Bone Cancer, Diagnosis and Treatment
The majority of bone cancers we see in our practice occur in children and adolescents' growing bones, and not all bone cancers are the same. It is detected by an accident feeling of pain or an extra hardness or growth of the bone felt by the child's mother and taken to the doctor for further evaluation. Rarely, a large growth of the bone which gives a bumpy appearance on the bone brings the patient to the doctor. So basically, just like we have several parts of every organ, there are several parts to a bone, so if you see the long bone, For example, the bone of our thigh, which is otherwise called the femur, has three components. It has got the diaphysis, or the middle of the bone, and it has got the epiphysis, or the tip of the bone, and then you have the bridging part of the epiphysis and the diaphysis, called the metaphysis. The metaphysis is the area where most of the growing bone tissue is located. For example, once a person achieves his or her maximum height in adolescence, the metaphysis would be fused so there would be no more growing cells in the metaphysis, but in a child, the metaphysis is composed of several actively growing bone-forming cells known as osteoids, which help in the growth of the bone length as well as breath-wise, so that is a normal bone. Inside the bone hollow area, which is called bone marrow, Bone marrow is usually located in the hollow bones that make up the hip bones.
Diagnosis
The bones of the thigh are also called the femur. The bones of the arm are also called the humerus, and the bone marrow is located in certain backbones also, so initially, the child, the adolescent, or even the adult is brought to the doctor for swelling of the bone, abnormal pain in the bone, a boring kind of regular increasing intensity pain, and sometimes deformity of the bone can also bring the patient to the oncologist. So, how do we proceed when the patient comes to us with these varied presentations? An x-ray of the bone is the first test that we usually ask for, and believe it or not, in the era of MRI and CT scan, Today, x-ray gives us a lot of information with respect to the diagnosis of the tumor and also strategies for management of the bone tuber. After the x-ray, we want to know what kind of bone cancer it is. Most bone tumors are benign today. Most of the bone deformities are also benign bone cancers, which means the malignancy of cancer. Where the bone is destroyed and also the tumor cells spread to other parts of the body. The minority of bone tumors, not all bone spellings or bone tumors, are malignant, so we proceed to do a biopsy. The biopsy is nothing but you putting a thick board needle into the tumor core, getting the tissue there, and studying it under the microscope, so most pathologists. Those who are well-oriented with a cancer diagnosis can easily differentiate between whether this is a bone tumor that is benign or a bone tumor that is malignant. However, not everybody can do a bone biopsy. If it's actually a malignant bone tumor and the biopsy is not done with the right technique, you may end up spreading cancer outside the bone house. That is why a highly qualified orthopedic surgical oncologist is qualified to take the bone biopsy in an adequate and optimal way so that the diagnosis is also established and there is no seeding of the bone tumor outside the bone. If the biopsy report turns out to be cancerous or malignant at that instant, we then proceed to a staging evaluation, so for bone tumors usually.
Nowadays, we do a whole-body contrast-enhanced CT scan or get a CT scan. Sometimes we also do a bone scan, which is a nuclear medicine test. With these tests, we then establish whether the bone tumor diagnosed is located only in that particular bone or has spread elsewhere.
Treatment and Surgical Procedure
If the imaging test shows that the bone is localized to the site of the symptom, then we proceed to think of curative management. If it is spread, then the treatment intention is only to control the disease and to palliate the symptoms. So, the most definitive modality for the treatment, and you know, the cure of bone tumors, is surgery. We repeatedly discover that many children and adolescents with bone tumors lose a limb. Basically, an amputation is done, after which the limb is removed and the patient is given a prosthesis so that the patient can perform whatever activities that it is possible to do with the limb. Limb salvage surgeries in which the same lymph can be salvaged by these advanced surgical techniques are called "limb salvage surgeries." Limb salvage surgery basically utilizes special processes or metallic processes which can be inserted end-to-end on either side of the selected bone, and this helps the individual perform as close to normal as before the patient was diagnosed with a bone tumor. This is not done by everybody. The reason is that it requires great skills and also requires you to know the downstaging of the tumor by chemotherapy. So keep in mind that anyone can develop a bone tumor. It does not mean that the patient has to lose their limb. Limb salvage surgery is certainly possible. In fact, for many patients who come with bone tumors, we always try and insist on a limb salvage surgery protocol. So that patients do not have to live a life forced to undergo bone tumor treatment while being severely handicapped, make sure that the earliest treatment is started when a bone tumor is diagnosed. It could not be malignant, but make sure the diagnosis is done and also make sure that treatment is taken from a center that has multi-disciplinary oncology management so that advanced techniques such as limb salvage surgery can be made possible, and in many cases, the limbs of the child or adolescent can be preserved using these latest strategies.
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