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