BONE CANCER
RAED ISSOU
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
Distribution of Common Pediatric Malignancies
Soft Tissue
6%
Leukemia
31%
Bone
5%
Wilms' Tumor
6%
Lymphoma
14%
Eye
3%
Other
7%
0%
Central Nervous
System
18%
Neuroblastoma
7%
Germ Cell
3%
BONE CANCER
PRIMARY : cancer arising from the bone itself.
SECONDARY : i.e. metastasis
PRIMARY BONE CANCER
RISK FACTORS:
1. Radiotherapy & chemotherapy
2. Paget's disease
3. Family Hx : hereditary retinoblastoma
Signs & symptoms
Bone pain that often is nocturnal
Swelling & tenderness near the affected area
Pathological fractures
Fatigue
Unintended weight loss
Fever
Night 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 >F
The most common sites are;
 Distal femur 52%
 Proximal tibia 20%
 Proximal humerus 9%
OSTEOSARCOMA (continued)
Usually the lesions are metaphyseal
Strong genetic predisposition (chr. 13)
Metastatic spread usually is pulmonary
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Diagnosis
 Radiological studies :
 1. X-Ray
 2. CT-scan
 3. bone scan & MRI.
 Bone biopsy.
X-ray findings
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1.Lesion
2.Cortical destruction
3.Extension to the marrow or soft tissue
4.Codman’s triangle
5.Sunburst Effect
Sunburst Appearance
TREATMENT
Surgical 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 Ewing
The second most common bone malignancy in pediatrics.
Incidence : 0.6 per million
M>F
Age 10-20 years
The 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 diaphyseal
T(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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