1. BONE CANCER
RAED ISSOU

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 legs
20 % 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

3. Distribution of Common Pediatric Malignancies

4. BONE CANCER PRIMARY : cancer arising from the bone itself.
SECONDARY : i.e. metastasis

5. PRIMARY BONE CANCER RISK FACTORS: Radiotherapy & chemotherapy
Paget's disease
Family Hx : hereditary retinoblastoma
Paget'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 area
Pathological fractures
Fatigue
Unintended weight loss
Fever
Night sweats

7. OSTEOSARCOMA The most common primary bone malignancy
Incidence: 2.8 per million
Age years (the 8th most common form of childhood cancer)
M >F
The most common sites are;
Distal femur 52%
Proximal tibia 20%
Proximal humerus 9%

8. OSTEOSARCOMA (continued)
Usually the lesions are metaphyseal
Strong 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 tissue
4.Codman’s triangle
5.Sunburst Effect

11. Sunburst Appearance

12. TREATMENT
Surgical resection
Preoperative & postoperative chemotherapy

13. Clinical appearance of a teenager who presented with osteosarcoma of the proximal humerus
swelling throughout the deltoid region, as well as the disuse atrophy of the pectoral muscule

16. Prognosis
Aggressive 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 million
M>F
Age years
The usual sites are : pelvis , long bones of the limbs & ribs , but most commonly around the knee joint.

19. Ewing’s sarcoma (continued)
Usually the lesions are diaphyseal
T(11.22).
Mets are found in 30% of cases, most commonly in the lungs & other bones & less commonly in the bone marrow.

20. Diagnosis Radiological studies: 1.X-Ray 2.CT-scan 3.bone scan & MRI
X-ray findings :
1.lytic medullary lesion
2.onion skin appearance

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)

24. TREATMENT
1- Local radiotherapy combined with systemic chemotherapy In young children amputation may be necessary due to severe compromise of bone growth

25. Prognosis The 5-year survival with the first approach is 50%.
The 5-year survival with the 2nd approach is 75%.

26. THANK YOU