- 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
- The 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
Osteosarcoma
- Aggressive malignant tumour
- Mesenchymal origin
- Aka osteogenic sarcoma
- The most common histological form of bone sarcomas
- The 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% of 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.
Follow-Up
- Regular Surveillance:
- Physical exams and imaging to detect recurrences or metastases.
- Rehabilitation:
- Physical therapy for functional recovery post-treatment.