RAED ISSOU

BONE CANCER

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

Soft Tissue6% Bone

5% Wilms' Tumor6%

Lymphoma14%

Neuroblastoma7%

Germ Cell3%

Central Nervous System

18%

0%

Other7%

Eye3%

Leukemia31%

Distribution of Common Pediatric Malignancies

BONE CANCERPRIMARY : cancer arising from the bone itself.

SECONDARY : i.e. metastasis

PRIMARY BONE CANCER

RISK FACTORS:1.Radiotherapy & chemotherapy2.Paget's disease 3.Family Hx : hereditary retinoblastoma

Signs & symptoms

Bone pain that often is nocturnal Swelling & tenderness near the affected areaPathological fracturesFatigueUnintended weight lossFeverNight sweats

OSTEOSARCOMA

The most common primary bone malignancy Incidence: 2.8 per million Age 10-25 years (the 8th most common form of childhood

cancer)M >FThe most common sites are;

Distal femur 52% Proximal tibia 20% Proximal humerus 9%

OSTEOSARCOMA (continued)

Usually the lesions are metaphysealStrong genetic predisposition (chr. 13)Metastatic spread usually is pulmonary•

Diagnosis

Radiological studies : 1. X-Ray 2. CT-scan 3. bone scan & MRI. Bone biopsy.

X-ray findings

• 1.Lesion• 2.Cortical destruction• 3.Extension to the marrow or soft tissue• 4.Codman’s triangle• 5.Sunburst Effect

Sunburst Appearance

TREATMENTSurgical resection Preoperative & postoperative chemotherapy

Clinical appearance of a teenager who presented with osteosarcoma of the proximal humerus

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%

Ewing’s sarcoma

Identified in 1921 by James EwingThe second most common bone malignancy in pediatrics.Incidence : 0.6 per millionM>FAge 10-20 yearsThe usual sites are : pelvis , long bones of the limbs &

ribs , but most commonly around the knee joint.

Ewing’s sarcoma (continued)

Usually the lesions are diaphysealT(11.22).Mets are found in 30% of cases, most commonly in the

lungs & other bones & less commonly in the bone marrow.

Diagnosis

Radiological studies: 1.X-Ray 2.CT-scan 3.bone scan & MRI

X-ray findings : 1.lytic medullary lesion 2.onion skin appearance

TREATMENT

1- Local radiotherapy combined with systemic chemotherapy

2- In young children amputation may be necessary due to severe compromise of bone growth

Prognosis

The 5-year survival with the first approach is 50%.

The 5-year survival with the 2nd approach is 75%.

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