Bones in our bodies have many functions, as they are a framework that supports and protects internal organs (such as the skull bones to protect soft tissue in the brain, and the chest cage protects the lungs). Bones move the bone, and the bone marrow (bone marrow) produces the blood cells in our bodies. Cancer growth that arises in the developing bone tissue is called "primary bone cancer". Such tumors appear mostly in the bones of the hands and feet, but they can occur in any type of bone in the body. Bone cancer in children is rare, but among young adults and young adults, it is the third in its spread after leukemia and lymphoma.
Primary bone cancer is often called "sarcoma". There are many different types of sarcoma, and each one distinguishes a different bone layer The most common ones are Osteosarcoma, Ewing and Chondrosarcoma.
Osteosarcoma, also called "osteosarcoma", is a metastasis in the bone originating in the bone-producing cells. It is characterized by the formation of a substance called Aostauaid, which is the first stage of bone formation.
About 60% of primary bone tumors are of the type of bone sarcoma. This tumor appears in young adults, especially in areas of rapid growth, in the shoulder, knee and thigh bone. The chances of a cure are better in the tumors in the limbs. The prevalence of bone sarcoma has been observed in patients with retinoblastoma, especially in parts of the body that have been subjected to radiotherapy, among patients over the age of forty, who suffer from Paget''s disease.
Osteosarcoma is defined by the type of dominant (dominant) cell responsible for the swelling process, such as the “Osteoplast” cell (Chon last) Fibroplast, and Telangiectatic (which includes voids) Filled with blood in tumor states). There are multiple placement cases, which do not respond to treatment in any way, and there are better tumor cases, in which the tumor does not cause any harm to the bone cavity, but rather to the bone itself, that is, the cortex (Cortex).
The typical appearance of swelling appears in the form of localized pain and swelling, without the appearance of fever, and the patient may remain in this condition for more than half a year. X-rays show an area where the bone has been torn and the soft tissue calcified. In orthopedic examination, bone activity is shown in that area. About 10% - 20% of patients have found metastases in the lungs that were shown by computerized tomography (CT) scan. Biopsy biopsy is necessary to confirm the diagnosis. Treatment for bone cancer includes chemotherapy and surgery.
Giving preoperative chemotherapy (Neoadjuvant) improves the ability to maintain the limbs without exposing the patient to danger. Chemotherapy depends on three of the four drugs: Methotrexate (MTX), Adriamycin and Cisplatin and Ifosfomide, the fourth drug is given in cases where side effects are severe, or failure to respond to other treatments. Tumor removal and ion of an artificial body into the bone site, or with its blood supply vessels, is more acceptable today, than amputation that was prevalent in the past.
60% - 80% of patients, without metastases during the diagnosis, will recover without evidence of disease recurrence, for the next five years However, the cure rate for the tumor with metastases is only 20%. In patients with stable tumors, directed radiation therapy can be given in addition to other drugs such as Gemcitabine, Etoposide and Carboplatin.
Ewing''s sarcoma was described for the first time by James Ewing in 1921, as a bone tumor characterized by circular blue, radiation-sensitive cells. It is the most common type of tumor, among children and young malignant tumors. Four new cases are diagnosed each year, for every million children under the age of 15. Diseases in the bone or soft tissue are more common in boys than in girls. Most cases are diagnosed on the limbs - 53%. And thigh - 25%. In the body, 47%, the pelvis - 20%, the spine and the ribs - 13%.
The first symptom of the disease is advanced local pain, which awakens the patient from sleep, depending on the location of the tumor, as the patient may limp and suffer from increased pain during breathing, or pain that is reflected in the limb. Swelling in the area of the tumor is particularly prominent in the extremities.
In 3% of cases, patients develop paralysis as a result of pressure of the tumor on the spinal cord. 28% of patients will develop a fever-like fever caused by bone contamination, and 26% of patients will be diagnosed with metastases in the diagnosis. The most common sites for metastases are the lung, bones, and bone marrow.
Patient assessment includes tumor imaging, search for metastases and a differential diagnosis. Through imaging, devastating disease can be detected in the bone and parallel calcined strips, such as onion peel. In computerized bone scan and MRI, a sample of the soft tissue mass can be examined. As in bone scans, the area of disease and bone metastases is determined. The erythrocyte sedimentation rate (ESR) and the lactated dehydrogenase (Lactatedehydrogenase) enzyme concentration are high.
Treatment of topical bone cancer depends on a high percentage of radiation (45 - 65 radiation units) or excision, and this is related to the ability to perform surgery and to functional results and the risks of secondary tumors caused by radiation (5% - 10% in 20 years). Radiotherapy is carried out for tumors in the pelvis and spine, and when there are residual tumors. Tumor surgery is done on the extremities, while preserving the limb.
Currently common treatment includes intravenous chemotherapy to reduce the tumor prior to excision and / or radiology. Chemotherapy includes five drugs: Vincristine, Doxorubicin and Cyclophosphamide, nating with Ifosfamide and Etoposide.
The chances of recovery for children and adolescents with Ewing''s sarcoma depend on the size and location of the tumor, the stage of the disease and the presence of metastases. International studies have found that the rate of survival and lack of feeling ill for five years for patients without metastases reaches 70%.
Chondrosarcoma is the most common of the malignant tumors of the chest wall. The incidence of this type of sarcoma is greater for men in the third or fourth decade of their lives The tumor is usually concentrated in the front thoracic cage, and may cause pain, but does not cause the rib to break. The tumor is removed with wide margins as much as four centimeters of healthy tissue. This extensive surgery with margins significantly reduces the risk of tumor recurrence and metastases, but as a result of extensive surgery, it often requires rebuilding the chest wall during surgery.
