Adult Medical-Surgical Nursing Musculo-skeletal Module: Bone Tumours
Bone Tumours: Classification Benign Malignant primary (rare) Metastases
Benign Bone Tumours
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
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)
Malignant Bone Tumours
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)
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
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
Bone Tumours: Clinical Manifestations
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
Bone Tumours: Diagnosis
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
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
Management of Benign Bone Tumours
Benign Bone Tumours: Management Surgery to relieve symptoms and restore function If potential to become malignant treat as primary malignant
Management of Primary Malignant Tumours
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*
Management of Metastatic Bone Tumours
Metastatic Bone Tumours: Management There is no cure The aim of management is palliative: To relieve symptoms To promote optimum quality of life
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
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
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
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