in section Oncology
Primary malignant tumors of bone are relatively rare and affect mainly children in the second decade of life, when the disease reaches to 3 100 thousand. Population. At the age of 30 years, the incidence rate is less than on 0,3 100 000. More than half of all cases of malignant bone tumors account for osteogenic sarcoma. Further, the frequency of the disease followed by Ewing's sarcoma, chondrosarcoma and clasmocytoma. Fibrosarcoma, parostalnnaya sarcoma and other histological forms are much rarer.
Neoplasms of the bone and divided into two groups: tumors that develop from the supporting tissue (osteosarcoma, chondrosarcoma, angiosarcoma, fibrosarcoma, miosarkoma) and tumors developing from bone marrow elements (Ewing's sarcoma, reticulosarcoma, lymphosarcoma, multiple myeloma).
Bone sarcomas occur more frequently in the long bones of the lower limbs and particularly common in the proximal metaphysis of the tibia and fibula, distal femoral metaphysis (t. E. In the area of the knee joint). The defeat of the flat bones is less common tumor of the sternum and clavicle are very rare.
Clinic malignant bone tumors Begins with blunt, dragging pains of an intermittent nature. The pains gradually increase, become permanent. At this time, usually determined dense, motionless, painful in palpation and not having clear boundaries of the tumor, which is located in the area where there were pain. Very often, local symptoms are accompanied by general symptoms, typical of which are weakness, malaise, fever to 39-40, leukocytosis, elevated ESR. When examined, there is local hyperemia and skin hyperthermia over the tumor, an expansion of the subcutaneous veins. The disease often occurs cyclically. The clinical picture depends little on the histological structure of malignant bone tumors. In this case, the features of diagnosis and treatment are very closely related to the type of sarcoma.
Diagnosis of osteogenic sarcoma is established on the basis of clinical, radiological and morphological studies. There are osteolytic, osteoplastic and mixed varieties. Osteolytic osteogenic sarcoma is characterized by the formation of a foci of destruction with uneven corroded edges in the metaepiphysarpic bone. In the osteoplastic variety there is a diffuse compaction of the bone structure with compulsory concomitant osteoporosis. Between these forms are variants of a mixed type. In most patients with osteogenic sarcoma during 6-8 months from the first signs of the disease, hematogenous metastases in the lungs are revealed.
Ewing's sarcoma occurs predominantly in males between the ages of 10 25 years before, the basic localization - the long bones of the limbs and pelvis. Radiological symptoms include bone loss, increased bone razvoloknenie cortical layer laminate periostoz, detachment of the periosteum as a visor. Symptom bone destruction is most often seen in the form of small focal destruction. Ewing's sarcoma with a high frequency metastasizes to lymph nodes and other bones, lung and liver, kidney, brain and other.
Radiographic manifestations reticulosarcoma bones are similar to symptoms of Ewing's sarcoma. For typical processes petrification chondrosarcoma tumors resulting bone structure is sealed.
The final diagnosis is established on the basis of morphological examination of surgical material, as well as trepanobiopsy, puncture or knife biopsy. In the latter cases, intervention is usually preceded by radiation or chemotherapy.
Treatment of bone cancer
Tactics of treatment malignant bone tumors Primarily depends on the histological structure and the degree of prevalence of the neoplasm. In tumors developing from the supporting tissue (see above), the main method of treatment is surgical. Savings operations in the form of marginal or segmental resection are rarely possible, and such operations can be justified at the earliest stages, when the spread of the tumor is limited by the tubular bone and there is no infiltration of the soft tissues surrounding the cortex. The main method of treatment is amputation or exarticulation of the limb. Amputations are performed outside the affected bones. Exceptions are sarcomas located in the distal femur section, where it is possible to undergo amputation, less traumatic and more profitable in terms of prosthetics. In the presence of distant metastases, the operation is performed only in cases of complicated course of the disease (pathological fracture with intolerable pain, decay with non-occlusive fever, etc.).
Radiation therapy in Schemes radical treatment osteosarcomas often used in the form of preoperative irradiation. This applies high, about 80-100 Gy total focal dose. Irradiation is advisable to combine with radiomodifying effects (hyperthermia, turnstile hypoxia, hyperbaric oxygen therapy). The operational phase is carried out either immediately after irradiation, or through 2-4 months. (During this time may appear distant metastases, making unjustified surgery).
With all the options of radical treatment of the primary tumor to prevent hematogenous metastases chemotherapy is, in which the most commonly used adriamycin, vincristine, cyclophosphamide, sarkolizin, cisplatin, and others. Often, preoperative chemotherapy is carried out by isolated perfusion, in which repeatedly increases the concentration of drug in the tumor tissue. When metastatic osteosarcoma used chemoradiotherapy.
Sarcoma Treatment Ewing has its own distinctive features and usually consists of a combination of irradiation and chemotherapy. The entire affected bone is included in the irradiation zone, and the total doses are of the order of 55-60 Gy. At metaphyseal or epimetaphyseal location of the tumor in children from the irradiation zone, the opposite epiphysis is excluded. In metastases in regional lymph nodes, the whole regional collector is irradiated, the total absorbed doses are adjusted to 28-30 Gy. Irradiation is supplemented with chemotherapy or combined with it. The most common scheme includes adriablastin, vincristine and cyclophosphamide, as well as prednisolone. To surgical treatment of Ewing's sarcoma is extremely rare (relapse after irradiation, radioresistant forms of the tumor, pathological fractures without the hope of consolidation).
The results of treatment depends on the histology of the tumor accessories, degree of differentiation, location and other factors. According to the summary data, 5-year survival after radical treatment is as follows: when osteogenic sarcoma - 10-15%, chondrosarcoma - 30-45%, fibrosarcoma - 20-30%, Ewing's tumor - 5-15%, retikulosarkome - 30- 55%.
В Kiev Center for Fungotherapy, Bioregulation and Ayurveda qualified doctors of alternative medicine are receiving. Cost of consultation 300 UAH. You can look at medical histories and treatment results on this link.
You can make an appointment by phone: (097) 231-74-44, (050) 331-74-44, (063) 187-78-78, +38 (098) 583-85-85 (Viber), +38 (093) 688-25- 88 (WhatsApp, Telegram) Email:This email address is being protected from spambots. You need JavaScript enabled to view it.