Bone Tumour

Bone Tumours in Adolescents: What You Need To Know


  • Bone tumours are a small fraction of childhood tumours/cancers.
  • However, more than 1/3rd of all bone cancers are diagnosed below the age of 30
  • Incidence rate of bone cancer is much lower in older age groups.
  • Due to rapid growth in bones during the adolescent age group, it is more common in this age group.
  • It is more common in boys compared to girls
  • Two common tumours seen in adolescent age groups are:
    • Osteosarcoma
    • Ewing’s Sarcoma


  • Aggressivemalignant tumor
  • Mesenchymal origin
  • Aka osteogenic sarcoma
  • Most common histological form of bone sarcomas
  • Average age of diagnosis is 15 years
  • Signs and symptoms:
    • Pain is the m/c symptom. It can be of varying degrees.
    • Swelling over bone
    • Pathological fractures
  • Occurs at the site of bone growth.
  • Metaphysical tumour of long bones
  • Origin: Knee>hip>shoulder>jaw
  • Xray: Sunburst pattern, Codman triangle

fig: Xray -Sunburst pattern

  • Standard therapy: limb-salvage orthopaedic surgery (whenever possible) or amputation.
  • Chemotherapy is combined with surgery: high-dose methotrexate with leucovorin rescue, intra-arterial cisplatin, adriamycin, BCD (bleomycin, cyclophosphamide, dactinomycin), etoposide, and muramyl tripeptide.
  • Prognosis: poor

Ewing’s Sarcoma

  • Very aggressive tumour
  • Type of small round cell tumour
  • Strong inherited risk factors
  • Diaphyseal tumour
  • Location: pelvis>femur>tibia>humerus
  • Signs and symptoms:
    • Systemic: fever, anaemia, leucocytosis
    • Local: pain, pathological fractures
  • The most common translocation t(11;22)(q24;q12),[24][25]
  • They are aberrant translocation seen in 90% cases.
  • Diagnosis: Small blue round cell tumour seen in HPE
  • Treatment: Multidrug chemotherapy ( vincristine, doxorubicin, cyclophosphamide, ifosfamide, and etoposide)
    • Local disease control: surgery or radiation
  • Prognosis: poor
  • Fig: HPE in Ewings sarcoma

Diagnosis and Evaluation

  • Clinical Assessment:
    • History: Pain, swelling, or restricted movement.
    • Physical Examination: Local tenderness, palpable mass, or reduced range of motion.
  • Imaging Studies:
    • X-ray: Initial screening for bone tumours.
    • MRI: Evaluates the extent of local disease, particularly soft tissue involvement.
    • CT Scan: Detects pulmonary metastases and provides detailed bone imaging.
    • Bone Scan: Assesses multifocal disease.
    • PET-CT: Evaluates metastases.
  • Biopsy:
    • Crucial for a definitive diagnosis.
    • Should be planned carefully to avoid compromising future surgical options.


  • Regular Surveillance:
    • Physical exams and imaging to detect recurrences or metastases.
  • Rehabilitation:
    • Physical therapy for functional recovery post-treatment.