malignant:  Other disease symptoms: weight loss, fever, malaise. Pathological fracture may occur

12.  Bone Tumours: Diagnosis

13. Diagnosis of Bone Tumours: Xrays and Scans  Patient history and clinical picture  Xray  CT scan  Bone scan  MRI  Biopsy (assists staging of malignant tumour)  Myelography  Arteriography

14. Diagnosis of Bone Tumours: Blood/ Urine Biochemistry  Serum alkaline phosphatase (raised in osteosarcoma)  Serum acid phosphatase (raised if metastases from prostate cancer)  Serum calcium (raised if bone metastases from breast, lung, kidney primary). May lead to symptoms of hypercalcaemia

15.  Management of Benign Bone Tumours

16. Benign Bone Tumours: Management  Surgery to relieve symptoms and restore function  If potential to become malignant treat as primary malignant

17.  Management of Primary Malignant Tumours

18. Primary Malignant Bone Tumours: Management  Aims to destroy or remove the tumour and prevent metastases:  Surgical wide-bloc excision (with restorative grafting)  Amputation may be required  Radiotherapy if radio-sensitive  Chemotherapy pre-op, intra-op and post-operatively to prevent metastases. *Adequate analgesia*

19.  Management of Metastatic Bone Tumours

20. Metastatic Bone Tumours: Management  There is no cure  The aim of management is palliative:  To relieve symptoms  To promote optimum quality of life

21. Metastatic Bone Tumours: Pain Relief  Pain assessment  Drugs: opioids, adjuvant therapy  Radiation therapy:  External beam  Bone-seeking isotopes  Hormonal therapy:  Appropriate where tumour is hormone-dependent  These therapies are used to reduce tumour mass and alleviate pain

22. Metastatic Bone Tumours: Promoting Quality of Life  Stabilisation of weakened bone to prevent pathological fracture  Monitor for and treat hypercalcaemia (from bone destruction)  Monitor effects on bone marrow (blood/ blood products to replace loss)  Prevent wound infection, delayed healing, osteomyelitis: asepsis/ antibiotics/ nutrition

23. Metastatic Bone Tumours: Spiritual/ Emotional Support  Support coping skills, self-esteem  Provide support and access for family members to share their experience  Encourage nutrition, fluids, fresh air, exercise as tolerated, change of scenery  Address spiritual and emotional need appropriately. Respect the patient’s wishes

24. Bone Tumours: Nursing Considerations  According to the type of tumour  Patient education about the condition  Provide support to patient and family  Ensure adequate pain relief and general comfort  Encourage nourishing diet and fluids  Monitor and report any complications