Bone tumors: what are they?

By Cristiano Antonino Last updated Jun 20, 2023

Let’s talk about bone tumors. Like all the tissues of our body, even the bones, essential for the support of the body, the functioning of the muscles and the protection of the vital organs, are formed by cells characterized by a normal life cycle

It may happen that their abnormal and excessive proliferation leads to the formation of neoplasms that can appear as nodules or masses.

Even the bones can become the site of benign or malignant tumors, depending on the nature of the proliferation.

Generally, the classification of a bone tumor directly depends on its degree of malignancy and the underlying cause.

Bone tumors can be divided into benign and malignant

Primary bone tumors are defined as those that originate directly from the cells of the bone tissue, while neoplasms that occur as metastases of primary tumors in other sites are secondary.

Finally, bone cancer is said to be recurrent if it recurs after the treatment of the original tumour.

Usually, primary bone cancer is a very rare malignancy.

The most common form remains the metastatic one, the result of the presence of other tumors in the body.

It should be remembered that even the bone marrow, responsible for some phases of hematopoiesis (production of blood cells), can undergo neoplasms that can modify the structure of the surrounding bone.

Types of bone tumors

There are different types of bone tumors, classified according to the benign or malignant nature of the masses.

In general, even if the young population is more frequently affected than the adult one by this type of neoplasm, the latter are rarely of a malignant nature and almost always benign.

In adults, bone cancer is often malignant and metastatic.

They are benign bone neoplasms:

Osteochondroma, which mainly affects adolescents and young people during the bone growth phase. This seems to be the main reason why this type of tumor mostly affects the ends of the so-called long bones, i.e. those of the upper and lower limbs (femur, tibia, humerus) in growth.
Osteoclastoma also affects the ends of the long bones of the lower limbs. More rarely, wrists, arms and pelvis are involved. Preferentially affects people young women.
An enchondroma is a tumor mass in the cartilage of the bone marrow. A real cyst forms on the bones of the hands, humerus, femur and tibia. Its incidence is highest among children and adolescents, but it can develop at any age.
Unicameral non-ossifying fibroma. It is the formation of a tumor cyst, especially in the lower limbs.
Fibrous dysplasia is the result of a genetic mutation that leads to the formation of fibrous tissue instead of bone. Bones become more fragile and break more easily and frequently. It mainly affects the skull and lower or upper limbs.

Alongside the benign bone neoplasms, there are those of a malignant nature:

Osteosarcoma is the most common primary malignant bone tumor. It can be located in any bone in the body, but is most common in the femur and tibia. It grows very quickly and creates metastases early, so it requires diagnosis and treatment as timely as possible.
Chondrosarcoma has one major difference from osteosarcoma. While the latter originates directly from bone cells, chondrosarcoma arises from cartilage and is typical of adulthood and advanced age.
Ewing’s sarcoma is a primary bone tumor that is very common among adolescents and young adults. It mainly affects the long bones of the lower and upper limbs, pelvis, clavicles and ribs.

Malignant bone tumors are expression of metastases from other sites

Called secondary or metastatic cancers, the cancers that most frequently metastasize to bone include breast cancer, prostate cancer, lung cancer, kidney cancer, thyroid cancer, and multiple myeloma (a malignant tumor affecting the bone marrow).

Symptoms

Symptoms associated with bone cancer vary according to whether it is benign or malignant and the stage of severity.

Benign tumors are mostly asymptomatic, but sometimes there are recognizable manifestations including small bumps and bone edema that can become painful.

Other symptoms include tingling and numbness caused by the mass compressing a nerve.

Care must be taken, as benign tumors may progress to malignant.

When a tumor is malignant, the symptoms may be more obvious:

Pain in the affected bones. It is an occasional nuisance at the beginning, but which becomes very strong and constant over time, until it persists even at night and at rest.
Bones are prone to pathological fractures because they become weaker and break more easily.
Localized edema, usually near the mass.
Non-specific symptoms such as fever, night sweats, large and unjustified weight loss and constant sense of tiredness and fatigue.

The presence of metastases from other anatomical areas is the most frequent malignant bone manifestation.

While in women metastases mainly result from breast or lung cancer, in men the prostate is the main culprit.

To a small extent, metastases can derive from carcinoma of the kidneys, thyroid, skin and uterus. The bones most frequently affected by metastases from other sites are those of the skull, trunk and limbs.

The causes of bone tumors

Neoplasms, including bone neoplasms, are caused by multiple genetic alterations that lead to gradual malfunctions in the mechanisms that control cell division and maturation.

Cells grow in an unregulated way, gathering in clusters that form tumor masses.

The medical community is engaged in a constant study of cancer causes, not just for bone cancer.

Unambiguous and precise reasons that influence genetic changes have not yet been identified, but it has been possible to draw up a list of the main risk factors based on the observation of affected patients.

Bone cancer can develop due to hereditary or genetic causes, or due to the presence of congenital pathologies such as Maffucci syndrome (skeletal and skin disease characterized by bone deformities, associated with multiple irregularly shaped dark colored angiomas or, more rarely, with lymphangiomas ).

Prolonged exposure to radioactive sources – present in the environment or deriving from the treatment of other forms of cancer – also makes the subject more prone to developing the disease.

Frequent fractures and bone trauma can weaken this tissue to such an extent that it becomes easier for bone cancer to develop.

It is possible that rapid bone growth is a risk factor, which is why it is mainly children and young people who are affected by this category of cancer.

The diagnosis

The diagnosis of a tumor is necessary to evaluate the stage of malignancy and the degree of progress.

Careful observation, combined with appropriate tests and diagnostic investigations, will highlight the size of the tumor mass, the capacity and speed of reproduction of the abnormal cells and the possible presence of metastases.

In the study of bone cancer, the history is essential.

It must be very detailed, with a careful collection of the patient’s symptoms and medical history.

In fact, it is not uncommon to confuse tumor symptoms with other pathologies or vice versa.

During the physical examination, the doctor will perform a histological examination of the patient.

Blood and urine tests are prescribed, useful to highlight any abnormalities not present in a healthy individual.

Subsequently, to deepen the investigation and observe which anatomical areas are affected, various diagnostic imaging techniques are used.

X rays show bone abnormalities and growths, but are not particularly helpful in determining whether the tumor is benign or malignant.

CT scans and MRIs provide additional information about the location and size of the tumor.

Positron Emission Tomography (PET) is used to investigate the location of the tumor and to evaluate the mass metabolism.

It is also useful for assessing response to treatments.

Bone scans are preferred when you want to look at an image of the entire skeleton to see if there are multiple localized tumors and bone metastases.

The most in-depth examination, but also the most invasive, is the biopsy.

Some cells belonging to the tumor mass are taken (by needle or surgical operation), to then be analyzed in the laboratory.

Carried out under local or general anesthesia, it provides information on cellular composition, their origin and evolution.

The biopsy also indicates whether the cancer is malignant or benign and at what stage of differentiation it is.

Treatment and prevention of bone tumors

The choice of the most suitable treatment for bone cancer depends on its primary or secondary nature, its degree of malignancy, its location and the number of bones involved.

How to treat benign bone neoplasms

There is usually no treatment for benign bone tumors.

The nodules can be removed with surgical therapy when they become too large and painful.

Even if the prognosis is most often positive, it is important to undergo constant oncological checks, since a benign tumor can evolve into malignant.

How to treat malignant bone neoplasms

Malignant tumors require three different intervention approaches based on staging, symptom intensity and the presence of metastases.

Surgical removal of the tumor mass is foreseen when the tumor is small and is located in a favorable anatomical area.

If, together with the tumor mass, a portion of healthy bone is also removed, a metal prosthesis with the same function is implanted or a portion of healthy tissue is taken from a donor.

Malignant bone tumors can be treated with radiation therapy.

Ionizing X-rays destroy diseased cells, preserving healthy ones and relieving symptoms.

We talk about neoadjuvant radiotherapy if carried out before the surgical removal or adjuvant radiotherapy if after the surgery.

Similarly, chemotherapy involves the administration of drugs aimed at blocking the rapid and uncontrolled proliferation of cancer cells.

It can be a complementary treatment to surgery, carried out both in the pre-operative phase (neoadjuvant chemotherapy, to reduce the size of the tumor and make it easier to remove it), and subsequently (adjuvant chemotherapy, carried out after surgery to eliminate the residual tumor cells).

It is the most used technique for tumors with metastases. Chemotherapy drugs are typically administered orally or parenterally, depending on their efficacy and risk profile.

Malignant tumors are often burdened with a poor prognosis. Timeliness of diagnosis and treatment are very important.

Constant screenings are, still today, the only preventive method, not only for this tumor category, but for oncological medicine as a whole.

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