If you’ve been diagnosed with a bone tumor, you are probably feeling confused and overwhelmed by the amount of information you’ve had to absorb. In addition to dealing with the diagnosis, you want to know more about your disease and the best available treatments. Whether you have a primary or secondary (metastatic) tumor, an orthopedic oncologist is an essential part of your medical team.
Because bone tumors are rare, and primary bone tumors are extremely rare, there are very few experts in the United States who are experts in orthopedic oncology. As an orthopedic oncologist, Dr. Daniel C. Allison has been specially trained both in cancer treatment and in the musculoskeletal conditions that may arise from primary or secondary bone tumors.
What is a Primary Bone Tumor?
Tumors are abnormal growths of tissue that generally arise in the body’s soft tissues and may or may not later spread to the bones. In 1% of cases, however, tumors develop in the bones first. These are therefore called primary bone tumors. Primary bone tumors can be either be benign (no cancerous cells) or malignant (cancerous).
Benign primary bone tumors often occur while the skeleton is still developing, and are therefore more common in children and young adults. Primary bone tumors may be painful but are often symptom-free.
The most common types of benign primary bone tumors are:
- Osteochondromas — Mostly affect young people between the ages of 10 and 20. Osteochondromas are most commonly found in the leg, pelvis, scapula or arm.
- Osteoblastomas — Affect children and adolescents. Can be painful and debilitating, especially if located on the spine. Spinal osteoblastomas may cause paralysis if not removed.
- Osteoid osteoma — A small, painful tumor that usually affects adolescents. May destabilize and/or deform the spine.
If untreated, some benign bone tumors can become malignant. That’s why it is essential that they be monitored by an orthopedic oncologist for evidence of cancerous changes.
Malignant primary bone tumors, on the other hand, usually affect older adults. The most common types of malignant primary bone tumors are:
- Osteosarcomas— Malignancy of the bone, cartilage or connective tissue (chondrosarcoma, Ewing sarcoma, fibrosarcoma).
- Marrow tumor—Malignancy of the bone marrow (multiple myeloma, lymphoma, leukemia).
What is a Secondary Bone Tumor?
Secondary bone tumors are those that arise as a result of soft tissue tumors metastasizing to the bones. Secondary bone tumors are always malignant. They commonly originate in the breast, kidney, lung, prostate, and thyroid.
What Causes Bone Cancer?
A family history of cancer may increase the risk of developing a bone cancer. Other risk factors may include exposure to toxins or radiation, obesity, a personal history of cancer, and injury or trauma to the bone. However, most cases of bone cancer have no known cause.
Treating Benign Bone Tumors
Because even benign primary bone tumors may become malignant, they need to be carefully monitored with regular imaging tests, such as x-rays. Many benign bone tumors resolve on their own. However, surgery may be recommended to preserve the integrity of the bones, prevent damage to surrounding soft tissues and nerves, and to avoid the development of skeletal abnormalities.
An orthopedic oncologist will make recommendations for treatment based on each patient’s age; the size of the tumor; whether it is affecting surrounding muscles, nerves, and other tissues; and its rate of growth.
Treating Primary and Secondary Bone Malignancies
Malignant bone tumors are treated with either chemotherapy, radiation, or a combination of both. If the bone tumors are a result of metastasis, the primary soft-tissue tumors must also be treated.
Chemotherapy is usually the first choice for malignant bone tumors because if it is successful, there is no need to move on to radiation. Chemotherapy can also prevent fractures and may shrink the tumors sufficiently to avoid surgery.
If the tumor doesn’t shrink after chemotherapy and surgery is needed, radiation is usually administered either before or after the tumor is removed. Radiation therapy can also prevent fractures and relieve pain.
In extreme cases, amputation may be necessary. If bones or joints have become weakened, they may be replaced or strengthened with rods or implants. Learn more about bone tumors at medlineplus.gov
The Importance of an Orthopedic Oncologist for Primary and Secondary Bone Tumors
An orthopedic oncologist will help choose the most minimally invasive and effective therapies plus design rehabilitative strategies to help restore function to the affected bones and joints. Even benign primary tumors must be watched carefully by an orthopedic oncologist for changes that could impair function or may be an indication of malignancy. If necessary, surgery will be performed to remove the tumor and preserve the integrity of the spine and/or bones.
Dr. Daniel C. Allison, MD, FACS, MBA, is a nationally-recognized orthopedic oncology surgeon and Assistant Director of Orthopedic Oncology, Cedars-Sinai Samuel Oschin Cancer Center. He partners with a team of orthopedic and oncology practitioners specializing in musculoskeletal tumors, bone cancer, sarcomas, bone preservation, and orthopedic trauma. If you have been diagnosed with a primary or secondary bone tumor, cal Dr. Allison in Los Angeles to schedule a consultation today.
Next, learn about the Four Types of Benign Bone Tumors.