BONE TUMORS

Understanding Bone Tumors in Children

When dealing with bone tumors in children, it’s crucial to differentiate between benign and malignant types. This distinction helps in determining the appropriate treatment plan and understanding the potential impact on a child’s health.

Malignant Bone Tumors

While benign tumors are more common, understanding malignant bone tumors is vital due to their aggressive nature. Among children and teenagers, the two most prevalent malignant bone tumors are:

• Osteosarcoma: This type of cancer often develops in the bones around the knee and is most frequently diagnosed in the teenage years.
• Ewing’s Sarcoma: This tumor tends to appear in the upper leg, pelvis, and other trunk bones. Like osteosarcoma, it often emerges during adolescence.

Both types require specific treatments, and early detection can significantly improve outcomes.

Benign Bone Tumors

Benign tumors outnumber malignant tumors and are typically less aggressive but still require attention. They can present themselves in various forms:

• Osteochondromas: The most common form of benign bone tumors, accounting for about 35 to 40 percent of cases. These tumors often occur in adolescents and teens, forming near the ends of actively growing long bones like the arms and legs. They consist of bone and cartilage and may appear as a single growth or multiple ones.
• Unicameral Nonossifying Fibroma: Known as the only true bone cyst, this solitary bone cyst typically appears in the legs of children and adolescents.
• Tumors with Giant Cells: Although rare, these tumors can grow quickly. They usually occur in adults and are found at the rounded ends of bones rather than growth plates.
• Enchondroma: These cartilage cysts develop within the bone marrow and can link to conditions such as Ollier’s and Mafucci’s syndromes. They primarily affect the hands, feet, arms, and thigh bones.
• Fibrous Dysplasia: This condition results from a gene mutation, causing fragile bones prone to fractures.
• Bone Cyst Aneurysmal: A blood vessel abnormality beginning in the bone marrow, these cysts can spread rapidly and affect growth plates, posing further complications.

Symptoms and Diagnosis

Benign bone tumors are often discovered during X-rays taken for other reasons. Symptoms may include slow-growing bumps, pain, or fractures through weakened bones. Family history can also play a role, with some benign tumors running in families. Understanding both benign and malignant bone tumors allows for a comprehensive approach to diagnosis and treatment, ensuring the best possible care for children and adolescents.

Different Types of Malignant Bone Tumors

Numerous cancers can lead to malignant bone tumors. The term “primary bone cancer” refers to cancer that began in the bones, accounting for less than 1% of all cancers, according to the National Cancer Institute (NCI). Among young patients, the two most common types of bone cancer are:

• Osteosarcoma: Most commonly found in the bones around the knee, this type of cancer primarily affects children and adolescents. It manifests around the hip, shoulder, or knee and grows quickly, often spreading to other parts of the body. Osteosarcoma is also known as osteogenic sarcoma. It affects two to five people per million each year, predominantly impacting teenagers and children. To treat this disease, chemotherapy, and surgery are commonly used.
• Ewing’s Sarcoma: This type of tumor normally appears in the upper leg, pelvis, and other bones of the trunk, primarily affecting adolescents and young adults, but can also affect children as young as five years old. Patients are typically between the ages of 5 and 20. Ewing’s sarcoma most commonly affects the legs (long bones), pelvis, backbone, ribs, upper arms, and skull. It starts in the bone cavities, where bone marrow is produced, and can also grow in soft tissue. ESFTs are rapidly growing and spreading, with males more likely than females to develop them. Chemotherapy, surgery, or radiation therapy are commonly used to treat this disease.

What Symptoms Are Associated with Osteosarcoma and Ewing’s Sarcoma?

When it comes to osteosarcoma and Ewing’s sarcoma, the symptoms can vary from one individual to another. However, the following are some common signs:

• Persistent Pain: Pain that may arise during physical activities or even when at rest. This pain tends to intensify gradually over time.
• Swelling or Lumps: You might notice a bump or swelling in the affected area, which could indicate a developing tumor.
• Unexplained Fever: Persistent fevers can appear without any other signs of infection.
• Weight Loss: A sudden drop in weight that does not link to dietary changes or increased exercise.
• Reduced Appetite: A noticeable decrease in hunger or interest in eating.
• Fatigue: Feeling unusually tired or lacking energy, which does not improve with rest.

Multiple Myeloma

The most typical primary bone cancer is multiple myeloma. This is a bone marrow tumor, the soft tissue in the center of many bones that produces blood cells. It has the potential to affect any bone. Each year, approximately seven people per 100,000 are diagnosed with multiple myeloma, with over 130,000 diagnoses annually according to the NCI. The majority of cases occur in patients aged 50 to 70. Chemotherapy, radiation therapy, and, on rare occasions, surgery are used for treatment.

Chondrosarcoma

Chondrosarcoma is a cancerous tumor made up of cartilage-producing cells, affecting people between the ages of 40 and 70. The majority of cases occur in the hip, pelvis, or shoulder area, with doctors typically using surgery to remove tumors. Middle-aged and older persons are more prone to develop chondrosarcoma, with this form of bone cancer often starting in the hips, shoulders, and pelvis.

Secondary bone cancer

The term “secondary bone cancer” refers to cancer that began elsewhere in the body and then spread to the bone. It usually affects elderly people. The types of cancer that are most likely to spread to your child’s bones are as follows:

• Prostate; lung (particularly osteosarcoma).
• the thyroid gland
• Myeloma multiplex.

Multiple myeloma is the most common type of secondary bone cancer. This bone cancer manifests as bone marrow tumors. Older individuals have a higher incidence of multiple myeloma.

What Factors Contribute to Bone Tumors?

There are no known causes of bone tumors. Genetics, radiation treatment, and bone injuries are all possible causes. Radiation therapy (particularly high doses of radiation) and other anticancer drugs have been linked to osteosarcoma, particularly in children. However, no single cause has been identified. Tumors frequently appear when parts of the body are rapidly growing. People who have had metal implants used to repair bone fractures are more likely to develop osteosarcoma later in life.

Recognizing Potential Symptoms of Bone Tumors

A discomfort in the damaged bone that is dull in nature is the most typical sign of bone cancer. The pain begins as intermittent and progresses to severe and constant. If the discomfort is bad enough, you could wake up during the night. When a person has an undiscovered bone tumor, a minor injury can break an already weakened bone, causing severe pain. This refers to a pathologic fracture. Swelling at the site of the tumor is not uncommon.

In addition to pain and swelling, other symptoms of bone tumors can include:

• Recurring pain: This may occur with activity or at rest and becomes more severe over time.
• Palpable mass: You might feel or notice a new mass of tissue on some part of the body.
• Systemic symptoms: Tumors can also cause night sweats, fevers, or a combination of the two. An unexplained fever, along with unexplained weight loss, poor appetite, and fatigue, can also be indicators.

Alternatively, your child may not feel any pain, but you will notice these additional signs. People with benign tumors may not experience any symptoms. The doctors may not discover the tumor until an imaging scan is performed in conjunction with other medical tests. If a benign bone tumor, such as an osteochondroma, does not interfere with your child’s daily function and movement, it may not require treatment.

By understanding these symptoms, you can better recognize when to seek medical advice, ensuring timely diagnosis and treatment.

Identifying Bone Tumors

Fractures, infections, and other conditions can all look like tumors. Your doctor will order and perform a number of tests to determine whether a bone tumor is present. First, your doctor will perform a physical exam, focusing on the suspected tumor’s location. In addition, the doctor will examine your child’s bones for tenderness and measure certain ranges of motion.

After the physical exam, the diagnostic process will typically involve:

1. Bone Scan

• This imaging test is vital to identify bone tumors and other skeletal abnormalities. Sometimes, a special dye called contrast is injected into the bloodstream prior to the scan to enhance image clarity. Adequate hydration is essential before undergoing this procedure.

2. PET Scan (Positron Emission Tomography)

• A PET scan is highly sensitive and is used to detect tumors not only in the bone but also in the surrounding tissues. It’s vital for picking up even the smallest abnormalities. Specific preparation steps, often provided by healthcare providers, are needed to ensure accuracy.

3. CT Scan (Computed Tomography)

• CT scans are instrumental in creating cross-sectional images of the body, focusing on bones, muscles, and organs. This study checks for the presence of tumors within the bone and can detect any spread to the chest or lungs.

4. MRI Scan (Magnetic Resonance Imaging)

• MRI scans offer detailed images using magnets and radio waves, allowing for thorough examination of the tumor’s extent within both bone and soft tissues. Pre-scan instructions about eating and drinking, tailored by the healthcare team, are crucial for optimal results.

These tests collectively provide the necessary information to determine the severity and spread of bone tumors, leading to more accurate staging and effective treatment planning. If these tests suggest a tumor, doctors may recommend a biopsy. This procedure is performed to determine if the tumor is benign or malignant, and it’s a critical step in crafting an effective treatment plan.

Staging Studies: To further classify the tumor, staging studies might be conducted. These tests determine the extent of the tumor and whether it has spread to other areas of the body. Accurate staging becomes key to ensuring the best treatment options are considered.

Finally, your doctor will also learn as much as possible about your family’s medical history. This information can lead to better health care for your child. We are here to help, and when it comes to children and their health, we are specialists in this area. Call us for an appointment today. Parents should choose Medical City Children’s Orthopedics and Spine Specialists, with offices in Arlington, Dallas, Flower Mound, Frisco, and McKinney, Texas. At our Medical Practice, our doctors specialize in kids and treat those with Bone Tumors. For their child’s bone tumor care for several compelling reasons. First and foremost, our team of highly skilled and experienced pediatric orthopedic and spine specialists is dedicated exclusively to caring for infants, children, and adolescents.

Why Medical City Children’s Orthopedics and Spine Specialists

Our Doctors will ensure that your child receives the most tailored and age-appropriate treatment available. Additionally, our practice utilizes cutting-edge diagnostic technologies and offers the latest advancements in bone tumor treatment.  This includes minimally invasive procedures, ensuring the best possible outcomes. Finally, we understand the unique emotional and physical needs of young patients and their families, providing compassionate, family-centered care every step of the way. With a commitment to excellence in pediatric orthopedics and spine care, we strive to give your child the best chance for a healthy and fulfilling future.

Steps to Take if Your Child Needs an Appointment or Has Questions About Bone Tumors

If you’re concerned that your child may have a bone tumor or have been advised to seek specialist care, here’s what you should do:
Consult Your Primary Care Doctor: Start by discussing any symptoms or concerns with your child’s primary care physician. They can provide initial assessments and, if necessary, recommend further evaluations.

• Seek Specialist Advice: If a specialist is needed, ask your doctor to refer you to an orthopedic oncologist or a pediatric orthopedic specialist like us who handles bone tumors. These experts can provide a more detailed evaluation and determine whether the tumor is benign or malignant.
• Schedule an Appointment:
  • Call the Specialist’s Office Directly: Use their contact number to schedule an appointment as soon as possible.
  • Online Scheduling Options: Many specialists offer online booking systems that provide greater flexibility in choosing appointment times. Check the specialist’s website for this option.

Prepare for the Consultation:

• Gather Medical Records: Bring any relevant medical records, including recent imaging tests, lab results, and referral notes from your doctor.
• Write Down Questions: Prepare a list of questions or concerns you wish to discuss during the appointment.

Explore Additional Resources: For further information on bone tumors, reputable medical websites and nonprofit organizations typically offer educational resources that can help you understand the condition better. By taking these steps, you can ensure that your child’s health is managed appropriately and all your questions are addressed.

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Footnote:

National Institute of Health: Common Musculoskeletal Tumors of Childhood and Adolescence