Bone Tumours in Adolescents: What You Need To Know

• Bone tumours are a small fraction of childhood tumours/cancers.
• However, more than 1/3^rd 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.