Musculoskeletal tumours

diagnosis and treatment of musculoskeletal tumours

Bone tumours are not very common and it is very important to treat patients who have contracted them in an experienced hospital.
 
Each cell line of the musculoskeletal system can cause a different tumour. This means that the tumours are very varied, so it is easy to confuse between distinct lesions and not using appropriate treatment. The possibilities of curing the disease are drastically reduced when the best treatment is not administered.
 
We base the diagnosis on the patient's clinical history, scans and a biopsy.
 
In the last 20 years at the Clínica Universidad de Navarra , we have treated thousands of primary malignant bone tumours. Osteosarcoma is the most common and the chance of survival after 10 years is 74% and the upper limbs are conserved in 90% of patients. When treating Ewing's sarcoma, the survival rate at the Clínica is around 65%.
 
Additionally, the Clínica Universidad de Navarra has experience treating sarcomas in soft tissue by surgically removing them using brachytherapy.
Numerous medical advances in diagnosis and treatment of bone tumors help maintain the limb. [Video only available in Spanish]

It is absolutely essential that the diagnostic process and the start of treatment are carried out as quickly as possible. Any delays could negatively affect the patient ́s survival rate."

The diagnosis is based on three pillars: clinical history, scans and biopsy.

Given the rare occurrence of these tumours, it is very important that the team of specialists are experts in the pathology.

Diagnostic tests:

  • As for imaging methods, the most specific is a simple X-ray.
  • MRI scans [SP] are also very useful for sarcomas to evaluate the local spreading of the lesion. Other imaging tests used for diagnosis and follow-up are scintigraphy and PET scans.
  • The computerized axial tomography (CAT) scanner [SP] is used fundamentally to rule out or confirm the presence of lung metastases. In the majority of sarcomas, a metastasis is not detected at the diagnosis stage. However, if this does occur, the possibilities of a full recovery are lowered.
  • With a bone scintigraphy [SP] (which consists in injecting a substance into the venous line that will then be deposited in the affected areas of the skeleton), we can detect if there is a bone metastasis, or multifocal lesions (polyostotic).
  • The positron emission tomography (PET) scan is also very sensitive in detecting lesions some distance away from the main tumour, evaluating its metabolism, etc.
  • Biopsies [SP] can have important prognostic and therapeutic consequences and, therefore, must always be carried out by the team who will care for the patient definitely. A biopsy using a needle or trocar is most suitable, to prevent the tumour from spreading.
The many medical advances in diagnosing and treating bone tumours enable the limbs to be preserved.
 
A bone tumour is an abnormal growth of cells inside the bone. For the majority of malignant skeletal tumours, the cause is unknown.
 
Studies into genetic mutations have greatly advanced and countless genetic studies have been carried aiming to further study this concept in the near future using samples taken from patients.
 
The most common symptom is constant pain in the limbs, normally in the knee of a growing child, although it can also appear in the bones in the torso, pelvis, etc. Sometimes, this is accompanied by a lump which grows very quickly.
 
The diagnosis is based on clinical history, scans and a biopsy. It is essential to diagnose and begin the treatment as soon as possible so as not to jeopardise the patient's life expectancy. 
 
The treatment of these tumours is also based on three pillars: surgery, chemotherapy and occasionally, radiotherapy, for almost a whole year, although with only intermittent admission into hospital. Currently, the possibility of preserving limbs without the need for amputation is very high.
 

Percutaneous treatment using CAT scans for osteoid osteoma.

Inside the benign lesions, there is a specific group of paratumoral lesions. Strictly speaking, they are not tumours, but an abnormal growth of cells. Examples of these lesions are bone cysts.

Osteoid osteoma is a typical benign bone tumour in children and adolescents. It's very small (about the size of a pea) and causes continual pain, predominantly at night-time, which is alleviated with anti-inflammatories (like aspirin®, for example).

The surgical removal of the tumour is a classic treatment. However, percutaneous treatments using CAT scans (percutaneous removal or radiofrequency thermocoagulation) are becoming more and more popular.

Its advantages include reducing the risks associated with surgery and enabling exact location of the lesion. Furthermore, the recovery period is much quicker (and can be done as an outpatient), it also doesn't immobilise the patient or mean they have to use crutches afterwards, etc.

Soft tissue tumours are not very common and there are very few expert centres for their treatment.

A delay in diagnosis, a relapse or metastasis can worsen the prognosis.

The tumours appear in muscles, ligaments, fat, blood vessels, etc., usually in just one limb. The most common are liposarcoma, malignant fibrous histiocytoma and synovial sarcoma.

The main symptom is a lump in a limb ́s soft tissue which is usually painless. As it grows, it can become painful, above all when putting pressure on muscles and nerve endings.

They are diagnosed using a MRI scan [SP] and the lesion is confirmed in a biopsy. If the tumour is aggressive, a thoracic CAT scan is done to rule out whether or not it is a lung metastasis.

The treatment is surgical and the Clínica is one of the few European accredited centres for doing hyperthermia with TNF, which demonstrates a high rate of local control over the disease.

The treatment of some types of sarcoma are also benefitting from new drugs available, such as STI-571 (Glevec®).

Furthermore, another treatment which is now available is brachytherapy which reduces the dose of external radiation, diminishing side effects from the treatment.

Important lines of investigation have also been developed into molecular biology aiming to improve diagnosis.

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