Questions about Orthopedic Oncology and Onsurgery
Welcome to our Frequently Asked Questions page, dedicated to clarifying common questions about oncology and oncological surgeries. We are committed to providing accurate and understandable information to help you better understand your diagnosis and treatment process.
– The growth of any tissue in our body, beyond normal, characterizes a tumor (neoplasia = new growth). For example: any mole on the skin, a wart, a “pimple” (acne), are tumors. They are growths of altered tissues in our body. Is this supposed to SCARED? No. This is not our goal. We want to clarify how to avoid heart attacks when you hear the word “tumor.”
– The name itself says it: it is a lesion that looks like a bone tumor, but it is not. For example: the simple bone cyst. It is an injury to the bone that does not produce any tissue. There is only one cavity, filled with liquid that appears on radiographic images as a lesion (bone tissue failure) that can be confused with true bone tumors.
– The cells in our body are constantly multiplying. Our skin “peeles” continuously, our red blood cells (red blood cells) are constantly reproducing (red blood cells are renewed every three months on average), all body tissues are renewed, even bone tissue. Therefore, the reproduction of cells is a continuous fact in our organism. When our body produces “more” tissue than necessary, a tumor forms. The cells of this tumor may be identical to normal cells, in which case a benign tumor is formed. For example: a lipoma is a benign tumor formed by lipocytes (fat cells). Benign tumors, therefore, come from our own body’s cells, which have gone into reproduction to replace old cells, but there has been a failure in quantity.
– In this case, in addition to the failure in quantity, there is also a change in the quality of the reproduced cells. At the time of reproduction, cells undergo a process of duplication of genetic material and subsequently cell division. If cell duplication or division fails, the result will be a “new cell”. This new cell may be similar to the one that was reproducing, but it is not the same and, therefore, does not have the same function as the previous one. It has no control over its reproduction, as its genetic material has been altered. When this cell manages to reproduce, it forms a malignant tumor. This tumor is named after the primitive cell that underwent genetic alteration when multiplying. The diagnosis is made by the similarity between the cells. Malignant tumors, therefore, also come from our own body’s cells, which began to reproduce to replace old cells, but in addition to a failure in quantity, there was also a failure in quality.
– To name tumors, the World Health Organization agreed that the suffix oma should be added to designate benign tumors: lipoma, osteoma, fibroma, etc. For malignant neoplasms (malignant tumors) of the musculoskeletal system, the suffix sarcoma is added: liposarcoma, osteosarcoma (primary malignant bone tumor), fibrosarcoma, etc. The term carcinoma was reserved for malignant neoplasms of tissues whose primitive cells originated from the ectodermal layer (in the embryological formation of the human body there are three layers: ectoderm, mesoderm and endoderm). The most common examples are: breast carcinoma in women and prostate carcinoma in men.
We use the term bone tumor to define all types of neoplasia that appear in bone tissue.
– Some benign bone tumors may be hereditary, such as osteochondromatosis (multiple osteochondromas), but the majority of neoplasms result from changes in cell reproduction that we have already discussed.
– Some factors are known, such as radiation and viruses, but generally failures occur due to occasional, unknown factors.
– No. Our body has a “quality control” system made up of cells that have the function of recognizing those that have become malformed and destroying them. Malformed cells constantly occur in the various processes of cell reproduction, which are automatically eliminated by our “quality control”. In this way, we verified that for a neoplasm to occur, reproduction must occur and, at the same time, the quality control system must fail.
– This is very relative. It is common to hear this question in our office. However, I don’t know any family that doesn’t have an affair. The fact is often not reported due to prejudice. I believe it is even a cultural aspect. We don’t like to admit cases of contagious diseases, tumors, homosexuality, separations, “unexpected” children, suicide, alcoholism, addicts, etc. But don’t feel exclusive or be surprised: 99.9999… % of families have these occurrences. The fact is that we try to report only the prodigious facts.
– This is correct. In reality, we all have a “place of least resistance”. That is, that organ may be more sensitive, more fragile, it is an “Achilles heel”. Eventually we had a failure in the formation of that organ, perhaps we inherited this failure and could also pass it on to our descendants. In this case, the probability of failure in the reproduction of this organ “x” may be greater than that of other reproductions in our organism. But this does not necessarily mean that if we have a tumor it will occur in organ “x”, much less that we will have a tumor. We have some “Achilles’ heels” that are particular to each one.
The tumor is primitive when it is in the organ that produced it. For example: When examining the breast, a tumor is found and the anatomopathological examination reveals that it is a breast tumor. In this case, the lesion is located in the primitive organ of origin.
– Continuing the example from the previous question, if we find a lesion in the bone and the anatomopathological examination reveals that it is a breast tumor, this means that this lesion did not originate in the bone. There certainly is or was a primitive tumor in the breast and some tumor cell broke off, reached the bloodstream and managed to lodge in the bone. There in the bone, it continued to reproduce, causing the injury. Therefore, a tumor originating in the breast, located in the bone. This is a metastasis (goal = distant; stasis = stop). Metastasis of a breast tumor into the bone.
– It depends on the type of tumor. There are tumors that can be treated exclusively surgically. They do not respond to chemotherapy or radiotherapy treatment. Others are chemotherapy treatment or a combination of chemotherapy – surgery and/or radiotherapy.
– Yes. Just as a failure occurred in the reproduction of cells in that organ, this can be repeated. Another situation is when it was not possible to remove it completely during surgery.
– The chemotherapy drug works by blocking cell reproduction. This block is not specific. The drug blocks the reproduction of all cells in our body (reproduction of red blood cells, white blood cells, epithelial cells (covering the skin, mouth, digestive tract, etc.), and others, as well as blocking the reproduction of tumor cells The hair cell, therefore, also suffers, resulting in temporary hair loss. With the blockage of blood cell reproduction, anemia occurs, resulting in the patient’s pale appearance when chemotherapy is stopped. anemia and hair grows back. With constant progress in oncology, chemotherapy drugs are being developed that act more closely on tumor cells and have less effect on normal cells in the body.
– Most bone tumors, diagnosed early and treated appropriately, are cured.
– No. Bone tumors represent only 1% of all neoplasms.
– Pain first. Increase in volume, “swelling”. Discreet local heat (due to increased metabolism, due to cell reproduction) and over time some functional limitation (decrease in joint movement), and fractures may even occur at the site of the bone injury.
– Firstly through history and clinical examination. This is fundamental. Subsequently, based on the patient’s complaint and the examination findings, the doctor will request additional tests, according to the suspected diagnosis/s made with the history and clinical examination.
– The specialist doctor in the area will request the necessary tests, relevant to each case. Generally speaking, the most frequently requested are:
Blood count; erythrocyte sedimentation rate, calcium measurement, phosphorus measurement, alkaline phosphatase measurement, PSA (prostate specific antigen) measurement and protein electrophoresis, among others.
Plain x-rays of the injury, chest x-rays, bone mapping, tomography, magnetic resonance imaging, among others. Biopsy: for anatomopathological examination.
– The anatomopathological examination is that carried out on the material collected from the tumor. This material can be obtained through a biopsy (removal of a sample, fragment, of the tumor) or the study of the entire tumor, which was surgically removed. First, the material is prepared and then analyzed using a microscope.
– The most common benign bone tumor is osteochondroma. The most common malignant primitive bone tumor is multiple myeloma, which originates from bone marrow cells that produce antibodies called plasma cells. In second place is osteosarcoma.
– The most common benign bone tumors are osteochondroma, osteoid osteoma, chondroma, chondroblastoma, giant cell tumor, among others.
– The most frequent pseudo-tumor lesions are simple bone cyst, aneurysmal bone cyst, non-ossifying fibroma, fibrous dysplasia, eosinophilic granuloma and brown tumor of hyperparathyroidism.
– The most frequent malignant bone lesions are bone metastases, resulting from primitive tumors of the breast, prostate, lung, thyroid or kidney. The most common primitive bone tumors are multiple myeloma, osteosarcoma, chondrosaccoma, Ewing’s sarcoma, liposarcoma, malignant fibrous histiocytoma, among others.
– These are tumors that affect the cellular tissue of the subcutaneous tissue, muscles, vessels, nerves, in short, all the tissues that make up the locomotor system with the exception of bone tissue.
– The most common benign soft tissue tumor is lipoma and the malignant tumor is liposarcoma.
Current treatment for both osteosarcoma and Ewing’s sarcoma consists of preoperative chemotherapy, followed by surgery to completely remove the tumor, with an oncological safety margin and complementation with postoperative chemotherapy.
– Oncological surgery means that after pre-operative chemotherapy (in which three cycles are performed, on average) the tumor must be completely removed. To do this, it is necessary that the lesion is removed with a covering of healthy tissue around it, to try to avoid local recurrence of the tumor.
– It is the reappearance of the tumor in the same location, which can occur in both malignant tumors and aggressive benign lesions.
Some types of neoplasms may present primarily as bone metastases.
– When a tumor cell detaches and reaches the bloodstream, our immune system, which performs “quality control”, generally eliminates this cell. If, however, the tumor cell manages to “deceive” our immune system, it may lodge itself far away (meta) from the organ of origin, in the different tissues of the body, but generally ends up stopping (stasis) preferably in one of the main “filters”. of the organism. The first major filter is the lung, through which the entire blood stream constantly passes. The second major filter is the liver, mainly for the digestive system and the third major filter is the musculoskeletal system. Bone tissue has a sinusoidal circulation (of small blood vessels, capillaries), in which the passage of the bloodstream is very slow, facilitating the “stasis” (stopping) of the tumor cell.
– It depends on the type of primitive tumor, the size of the lesion, its location, etc. In general, when metastases occur in the long bones (humerus, femur, etc.), presenting a risk of fracture, they must be operated on, replacing the diseased area with an internal prosthesis, avoiding the discomfort of the fracture. In this situation, the patient can return to walking and performing their functions within a few days.
– Firstly, breast tumors in women and prostate tumors in men. Next, lung, thyroid and kidney tumors represent, most frequently, the source of metastatic lesions (presenting in a similar way to a bone tumor) to the bones.
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