Find out what symptoms accompany osteosarcoma

Osteosarcoma is a life-threatening tumor that develops in osteoblasts, the cells that form bone tissue. Such neoplasms are called malignant because they grow uncontrollably, destroy surrounding tissues and affect organs located far from the main focus of the disease.

How does osteosarcoma develop?

Oncology begins with the appearance of just one altered cell in the body. It occurs due to exposure to radiation, various diseases, hereditary characteristics or random failures. Most of these cells are destroyed by the immune system - it identifies and destroys them, but some manage to hide from the attention of our natural defenses or resist it. They develop and create many copies of themselves, which gradually turn into a new formation. Their dangerous properties do not end there. Unlike normal cells, which are born, work and die in a strictly defined place, tumor cells multiply uncontrollably and grow into the surrounding tissues. Over time, they enter the bloodstream and lymphatic system. The lymphatic system complements the cardiovascular system. The lymph circulating in it - the intercellular fluid - washes all the cells of the body and delivers the necessary substances to them, taking away waste. In the lymph nodes, which act as “filters,” dangerous substances are neutralized and removed from the body. systems, through their vessels spread to other parts of the body and create metastases in them - new foci of the disease.

Most of these tumors develop in the bones located next to the knee - the lower part of the femur and the upper part of the tibia. They often occur near the shoulder joints and are quite rare in other areas, including the pelvis, hip, spine and jaw.

Signs of bone sarcomas

Diagnosing bone sarcomas at the initial stage of development is extremely difficult. Specialists and patients often mistake dull pain in the joints for inflammatory processes or the consequences of injuries, and are in no hurry to conduct a thorough diagnosis. As the tumor grows, the tissue above it becomes swollen, with a pronounced vascular network.

The joint becomes inactive, contracture develops and a pronounced limitation of physical activity occurs; patients often take a forced position of the body. The tumor itself, when palpated, can be painful and inactive. The local temperature of the pathological focus is often elevated. The pain tends to get worse at night.

Among young patients, the following are common: osteoscarcoma, Ewing's sarcoma, and malignant fibrous histiocytoma. At a more mature age, the following types of bone sarcomas are diagnosed: chondrosarcoma, malignant fibrous histiocytoma, fibrosarcoma. As a rule, such neoplasms metastasize to the lungs, bones and liver.

Methods for diagnosing bone sarcomas:

• X-ray examination;
• tumor puncture with morphological examination of tissues;
• computer, magnetic resonance imaging;
• positron emission tomography scintigraphy.

What parents need to pay attention to

Early symptoms:

Pain

The first significant symptom is increasing pain in the affected limb. After some time, the pain becomes unbearable, depriving sleep, it can appear both during exercise and at rest and is not relieved by conventional analgesics.

Swelling

The affected part of the bone increases in volume, the soft tissues above it become swollen, and phlebectasias (a network of small dilated veins) appear on the skin.

Impaired function of the affected limb. Restricted mobility in a nearby joint

When osteogenic sarcoma is localized in the bones of the lower extremities, movements in the joints become difficult, and lameness develops over time. A late symptom of this disease may include a pathological fracture in the area of ​​the primary lesion.

The main problem of late diagnosis of osteogenic sarcoma is due to the fact that for a long time local pain is associated with a previous injury to the limb. But at the same time, the severity and duration of pain symptoms are not compared with the extent of the injury.

Unfortunately, pain in the extremities in children and adolescents often goes unnoticed or underestimated and is associated primarily with “growing pains,” as a result of which the child receives long-term analgesic therapy without effect.

The duration of the pain syndrome, its pronounced nature, not correlated with previous traumatic changes, is always a reason for an expanded diagnostic search.

Features of treatment of bone sarcomas

With the development of modern medicine, significant breakthroughs have been achieved in the treatment of sarcomas. Today, many patients have access to organ-preserving surgical treatment methods, as well as combined methods, including radiation therapy and chemotherapy drugs (cytostatics). Many bone tumors are sensitive to cytostatics and are treated quite successfully with their use. If you seek medical help in a timely manner and carry out effective treatment, the prognosis is generally favorable.

Osteosarcoma

Osteosarcoma is a malignant neoplasm that affects the human skeletal system and rapidly develops with the formation of multiple metastases. The tumor occurs mainly among young people. Sarcoma originates mainly in the metaphysis - the section of long tubular bones adjacent to the epiphyseal plate. The tendency to early metastasis makes this disease extremely malignant and dangerous.

The majority of patients with osteosarcoma are young men under 25-30 years of age. A surge in the disease is observed during puberty and accelerated skeletal growth. The tubular bones of the lower extremities are affected several times more often than the upper ones. As a rule, the pathological focus covers the femur, humerus or tibia.

Reasons for the development of osteosarcoma

Doctors do not know exactly the reasons why some people develop this type of cancer - they only know about the factors that can lead to the occurrence of this event. These include:

• Radiation
  . Patients who have undergone radiation therapy to treat cancer or other conditions are at particular risk, especially if the exposure was given in high doses at a young age.
• Diseases
  of various
  areas of the skeleton
  : Hereditary multiple osteochondromas are benign, that is, non-life-threatening tumors that develop in bones and cartilage.
• Fibrous dysplasia is when cells create too much scar tissue to replace bone.
• Paget's disease of bone is the formation of altered tissue that causes the affected bones to become heavier and thicker, but weak and susceptible to fracture.

Signs of progression

Like all malignant bone tumors, osteosarcoma is diagnosed quite late. Many people (and doctors too) mistake dull, sudden pain in the joints for signs of an inflammatory process (myositis) or echoes of an injury received several months ago. In fact, it is osteosarcoma that progresses, taking over more and more healthy bone tissue.

As the disease progresses, more noticeable signs of pathology begin to appear: - the appearance of a tumor and characteristic effusion in the joint; - increased pain; - pain of the pathological focus upon palpation; - decreased activity, lameness, restrictions in movement (joint contracture); - tumor growth into muscles; - formation of metastases, spread of malignant cells through the bloodstream to the lungs and brain; - swelling, redness of the tumor, the appearance of a pronounced vascular network on its surface.

If you seek medical help at the first pathological signs, undergo a routine x-ray examination, and be vigilant, then subsequent treatment will be more effective. Often, osteosarcoma is diagnosed in the later stages of development, when metastases are detected in many organs and tissues, but even in this case, well-chosen treatment can save a person’s life and health.

What is osteosarcoma?

Bones contain several types of cells. Osteoblasts are responsible for the formation of the foundation of bones, namely connective tissue and inorganic substances (minerals) that provide bone strength.

Osteoclasts help regulate the level of inorganic substances in the blood, influencing the deposition and removal of these substances from the bones, which allows the bones to maintain the necessary shape. Bone marrow, found in some bones, contains fat and, most importantly, hematopoietic cells that produce various blood cells.

There are flat and long tubular bones. Flat bones help protect the brain and organs of the chest, abdomen, and pelvis from injury. For example, the bones of the skull and sternum are flat bones, while the bones of the upper and lower extremities are long tubular bones.

Osteosarcoma is the most common bone tumor.

Like other malignant tumors, osteosarcoma can spread to nearby tissue (muscle, tendons, fatty tissue), as well as through the bloodstream to other bones, lungs and other internal organs. This process is called metastasis.

Most often, osteosarcoma occurs at the ends of long bones, especially in the area of ​​the knee joints. 80% of osteosarcomas in children and adolescents develop in these areas. The second most common location for osteosarcomas is the upper humerus. However, osteosarcoma can occur in any bone, including the pelvis and jaw.

Not all malignant bone tumors are osteosarcomas. Ewing's sarcoma is the second most common malignant tumor in children and adolescents. Other tumors are usually found in adults and very rarely in children. These include chondrosarcoma, which arises from cartilage, and malignant fibrous histiocytoma.

Benign bone tumors include osteomas, chondromas, osteochondromas, eosinophilic granulomas, fibromas, xanthomas, giant cell tumors, and lymphangiomas.

There are several subtypes of osteosarcoma with different prognosis of the disease.

Osteosarcomas are classified into low, intermediate and high grades of malignancy.

Among high-grade osteosarcomas, osteoblastic, chondroblastic, fibroblastic, mixed, small cell and telangiectatic variants are found.

The periosteal variant refers to osteosarcomas of intermediate malignancy, while the paraosteal and intramedullary variants refer to osteosarcomas of low malignancy.

The degree of malignancy of osteosarcomas determines the prognosis of the disease.

Thus, after complete removal of low-grade osteosarcoma, chemotherapy is usually not required and the outcome of the disease is favorable.

For high-grade osteosarcomas, both surgery and chemotherapy are necessary. The outcome of the disease in patients with intermediate-grade osteosarcomas is variable.

Most osteosarcomas in children are high-grade tumors.

Diagnostic methods

The initial stage of osteosarcoma has practically no symptoms. The patient may experience minor aching pain in the joint, but there are almost never external signs of the disease (swelling, redness, small dilated veins). The absence of pronounced symptoms misleads both patients and doctors themselves.

Often, when visiting hospitals and clinics, people with osteosarcomas begin to undergo anti-inflammatory therapy. Some of the prescribed techniques may not only be ineffective, but also dangerous. For example, warming physiotherapeutic procedures can accelerate the growth of tumor cells. The patient should be interested in the prescribed treatment and insist on a high-quality and more detailed diagnosis. Especially in cases where the doctor, due to lack of time or for some other reason, does not strive to get to the bottom of the truth and find the true cause of the patient’s poor health.

Common diagnostic methods used for osteosarcoma include the following:

• radiography: the most accessible diagnostic method for all malignant bone tumors;
• tissue biopsy, tumor histology;
• laboratory examination of blood parameters: in patients with osteosarcoma, some indicators are elevated (lactate dehydrogenase, alkaline phosphatase);
• computed tomography: allows you to detect metastases, but, as a rule, the smallest of them are never detected;
• skeletal scintigraphy;
• arteriography.

If questionable results of the study are obtained, it is recommended to carry out a number of additional diagnostic procedures. A thorough examination is necessary to select the correct treatment tactics and predict the outcome of the disease.

Symptoms and manifestations of bone cancer

A characteristic manifestation of malignant bone formation of any location is constant, aching pain, disturbing for several weeks or months, not eliminated by analgesics and increasing over time.

For a long time, patients associate the appearance of pain with a former injury, so they do not consult a doctor and this becomes the reason for a late diagnosis. Pain from bone tumors does not depend on physical activity and bothers patients even at rest. Sarcoma is characterized by pain that worsens at night and relief does not occur in any position of the limb. Symptoms of osteosarcoma also include swelling of the tissue in the area of ​​the tumor. But local swelling appears later - at first it is a deeply located tumor in the soft tissues, and then the swelling area increases, the affected area swells, and a venous network appears on the skin, sometimes the skin turns red.

When joints are affected, swelling appears in their area. Cancer of the knee joint or any other joint disrupts the function of the joints - they bend poorly and movement is limited. Movements are impaired not only when there is a tumor in the joint, but also in the nearest joint when the bone is damaged. A tumor of the joints changes their shape. In some cases, effusion appears in the joint cavity.

Photo of osteosarcoma of the knee joint

Bone cancer is accompanied by fragility, so patients often experience spontaneous fractures due to minor trauma. When the tumor process affects the spine, difficulties appear when walking, weakness in the limbs, and paretic phenomena. A tumor of the leg bones is accompanied by numbness of the limb and lameness. Symptoms of advanced bone sarcoma include abdominal pain, nausea and vomiting, which is associated with increased levels of calcium in the blood ( hypercalcemia ) due to bone breakdown. In the advanced stage, general symptoms are also noted - fatigue and weight loss. The appearance of general symptoms indicates a process with metastasis.

Symptoms of jaw cancer

Osteosarcoma that occurs in the thickness of the jaw is called central, and that developing in the peripheral parts is called peripheral. For a long time, signs of bone cancer do not appear. Then pain appears that is not associated with tooth pathology. Long-lasting pain should alert the patient. The tumor process can be recognized using radiography and MRI. With a tumor formation in the lower or upper jaw, pain in the teeth occurs for no reason and radiates to the ear and eye. It gets worse at night and becomes unbearable, forcing patients to wake up and take painkillers.

Palpation of a tumor in any part of the jaw is painful. In addition, osteogenic sarcoma of the jaw changes the sensitivity of the trigeminal nerve and causes changes in tooth position. The teeth within the tumor become mobile. paresthesia and anesthesia occurs (Vincent's symptom).

Photo of sarcoma of the lower jaw

As the jaw grows, it becomes deformed. The tumor quickly grows, spreads to the surrounding tissues and compresses them, causing exophthalmos and congestion in the soft tissues. Lymph nodes are often not enlarged. The mucous membrane of the alveolar process at the site of the tumor is red and swollen, and when the mucous membrane is injured, ulcers appear on the gums. In some cases, osteosarcoma festeres (the temperature rises, weakness and malaise appear).

Features of treatment of patients with osteosarcomas

High-quality treatment of osteosarcoma should be carried out in a special oncology department, in a clinic specializing in providing medical care to patients with bone tumors. Treatment tactics are selected strictly on an individual basis, taking into account the stage of the disease, tumor size, patient’s age and other characteristics.

As a rule, the choice of doctors when treating patients with sarcomas is complex treatment, including surgical removal of the tumor, radiation and drug therapy. A course of chemotherapy is usually given before surgery. The use of modern chemotherapy drugs makes it possible to reduce the size of osteosarcoma and destroy micrometastases that were not detected during diagnosis.

During the operation, the entire pathological focus is removed, including healthy tissue. Until recently, patients with osteosarcomas underwent amputation. Today, the possibilities of surgery make it possible to eliminate tumors while preserving a limb, replacing part of the bone with an endoprosthesis made of metal, plastic, or the patient’s own bone tissue. Currently, amputations are carried out only for special indications (for large tumor sizes, often relapsing course of the disease). In addition to resection of the tumor focus, operations are performed to remove distant metastases from the lungs and resection of lymphatic vessels affected by the oncological process.

After surgery, chemotherapy is given. A repeated course of using cytostatics allows you to completely destroy all the smallest metastases in the body. Thanks to the active use of new generation combination drugs, it is possible to avoid many complications that usually occur after chemotherapy treatment. In rare cases, radiation therapy is also used.

Treatment of osteosarcoma

Fighting tumors, whose cells multiply uncontrollably and spread throughout the body, is not an easy task. One, even the most experienced doctor, cannot cope with it - to defeat such neoplasms, the participation of several specialists is necessary.

We have such a team of professionals in our field at Lapino-2. All interventions in our center are prescribed by decision of a council, which includes candidates and doctors of science with extensive experience in the field of diagnosis and therapy of oncology. Working together allows us to avoid mistakes, obtain maximum information about the patient’s condition and select the most appropriate treatment regimens for tumors. We carry out any treatment for osteosarcoma, work with the most modern equipment and use only original drugs that give predictable results. Our doctors and medical staff value your time - we have no queues, and all procedures are performed without delays.

To combat this type of dangerous tumors, three main methods are used:

• Surgery
  is an important part of the treatment for most cases of the disease. The main goal of the intervention is complete removal of the cancer focus. Even a small number of altered cells remaining in the body can lead to the re-development of the tumor. To reduce such risks, specialists remove not only the osteosarcoma, but also the healthy, normal tissue surrounding it, which is sent to the laboratory and studied under a microscope. The doctor performing the operation faces a difficult task - he needs to preserve the nearby tendons, nerves and blood vessels. In such cases, part of the damaged bone is replaced with a graft obtained from a donor or an artificial device made of metal or other materials. If the disease has damaged a large number of important structures, the best option may be amputation - complete or partial removal of the affected limb.
• Chemotherapy
  is the use of special drugs that destroy cancer cells. They are injected into the vein, spread throughout the body through the bloodstream and act in all areas of the body. In most cases, this treatment is given before surgery for about 10 weeks. In some patients, such substances reduce the size of the tumor and facilitate its removal. Chemotherapy is then re-administered for up to a year to destroy the remaining foci of the disease.
• Radiation therapy
  is the destruction of damaged cells using radioactive particles or radiation. This procedure is usually used when it is impossible to completely surgically remove the tumor, relapse - re-development of the tumor, to destroy the abnormal cells remaining after surgery, slow the growth of osteosarcoma and control its symptoms.

Prognosis for treatment for osteosarcoma

The prognosis for osteosarcoma can vary depending on the size of the tumor, the stage at which surgery was performed, the results of chemotherapy, and the age of the patient. With properly organized treatment and timely assistance, the survival rate is quite high - 70%.

The success of treatment depends on the quality of tumor resection and all detected metastases, as well as on the results of chemotherapy. In many clinics in Europe, care for patients with sarcomas is provided at a very high level, and similar conditions are organized in large oncology centers in Russia. A special role is given to primary diagnosis, since time is almost priceless for people with sarcomas.

Hip cancer

The main symptom of this disease is severe pain.

Moreover, the area where pain is felt depends on the location of the tumor.

Severe pain in the buttock or thigh indicates that the tumor is located near the lumbosacral spine.

The appearance of pain in the hip joint indicates the presence of a tumor in it.

In addition, pain increases over time as the focus of cancer cells increases.

And, conversely, the small size of the malignant formation causes pain that is still weak.

Ewing's sarcoma and PNET

Ewing sarcoma and peripheral primitive neuroectodermal tumors (PNET) belong to a large group of closely related tumors that grow in bones and soft tissues and are characterized by an unfavorable course.

This group of malignant neoplasms can affect patients of working age. According to long-term observations, the average age of patients does not exceed 25-30 years. Tumors of this type are most often diagnosed in childhood and adolescence, mainly in males. In 1921, Ewing's sarcoma was discovered by James Ewing, an American oncologist and pathologist.

Over many years of studying these oncological tumors, scientists have come to the conclusion that they are neurogenic in nature and must belong to the same family. Ewing's sarcoma and primitive neuroectodermal tumors have similar molecular genetic features. Neoplasms grow very quickly, are difficult to diagnose early, and almost always give metastases during the period of their detection. Because of this aggressive spread, they are considered the most dangerous tumors affecting the skeletal system.

But modern medicine has made a huge breakthrough in improving methods for diagnosing and treating cancer of this type. Patients with malignant bone tumors, if they seek professional help in a timely manner, today receive highly effective complex treatment that eliminates the pathological focus, metastases and prevents relapses of the disease.

Causes of development of bone PNET and Ewing's sarcoma

Despite the persistent research work carried out by scientists regarding a family of tumors similar to Ewing's sarcoma, the exact cause of the appearance of these tumors could not be determined. But today there are a number of predisposing factors to the development of these diseases:

• hereditary factor: it has been noted that people with gene mutations or cases of sarcomas in the family are more likely than others to suffer from PNET and Ewing's sarcoma;
• race: according to statistics, malignant bone tumors most often affect people of the Caucasian race, mainly males (boys suffer from Ewing's sarcoma twice as often as girls);
• benign bone tumors;
• young age (5-30 years);
• traumatic factor: a connection between bone injuries and the development of sarcomas can be traced, but it has not been confirmed;
• X-ray examination: X-ray diagnostics is the main method for detecting pathological foci in bone tissue;
• computed tomography, magnetic resonance imaging: allow you to determine the stage of development of sarcoma, the exact location of the tumor, the degree of damage to tissues and blood vessels;
• tumor histology: this method cannot be considered as the main one, since the results of a biopsy of other tumors may coincide with the results of a histological examination of Ewing’s sarcoma;
• laboratory tests: in the presence of sarcomas, pronounced leukocytosis, increased ESR and lactate dehydrogenase levels are observed;
• bone marrow biopsy;
• scintigraphy: the use of radiopharmaceuticals to detect bone pathologies;
• ultrasound diagnostics;
• molecular genetic diagnostics.

Tests and diagnostics

• X-ray of the affected area in two projections. X-ray examination covers the entire affected bone and joints nearby. This is necessary in order not to lose sight of the “step-by-step” metastases. With osteosarcoma, the x-ray picture may be different. A large tumor node with unclear outlines. The cortex and medulla of the bone are affected. The tumor destroys the periosteum, often revealing a “cloud-shaped” component, which is associated with uneven ossification of the tumor. In the newly formed bone, osteosclerotic and osteolytic (sparse) areas alternate. However, areas of bone change become visible on x-ray when the tumor grows to a certain size. Therefore, to avoid diagnostic errors, you need to use MRI and CT.
• MRI and CT provide layer-by-layer visualization of bone, bone marrow, soft tissue and connective tissue. They are carried out with contrast. These methods clarify the size of the lesion, the exact location and spread of the tumor beyond the bone.
• To detect distant metastases, a CT scan of the chest and abdominal pelvis is performed. Chest X-ray also reveals metastases in the lungs.
• To identify lesions in other bones, skeletal scintigraphy (radionuclide scanning) is prescribed.
• The main method to confirm the disease is a biopsy and histological examination of the obtained material. The patient's bone tissue is collected and the type of tumor is determined. Tissue collection is carried out by excision of the bone, which makes it possible to obtain sufficient material. If the lymph nodes are enlarged, a biopsy (puncture) is also performed.
• Histological examination. To make a diagnosis, detection of neoplastic tissue (osteoid) is mandatory. The amount of osteoid is not important because it is different in different fields of view. Osteoid is produced by tumor cells and may be found adjacent to or surrounding the cells.
• Angiography. Detects vascular damage.
• Molecular genetic diagnostics. It determines the presence of mutations in the genome. This is necessary to determine the need for targeted therapy (biological).

Specific markers for osteosarcoma are currently unknown. Sometimes patients are prescribed a CEA test. Let's find out how necessary this is. Carcinoembryonic antigen , what is it? This is a tissue marker of cancer. What does this marker show? This type of protein is detected in minute quantities in a healthy person, but during the oncological process its level increases.

Determination of this antigen is used to diagnose the following tumors:

• colon and rectum;
• stomach;
• mammary gland;
• pancreas;
• lungs;
• metastases to the liver and bones (the sensitivity of the method in the metastatic process is much lower).

This test is not specific for malignant tumors, since an increase in antigen is observed in inflammatory and autoimmune diseases, benign tumors (intestines, liver, pancreas), liver cirrhosis , hepatitis , Crohn's disease , tuberculosis , pneumonia , cystic fibrosis . During a malignant process, the level increases throughout the entire period of the disease. CEA analysis is used to monitor the effectiveness of treatment of malignant neoplasms. A decrease in its level during the course of treatment indicates a positive result. The norm of carcinoembryonic antigen for non-smokers: 0-3.8 ng/ml, the norm for women who smoke is slightly higher than 0-5.5. A negative result does not exclude cancer.

Methods for diagnosing Ewing's sarcoma and PNET

- FISH (fluorescent in situ hybridization) method: determination of translocation between certain chromosomes with identification of gene changes and synthesis of the EWS/FLI1 protein, which occurs only in patients with Ewing sarcoma;

— polymerase chain reaction (PCR): the method allows you to repeatedly copy a certain section of DNA, detecting the slightest changes in genes.

- angiography.

Diagnosing sarcoma can be quite difficult for a primary care doctor. In city clinics and provincial hospitals, this disease is often mistaken for a common inflammatory process, bruise or sprain, without prescribing an initial X-ray diagnosis. As a result of this, the treatment regimen chosen is completely incorrect, and some methods of therapy can even aggravate the patient’s condition and contribute to the progression of the disease.

Bone sarcoma

Malignant skeletal neoplasms are a condition in which atypical cells appear in the bone, which have the ability to grow and divide uncontrollably.

Primary bone tumors are among the rarest human tumors and account for only 1% of all cancers. More often, metastatic bone damage occurs in other malignant diseases, such as breast cancer, lung cancer, etc.

Photo: Osteoscintigraphy for metastatic lesions of skeletal bones

The most common subtypes of bone tumors are osteogenic sarcomas, Ewing family sarcomas, and chondrosarcomas.

Sarcoma (lat. sarcoma; from ancient Greek σάρξ - “flesh”, “meat” + lat. ōma - “tumor”) - a group of malignant tumors of connective tissue: bone, cartilage, muscle, fat, walls of blood and lymph vessels , nerves, etc.

Photo: Rg for osteogenic sarcoma of the femur

Photo: Osteogenic sarcoma, pathological specimen

Approximately 50% of bone sarcomas are diagnosed before the age of 35, with the main incidence peaks in the second and third decades of life.

Currently, at least 70 subtypes of this disease have been described. This determines the fact that diagnosis and treatment of such a rare pathology should only be carried out in specialized reference oncology centers.

In addition, making a diagnosis requires the coordinated work of a multidisciplinary team: clinicians, radiologists and pathologists.

Photo: Discussion of a clinical case at a meeting of the multidisciplinary team of the N.N. Petrov National Medical Research Center of Oncology

Photo: Multidisciplinary approach in the treatment and diagnosis of patients with bone cancer

Diagnosis of this pathology consists of several stages. The first is the collection of anamnesis and disease history during a clinical examination by an oncologist. Then, various radiation imaging methods are performed: radiography, ultrasound, computed tomography and magnetic resonance imaging, scintigraphy, and sometimes proton emission tomography.

Photo: MRI osteogenic sarcoma of the lower third of the left femur

Photo: CTchondrosarcoma of the acetabulum of the right ilium

Photo: X-ray of the pelvic bones. Osteogenic sarcoma of the ischium

Performing only one visualization method does not allow a sufficient assessment of this pathology; for example, radiography and computed tomography allow a detailed assessment of changes in bone tissue, however, due to the specific optical properties, they do not provide a complete picture of the soft tissue structures and distribution along the bone marrow canal, which requires magnetic resonance imaging. resonance tomography. The spread of the disease as a whole can be assessed by the use of various radionuclide diagnostic methods - bone scintigraphy, SPECT and PET computed tomography.

After analyzing the data obtained, a decision is made on the advisability of performing a biopsy of the tumor.

Photo: MRI of the knee joint. The relationship of the neoplasm with blood vessels is shown

Biopsy (from ancient Greek βίος - life + ὄψις - appearance) is a research method in which intravital sampling of cells or tissues (biopsy) of a tumor is carried out from the body for diagnostic purposes. Without a morphological diagnosis (microscopic assessment of tumor tissue), it is impossible to make a clinical diagnosis, and therefore, prescribe treatment.

Photo: device for trephine biopsy

Photo: bone biopsy needle

Photo: Trephine biopsy of a tumor under ultrasound navigation

In order to diagnose a bone tumor, it is recommended to use a trephine biopsy (with the help of a special device and a biopsy needle, columns of tumor tissue are collected through a puncture of the skin and surrounding tissue) and incisional biopsy (a fragment of the tumor is removed through an incision in the skin and surrounding tissue). When performing a trephine biopsy, various navigation methods are used: ultrasound, radiography, computed tomography.

Photo: Trephine biopsy of a tumor under CT navigation

When performing a biopsy, as with any invasive procedure, there are certain health risks that should be discussed with your doctor.

The resulting biopsy material (tumor tissue) is sent for histological examination.

Photo: Biopsy material

The morphological picture of various bone and soft tissue tumors may be similar. Only a comparison of clinical, morphological (including immunohistochemical), as well as data from radiation imaging methods allows a full assessment of the tumor process to make a correct clinical diagnosis.

The main method of treating bone tumors is surgical, but it is not always the only one and is used at the first stage. For certain tumor subtypes, the required first line of treatment is chemotherapy, radiation therapy, or a combination of both. The cornerstone in choosing treatment tactics is the morphological subtype of the tumor, thus, correct diagnosis = correct treatment.

Currently accepted treatment tactics for patients with localized osteosarcoma involve combined treatment, which includes:

• chemotherapy in preparation for surgery;
• surgical intervention;
• postoperative chemotherapy.

Surgery alone is not advisable, because in 80-90% of cases, local relapses and metastases in the lungs are detected within 1.5 years after it. As part of complex treatment, chemotherapy significantly increases 5-year survival rates in patients with localized pathology - from 20% to 60%.

The main advantages of preoperative chemotherapy are:

• the ability to assess how active chemotherapy drugs are;
• facilitating surgery.

Before surgery, 2 to 4 cycles of chemotherapy are usually given. If a pronounced tumor response to therapy is obtained - tumor necrosis of 90% or more - then there is a high probability of increasing overall and relapse-free survival.

The next stage is surgery. First of all, it is necessary to consider the possibility of organ-preserving interventions. The use of modular endoprosthetics systems is the most relevant and modern method of treating bone sarcomas. However, this type of treatment should be carried out only in specialized large oncology hospitals, where there is a team of orthopedic oncologists, experience in endoprosthetics for bone cancer, well-developed methods of revision endoprosthetics and special innovative equipment, as well as high-tech surgical instruments.

In recent years, 3D printing technologies have become increasingly popular. This means that, based on the data obtained from radiological diagnostics, 3D modeling of the operation is performed and the prosthesis is manufactured individually for each patient.

Photo: 3D modeling of surgery

Photo: Endoprosthetics for chondrosarcoma of the iliac body

Chemotherapy after surgery is determined by how much the disease has changed under the influence of drugs at the preoperative stage. If there was 90% necrosis of the neoplasm, then after surgery 4 courses of chemotherapy with the same cytostatics are indicated. If the degree of necrosis is less, then the duration of treatment will be approximately 1 year using alternating regimens that include 5-6 cytostatics.

Ewing family sarcomas are rare neoplasms, predominantly of young people. They have increased sensitivity to radiation and chemotherapy and require an integrated approach to therapy, which should be carried out in specialized medical centers. It is recommended to include skeletal bone scintigraphy as well as trephine biopsy of the bone marrow in the standard diagnostic algorithm for primary neoplasms, because there is a high incidence of metastases in the bones and bone marrow.

After a thorough examination and biopsy, 4-6 cycles of induction chemotherapy are given over 12-24 weeks. After this, a local treatment method is applied - radiation or radical surgery - and then 6-10 cycles of chemotherapy are prescribed with an interval of 3 weeks. Duration of treatment – ​​1 year.

Radical surgery, if possible, is the best option for local control.

Radiation therapy is prescribed if radical surgery is not possible, and is also discussed if a histological examination of the removed material reveals an insufficient response to treatment, that is, more than 10% of viable tumor cells are detected.

Non-radical surgery followed by radiation is as effective as simple radiation therapy. It is carried out in doses of 40-45 Gy in the presence of microscopic residual tumors and 50-60 Gy if macroscopic changes are present.

An important stage in the treatment of patients with primary bone tumors is rehabilitation. It allows you to improve the quality of life both after organ-preserving and after mutilating surgical interventions, and accelerates the socialization of the patient.

Those who have completed the combination therapy phase are recommended to be monitored over time every 3 months for the first 2 years, and then every 6 months until 5 years. Mandatory procedures are ultrasound of the postoperative scar area and CT scan of the chest. The purpose of this observation is early detection of relapse and earlier initiation of chemotherapy and surgical treatment of those metastases that can be resected and recurrent tumors, as well as the prevention of orthopedic complications and detection of endoprosthesis instability, also in the early stages.

Additionally, radiography of the area of ​​bone lesion is recommended for patients with osteosarcoma.

Patients with Ewing's sarcoma are recommended to additionally undergo ultrasound examination of the abdominal cavity and peripheral lymph nodes.

Clinical picture

Ewing's sarcoma and primitive neuroectodermal tumors can develop in any bone, affecting the surrounding soft tissue. Almost half of Ewing's sarcomas affect the lower extremities and pelvic region. Often the bones of the upper extremities are also involved in the pathological process. PNETs most often affect the bones and soft tissues of the chest, lungs, mediastinal organs and pleura.

The main sign of pathology is pain. At first, the pain is mild and may spontaneously weaken or even disappear for a while. But as the cancer process develops, the pain progresses and becomes more noticeable. All patients with bone sarcoma note swelling in the area of ​​development of the tumor process. The swelling gradually affects the surrounding articular surfaces, causing impaired mobility of the joint and the limb as a whole.

During palpation, the area of ​​edema is painful, characterized by severe hyperemia, an increase in the vascular pattern and pastosity, and is hot to the touch. There is a moderate increase in lymph nodes. If a tumor develops in the pelvic area, then dysfunction of the internal organs of this area may occur (fecal incontinence, urinary incontinence, paralysis). The pain tends to intensify at night, and often cannot be relieved by traditional methods. As tumor cells increase, the load on the bones increases, which can result in fractures.

Some patients at the time of diagnosis of the disease note signs of intoxication: patients complain of weakness, weight loss, and a slight increase in body temperature. Tumors of this family tend to metastasize very quickly to the lungs, bone marrow, and bones.

Many patients do not seek medical help when pain and swelling occur, as they attribute these symptoms to minor inflammation that develops after an injury or illness. Due to late diagnosis of the tumor, before effective treatment measures are taken, severe metastasis already develops, as a result of which treatment of Ewing sarcoma and PNET is often ineffective. It is extremely important to promptly contact doctors as soon as early signs of pathology appear.

Sarcomas should be treated only in specialized clinics that have modern diagnostic equipment and experience in managing patients with similar diseases. Modern medicine, alas, is imperfect, many doctors are incompetent, and delay in this case is simply unacceptable. Patients with sarcomas need treatment from real professionals.

The most important thing is diagnosis and timely treatment. Insist on being examined, even if the doctor does not see the need for it. The patient is an active participant in the treatment process. Many specialists have long recognized this fact and are successfully implementing it into their modern practice.

Classification

The most common malignant bone tumors are:

• osteogenic sarcoma;
• Ewing's sarcoma;
• chondrosarcoma;
• fibrosarcoma;
• parosteal sarcoma;
• fibrous histiocytoma;
• lymphosarcoma.

Bone sarcoma

The most common tumor develops from osteoblasts and in the process of neoplasm develops altered, atypical bone. This tumor is called differently - synonyms are osteogenic sarcoma, osteosarcoma, osteoidsarcoma, osteoblastosarcoma. Chondrosarcoma and fibrosarcoma are distinguished as independent forms.

Classic osteosarcoma is a highly malignant intraosseous tumor. If a tumor appears in an unchanged bone, it is a primary sarcoma; if it develops after irradiation or against the background of Paget’s disease , it is a secondary sarcoma. The tumor affects the metaphysis (growth zone) of the tubular bone of the arm or leg. Active growth processes occur in the metaphyses, so they are associated with a high risk of tumor transformation. The appearance of a tumor is associated with the rapid growth of bone tissue.

The peak incidence is observed in children aged 10-14 years. They are more likely to affect the tubular bones of the leg - osteosarcoma of the femur in the hip joint, as well as the bones of the knee joint (femur and tibia). When the femur is affected, a large lesion zone of 5-10 cm is revealed. Hemorrhages , necrosis and cystic cavities are found in the newly formed bone. The tumor gradually destroys the periosteum. Sarcoma of the hip occurs at any age, but is more common in young men.

It is characterized by aggressive growth and metastasizes early. Malignant formation of the knee joint in most cases is a secondary metastatic process and less often - as a primary process. In adults, osteosarcoma affects the spine and maxillofacial bones. This type of tumor rarely develops in the area of ​​the coccyx, shoulder girdle, ulna and humerus. Primary osteosarcoma of the ribs is less common, but secondary (metastatic) tumors predominantly affect the ribs, vertebrae and pelvic bones. Malignant transformation of Paget's disease to sarcoma occurs in 1% of cases and the peak incidence occurs at 60 years of age and older. Of all the bones, the jaw is the most commonly affected. Jaw cancer is a tumor with rapid aggressive growth and early metastases to the lungs (most often). There are isolated cases of metastases to the stomach and soft tissues. Damage to the lower jaw is somewhat more common than to the upper jaw (corresponding to 58% and 42%).

Hand bone cancer in most cases is metastatic. In the bones of the skull there are various types of primary sarcomas, as well as secondary metastatic tumors from the primary focus (uterus and prostate). Skull bone tumors cause headaches due to compression of the brain. Spinal cancer is characterized by active growth and rapid progression. Patients develop movement disorders: when the lumbar region is affected, the lower limbs and the functions of the pelvic and genital organs are affected. Cervical spine cancer is very dangerous and requires immediate treatment. When the cervical vertebrae are damaged, the functions of the arms and legs are affected.

Ewing's sarcoma

This type of tumor occurs in children and adolescents. Develops in bone tissue and soft tissues. It is aggressive and metastasizes quickly. There is a high mortality rate in the first year of diagnosis. If we consider damage to the inert system, then in 70% this type of tumor occurs in tubular bones, flat bones (scapula, ribs) and pelvic bones. Compared to osteosarcoma, the diaphyses of bones are more often affected. Many patients have genetic mutations that cause disruption of cell differentiation processes.

Chondrosarcoma

The neoplasm develops from cartilage tissue. Occurs in people over 40 years of age. The course of this type of cancer is difficult to predict. In some, chondrosarcoma develops slowly, while in others it develops very quickly and metastasizes . This type of tumor affects any bone, but the femur and pelvic bones are predominant. The tumor can also develop in flat bones (scapula, skull, ribs). Most often, the course of chondrosarcomas is slow and metastases appear late. The appearance of pain is characteristic, and when the pelvis is damaged, the nerve roots are involved, therefore, in addition to pain, the function of the pelvic organs will be impaired.

Fibrosarcoma

A rare tumor that develops from connective tissue. Tumor cells are located between the collagen of the connective tissue and look like a spindle. In most cases, fibrosarcoma appears after radiation treatment.

Classification of osteosarcomas according to the TNM system

• T0 - no data on the tumor process.
• T1 - formation no more than 8 cm.
• T2 - neoplasm larger than 8 cm.
• T3—tumor continuity is disrupted.

Involvement of lymph nodes (“N”) is rare, since bones do not have a lymphatic system. But if there are metastases to the nodes, this is a poor prognostic sign. Regional lymph nodes are nodes that correspond to the location of the primary tumor.

• N0 - no metastases in the lymph nodes.
• N1 - metastases are present.

Osteosarcoma is characterized by the development of hematogenous metastases, which in the diagnosis of o. By the time of diagnosis, 20% of patients already have small metastases in the lungs. Metastases can also be in the pleura, pericardium, bones, kidneys, and central nervous system.

• M0 - no distant metastases.
• M1 - distant metastases are present (“a” - to the lungs, “b” - to organs and tissues).

An important point is histological examination, which confirms the diagnosis, determines the type of tumor and its malignancy. There are five forms of osteosarcomas, with different degrees of differentiation.

Metastatic bone lesions

The course of metastatic bone lesions is not asymptomatic - pain is the first manifestation of bone metastases. Most patients describe it as unbearable. Patients with metastases also experience:

• pathological fractures of tubular bones;
• vertebral compression fractures;
• spinal cord compression;
• hypercalcemia.

A quarter of breast cancer have fractures of long bones associated with destruction of the cortical layer. radiation therapy or surgery is required .

Benign bone formations

Bones are affected by benign tumors ( chondroblastoma , fibrous dysplasia , osteoclastoma , aneurysmal cyst and others), with which a malignant formation must be differentiated.

Aneurysmal bone cyst

A benign tumor-like bone lesion, which is characterized by the proliferation of connective tissue. It contains cavities filled with blood. A distinctive feature of this cyst is its spread through the epiphyseal plate, as well as to adjacent bones. The cyst appears at any age, but more often in adolescents and children. Its most common location is the bones of the spine, the distal part of the femur, the proximal part of the humerus and tibia, and the pelvic bones. A secondary cyst is formed after damage to benign chondroblastoma , fibrous dysplasia , giant cell tumor and malignant neoplasms - osteogenic sarcoma .

Chondroblastoma

A benign tumor that forms at the articular ends of a bone. It develops from chondroblasts and resembles mature cartilage tissue. It is characterized by slow growth and a favorable course, but there is information about cases of a malignant course or malignancy by chondroblastoma. Like all bone tumors, it affects children and adolescents, and in rare cases, older people. Clinical manifestations are pain and swelling of the joint. Treatment is surgical. The prognosis is favorable.

Methods for effective treatment of Ewing's sarcoma and neuroectodermal bone tumors

In recent years, methods of treating oncological lesions of the skeletal system have significantly improved, which has a positive effect on the life expectancy of patients and the prognosis of the course of these pathologies. Treatment should be comprehensive, affecting both the tumor itself and the entire body - with the goal of destroying all areas with metastases.

Treatment methods include the following:

• Surgical removal of the pathological focus. During the operation, the femur, pelvic bones, and ribs may be partially removed. The scale of resection depends on the extent of the pathological process. Endoprostheses can be placed in place of the removed bone areas. Today, all surgeons in the world try not to carry out radical interventions that end in limb amputation and disability.
• Radiation therapy. Radiation exposure is carried out repeatedly: before surgery and after surgery. High-quality radiation therapy can effectively combat metastases and prevent relapses of the disease. The radiation dose is selected individually. One course of radiation treatment usually lasts 4-6 weeks.
• Chemotherapy. The introduction of certain chemotherapy drugs into the body (cyclophosphamide, adriamycin, vincristine) helps destroy the smallest metastases, which are very common in sarcoma. Diagnosing them can be difficult, and chemotherapy affects all human organs and tissues, making it possible to fight micrometastasis and slow down tumor growth. Cytostatics are prescribed in courses with breaks of 2-3 weeks between them. If metastases are detected in the bone marrow, the use of large doses of chemotherapy drugs with a stem cell transplant is indicated.

In children

Among all tumors in children, 5% are bone sarcomas : 3% osteosarcoma and 2% Ewing sarcoma . The lack of alertness among doctors and the atypical nature of the course greatly complicate early diagnosis. Osteosarcoma in children in half of the cases is localized in the knee joint (the femur and tibia are affected). In second place is damage to the metadiaphysis of the humerus. The most common symptom of osteosarcoma is constant, dull pain with a gradual increase. Most children have a soft tissue component - swelling and an increase in the volume of the limb. Weight loss and fever at the onset of the disease are rare.

Ewing's sarcoma occurs before the age of 17 years, but the peak incidence occurs between 12 and 15 years of age. Boys are most often affected. Ewing's sarcoma, unlike osteosarcoma, does not synthesize osteoid . Often this tumor is located in the scapula, ribs, vertebrae, pelvic bones, as well as the femur, fibula, and humerus. Unlike osteosarcoma, flat bones are affected. Signs of Ewing's sarcoma are increasing pain, tissue swelling, dysfunction, and fever. The soft tissue component is more pronounced than bone destruction. An increase in local temperature due to the appearance of hemorrhages and necrosis in the tumor complicates diagnosis, since osteomyelitis is suspected. Neurological symptoms are associated with nerve damage.

Combined treatment for Ewing's sarcoma:

• Chemotherapy courses (standard drugs for this pathology).
• Surgery (similar to osteosarcoma).
• Radiation therapy. It is carried out on the area of ​​the primary tumor and on distant metastases.

Survival Prognosis for Patients

The prognosis for Ewing's sarcoma and neuroectodermal neoplasms is quite unfavorable. The outcome of treatment depends on the stage of the disease at which the patient seeks medical help and the degree of spread of the tumor process. Patients with metastases in the lungs have a better chance of recovery than patients with evidence of metastases in the bone marrow or bones. If the tumor is detected in a timely manner, when it has not yet had time to disseminate, then the chances of a complete recovery are quite high - up to 70%.

Modern chemotherapy drugs do not have as severe side effects as before. During chemotherapy and radiation treatment, most complications can be avoided. But the success of therapy also depends on the patient himself. It is very important for the patient to understand that sarcoma is not a death sentence. The capabilities of modern medicine make it possible today to overcome almost any disease. If you do not create obstacles to treatment, follow all medical recommendations, look for the best doctors and believe in your own recovery, then the disease will recede.

Time is very important. If even the slightest signs of illness appear, it is necessary to carry out a diagnosis. Having discovered a tumor, doctors will do everything possible to destroy the pathological process. The patient needs to mobilize, tune in to long-term treatment, accept the support of his family and think only about the best.

Staging of osteosarcoma

Staging means determining the extent of the process.

In principle, osteosarcomas are divided into localized and metastatic .

With localized osteosarcoma, only the bone and adjacent tissues, including muscles, tendons, etc., are affected.

In the case of metastatic osteosarcoma, there is multiple damage to the bones and lungs (85%). In addition, the brain and other internal organs may be involved.

Patients with metastases have a worse prognosis than patients with localized disease. However, in the case of surgical removal of metastases and chemotherapy, the prognosis improves.

Chondrosarcoma

Chondrosarcoma is a type of malignant tumor that affects cartilage tissue. The disease is quite common, accounting for up to 10-15% of all bone tumors. It is diagnosed in people of all ages, but more than 60% of patients belong to the mature age group (after 40 years). In 15% of patients with chondrosarcomas, the tumor develops secondarily from osteochondral exostoses, chondromas, and deforming osteosis.

It has been noted that chondrosarcoma most often affects the bones of the pelvis, upper limbs and ribs. Men get sick slightly more often than women. The etiology of the disease is not completely clear. Predisposing factors include gene mutations, the presence of certain hereditary pathologies, and carcinogenic effects on the human body.

Consequences and complications

The course of the disease itself is complicated by fractures and infection of soft tissues. All bone cancers after treatment have consequences:

• Secondary cancer , which develops as a result of exposure to radiation.
• Chronic heart failure (exposure to doxorubicin ).
• Osteoporosis.
• Hearing and vision impairments.
• Renal dysfunction and renal failure .
• Endocrinopathies.
• Impaired fertility ( infertility ). Reproductive functions suffer after chemotherapy with alkylating drugs ( Ifosfamide , Carboplatin , Cyclophosphamide ) and after the use of radiotherapy in the pelvis, abdomen, and spine. Menstrual irregularities are always observed after high-dose chemotherapy and stem cell transplantation.
• The consequences of the operation are significant - after amputation, limb prosthetics and long-term rehabilitation are necessary.

Signs of chondrosarcoma

Chondrosarcoma is characterized by an asymptomatic gradual course. At the initial stage of development, there are no pathological signs. As the tumor grows, pain begins to occur in the area where the chondrosarcoma is located. If it is located near the joint, then in the clinical picture of the disease there are signs of limited movement.

If the tumor begins to compress the sciatic nerve (if localized in the thigh area), then the pain changes from minor to unbearable. The skin above the tumor becomes swollen; the tumor itself, which has reached a significant size, can be easily palpated. In 15% of patients, fast-growing chondrosarcomas are found, prone to accelerated growth and rapid malignancy.

Causes of sarcoma of the pelvic bone

• the dynamics of sarcoma development are often associated with rapid bone growth, that is, the tumor occurs where parts of the skeleton grow faster;
• The onset of the disease is often detected if the patient has suffered some kind of trauma. Upon examination, it turns out that the area is damaged by cancer cells;
• sarcoma of the hip bone appears under the influence of an external factor - ionizing radiation;
• If the patient has previously been diagnosed with benign tumors, this increases the risk of osteosarcoma.

Methods for diagnosing chondrosarcoma

The capabilities of modern medicine make it possible to detect bone tumors already at the initial stage of development. But since chondrosarcoma is rarely detected at an early stage of growth, diagnosis can be delayed. Many patients and doctors mistake pain, inflammation and other early signs of the disease for arthrosis, bursitis, injuries and are in no hurry to conduct a detailed examination. And the outcome of treatment and the further prognosis of the disease largely depend on the timeliness of diagnosis.

Among the modern and popular diagnostic methods for chondrosarcoma are the following:

• X-ray examination: the images reveal foci of destruction with areas of calcification, the tumor itself and signs of its growth into soft tissues;
• osteoscintigraphy;
• magnetic resonance, computed tomography;
• biopsy of tumor tissue with further study under a microscope.

Patients with chondrosarcomas should be examined in large diagnostic centers that have modern technical equipment and a professional staff of specialists who know the technique of decoding the diagnostic results obtained.

Central chondrosarcomas often have intraosseous areas of destruction. On x-rays, characteristic calcifications are diagnosed with such neoplasms. Areas of calcification are often diagnosed along the edges of the neoplasm.

Diagnostics

The primary methods of examination are: examination of the patient, history taking and x-ray examination. Computed tomography will provide more accurate data, helping to determine the type of tumor, its location and size, as well as the extent of its spread.

Additional studies: general blood and urine analysis, blood biochemistry, ECG. For differential diagnosis, magnetic resonance imaging and PET are used.

The decisive analysis is histological examination of the tumor biopsy.

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Treatment options for chondrosarcomas

In the early stages of tumor development, radiation treatment with surgical excision of chondrosarcoma is used. If the disease has a high risk of malignancy, then minimally invasive operations have to be abandoned and complete amputation must be performed. Partial bone removal with subsequent plastic surgery is appropriate only if long-term tumors that are not prone to malignancy and metastasis are detected.

Chondrosarcoma cells are quite resistant to radiation exposure (especially at later stages of development) and chemotherapy. Therefore, these methods are perceived not as the main ones, but as auxiliary methods for the treatment of chondrosarcomas. The main emphasis is on complete surgical excision of the pathological focus and metastases. When a tumor grows in the pelvic bones and humerus, it is sometimes necessary to perform extensive surgery to remove half of the pelvis and amputate the entire upper limb. But in any case, doctors try to perform organ-preserving operations if the situation and clinical picture allow it.

Disease of the young

Like many cancers, osteosarcoma begins gradually. Initially, a person is bothered by itchy, vague pain that occurs near the joint, to which the patients themselves, and in some cases doctors, do not attach much importance.

The sad truth is often revealed too late, when the parts of the bone tissue affected by the tumor increase in volume, and the pain becomes sharp and unbearable (especially at night).

The low oncological alertness towards osteosarcoma can be partly explained by the relative rarity of this disease, which occurs in 1 in 100 thousand adults and in 5-6 out of 100 thousand children, mainly in adolescents 14-15 years old, which many experts associate with rapid growth and hormonal changes in the body.

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Forecast

The prognosis for recovery of patients with chondrosarcomas is quite favorable. It directly depends on the timeliness of treatment, the degree of malignancy of the tumor and the quality of the operation performed. Treatment of chondrosarcomas requires considerable professionalism from doctors. Therefore, when choosing a clinic, you should give preference to specialized institutions with considerable experience in treating bone tumors and an individual approach to each individual patient.

After successful surgical intervention, more than 25% of patients live for 5 years or more. To prevent recurrence of the pathology, such patients are recommended to undergo regular diagnostics and preventive examinations.

Prevention

There is no specific prevention. However, you can perform non-specific activities:

• Observation and treatment of precancerous diseases of the skeletal system. Processes that tend to become malignant include chondroma, fibrous degeneration, Paget's disease, and osteochondral exostoses. The malignancy rate of these benign formations reaches 15%. It is important to undergo follow-up examinations annually to detect malignancy at an early stage. Healthy lifestyle. Balanced diet. Avoiding injuries and occupational hazards.

Secondary relapse prevention includes:

• The use of drugs that restore the immune system after chemotherapy and radiation therapy .
• Complete nutrition, rich in vitamins, antioxidants, proteins.
• Rejection of bad habits.
• Prevention of viral infections.
• Preventive examinations with an oncologist. Local relapses can be detected visually. It is important to have examinations during the first 4 years. After this, local relapses are rare.
• Carrying out diagnostic procedures according to the protocol. Metastases develop in 95% of cases within the first 5 years and most often affect the lungs. Bone metastases present with pain, and they appear simultaneously with pulmonary metastases.