Primary bone cancer - Acute
Rahul Soman, M. Pharm
Definition
Rare malignancies of the musculoskeletal system that include osteosarcoma, Ewing sarcoma of bone, chondrosarcoma, and others
Medical History
* Genetic mutation
* Disorder of the genitourinary system
* Exclude For: Past medical history of Radiation-induced disorder
* Past medical history of Traumatic injury
* Hereditary disease
Findings
* Limitation of joint movement
* Muscle atrophy
* Limping
* Mass of body structure
* Swelling
* Deformity
* Aching pain
* Pain, chronic
* Referred pain
* Weight loss
* Fatigue
Tests
Suspected neoplasm of bone
* Biopsy of lesion of bone: The ultimate diagnosis of bone cancer requires a biopsy and a histopathologic analysis .
Initial study for suspected neoplasm of bone
* Radiographic imaging of bone
Suspected neoplasm of bone
* Magnetic resonance imaging, All bone (tissue): MRI helps determine tumor size, intraosseous and extraosseous involvement, and the presence of skip lesions .
Suspected neoplasm of bone
* CT of musculoskeletal system structures: CT can provide evidence of osteosarcoma, Ewing sarcoma of bone, and chondrosarcoma, but a biopsy confirms the diagnosis .
Histology of bone lesion biopsy sample
* Histopathology test, Bone biopsy sample
Suspected and known neoplasm of bone
* Nuclear medicine imaging procedure: Nuclear-medicine scintigraphy provides evidence of osseous metastasis throughout the skeleton .
Suspected and known neoplasm of bone
* PET study for tumor uptake of glucose: FDG-PET imaging may help in staging bone sarcomas and in evaluating chemotherapy effectiveness in osteosarcoma and Ewing sarcoma .
Differential Diagnosis
* Osteosarcoma of bone
* Ewing's sarcoma of bone
* Chondrosarcoma
* Malignant fibrous histiocytoma
* Lymphoma involves bone marrow
* Secondary malignant neoplastic disease
* Metastasis from malignant tumor of prostate
* Metastasis from malignant tumor of breast
* Metastasis to bone of unknown primary
* Osteoid osteoma
* Osteochondroma of bone
* Osteomyelitis - Acute
* Aneurysmal bone cyst
* Langerhans cell histiocytosis, unifocal (clinical)
* Fibrous cortical defect
* Multiple myeloma
Treatment
Drug Therapy
Osteosarcoma
DOXORUBICIN HYDROCHLORIDE
METHOTREXATE SODIUM
CYCLOPHOSPHAMIDE (Related toxicological information in CYCLOPHOSPHAMIDE AND RELATED AGENTS)
IFOSFAMIDE (Related toxicological information in CYCLOPHOSPHAMIDE AND RELATED AGENTS)
CISPLATIN (Related toxicological information in CISPLATIN AND RELATED AGENTS)
VINCRISTINE SULFATE
ETOPOSIDE (Related toxicological information in ETOPOSIDE)
Ewing sarcoma
DOXORUBICIN HYDROCHLORIDE
CYCLOPHOSPHAMIDE (Related toxicological information in CYCLOPHOSPHAMIDE AND RELATED AGENTS)
IFOSFAMIDE (Related toxicological information in CYCLOPHOSPHAMIDE AND RELATED AGENTS)
Procedural Therapy
Neoplasm of bone
* Surgical procedure: Low-grade osteosarcoma is treated surgically . Complete excision of tumor with wide margins improves the chance of cure in chondrosarcoma .
Neoplasm of bone
* Radiation therapy procedure or service: Ewing sarcoma is responsive to radiation, but radiation has limited use in osteosarcoma . Radiation may be used for unresectable chondrosarcoma .
Initiation of physical therapy is indicated for patients following surgical resection, who have evidence of response to neoadjuvant chemotherapy and who are currently receiving adjuvant chemotherapy. Because of the possible combinations of surgery, chemotherapy, and radiation therapy, physical therapy needs may be extensive .
* Cancer rehabilitation and readaption
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