Malignant bone tumors can be primary or secondary. Primary tumor that develops from the bone tissue, called osteosarcoma. If it affects the cartilage chondrosarcoma arises. Often affects the long bones: the femur, humerus, tibia.
Secondary sarcoma - the result of metastasis of malignant tumors of other organs, eg, prostate, lung, breast.
The risk of developing bone sarcomas increase injury, genetic predisposition, Paget's disease, radiation therapy.
Osteogenic sarcoma often affects children and young people. The risk of disease also increases after the age of 65.
Diagnosis of bone cancer in Israel
During the examination the doctor collects history. Also performs inspection and planning laboratory studies and a number of other diagnostic tests. Let us consider them in more detail.
Methods of Medical Imaging
- X-rays reveal the location, size and shape of the tumor in the bone tissue. If the X-ray suggested the presence of the abnormal area, the doctor will prescribe additional methods. Even if there is an indication of benign neoplasms, continue diagnosis, especially when the patient experiences unusual or persistent pain.
- bone scan is a kind of inspection, in the course of which a small amount of radioactive material injected into the blood vessel, it is spread through the bloodstream and accumulate in the bone tissue. Identify it with the scanner.
- CT examining body, creates a series of detailed images of certain areas within it, taken under different angles and creates a computer which is connected to the X-ray machine.
- MRI - Diagnostic methods used a powerful magnet linked to a computer to create detailed pictures of internal organs without using X-rays.
- PET - inspection method, in the course of which the radioactive material - fluorodeoxyglucose (biological glucose analog) was administered into a vein, and a scanner is used to create a more accurate, computerized images of internal organs where glucose accumulates. Cancer cells absorb more of the substance than healthy. The resulting images accurately represent the localization of abnormal cells.
- An angiogram is a X-ray examination of blood vessels.
Biopsy - a procedure to remove a sample of tissue from the bone tumor, to determine whether cancer is present. The surgeon can perform a fine needle or incisional biopsy. During a biopsy he makes a small hole in the bone tissue, and removes the sample from the tumor using a needle as a tool. During incisional biopsy surgeon performs an incision in the tumor and removes a sample of tissue. Biopsy carries a specialist in orthopedic oncology. Then studied tissues for the presence of pathological cells in vitro.
Blood tests determine the level of enzyme in the body called alkaline phosphatase. The high level of the substance present in the blood when the cells that form bone tissue, become active, - during the growth of children, when splicing a broken bone, or when the disease or tumor elicits abnormal bone tissue. The increased amount Since of the enzyme is considered the norm for growing children and adolescents, this test is not considered as a valid method of diagnosis of cancer of bones in Israel .
What are the treatments for bone cancer in Israel apply?
Depending on the type and stage of the disease therapy program may include several methods. The main methods of treatment of bone cancer are surgery, radiation therapy, chemotherapy, targeted therapy.
Surgery in the treatment of bone cancer in Israel
Surgeryis the main (main) process therapy. Surgical intervention may be required and the diagnosis - for biopsy. The main purpose of the medical operation is the most complete removal of a malignant tumor. The surgeon resected the tumor plus a segment of the healthy tissue surrounding it - "wide excision." Later, the tumor studied under a microscope for cancer cells on the edges of the fabric. If they find a field called positive - if not negative. Doctors at theclinic Assuta as far as possible using special techniques to minimize the amount of removed tumor to healthy tissue.
Improvement of surgical techniques and preoperative tumor treatment have made it possible for the majority of patients with bone cancer in the limbs (arm or leg), not to resort to radical surgical intervention - removal of the entire limb. Despite this, most of the patients who go through sparing surgery, reconstructive surgery is required later to restore maximum function of the limb.
Radiation therapy in the treatment of bone cancer in Israel
Radiation therapy, also called radiotherapy or irradiation, involves the use of high-energy X-rays in the treatment of oncology .
Most types of bone cancer is not easy to destroy by means of radiation, high doses that can cause damage to healthy structures. That is why the radiation therapy is not used as the primary treatment, with the exception of Young's tumor. Often radiation is indicated for inoperable cancer of the bone, as well as after surgery if the cancer cells were present at the edges of the tissue removed. In case of relapse radiotherapy helps to control symptoms such as pain and swelling.
For When the treatment of bone cancer in Israel are Used IMRT technique's and gifts proton radiation therapy, the the latter is particularly Useful in the treatment of chondrosarcoma of the base by skull and the chord.
Targeted therapy in the treatment of bone cancer in Israel
Targeted agents act on the molecular and genetic changes in cells that cause cancer. Especially useful for this type of therapy chordoma and other types of malignant bone tumors, where the chemotherapeutic treatment ineffective.
Imatinib (Glivec ®)
Chordoma may have mutations in the genes (PDGFRB, PDGFRA, c-kit), which produce proteins that promote cell growth. Imatinib (Glivec ®) suppresses signals from these genes. Stops tumor growth, as well as it can be reduced in volume. The medicine is indicated for the treatment of common forms chordomas or relapse.
Denosumab (Xgeva ®)
Denosumab (Xgeva ®) is a monoclonal antibody that binds to a protein called RANK ligand. This protein indicates cells osteoclasts break down bone, but when the drug affects the signal is blocked. Denosumab helps reduce large tumors in the bones, recurrent after surgery or those that can not be surgically removed.
For Chemotherapy the treatment of bone cancer in Israel uses anticancer drugs (cytostatics). When given diagnosis is assigned in most cases , a combination of drugs. However, chemotherapy is currently used to treat chondrosarcoma.
Cryosurgery uses liquid nitrogen for freezing and destroy malignant cells. It is sometimes replaced by a conventional operation to destroy the tumor.
Chemotherapy for bone cancer in MC Assuta
Chemotherapy - a method that for the treatment of malignant tumors involves cytotoxic drugs, primarily as a systemic therapy. Drugs through the bloodstream spread find abnormal cells throughout the body and destroy them.
Chemotherapy for cancer of bones held:
- Before surgery or radiotherapy to reduce tumor size.
- After surgery to destroy any remaining cancer in the segments of the body and reduce the chances of cancer returning.
- As a primary treatment with radiotherapy or separately if the tumor is located in the area of inoperable (spine or pelvis, for example).
- To relieve pain or to control symptoms of metastatic bone cancer (palliative chemotherapy).
Chemotherapy with bone cancer
More often than other cytotoxic agents for the treatment of bone cancer in Israel is used:
- High doses of methotrexate. Leucovorin give extra to protect healthy cells from damage and reduce the severity of side effects.
- Doxorubicin (adriamycin).
- Cisplatin (Platinol AQ).
- Ifosfamide (IFEX). Mesna (Uromitexan) is assigned to prevent problems with the urinary tract and bladder, to protect against damage caused by ifosfamide.
- Etoposide (VePesid).
- Cyclophosphamide (Cytoxan, Procytox).
- Vincristine (Oncovin).
In most cases, the following combinations of chemotherapeutic agents are used:
- cisplatin, doxorubicin and high-dose methotrexate;
- cisplatin and doxorubicin.
In the treatment of Ewing's sarcoma - the most common combination chemotherapy - vincristine, doxorubicin, and cyclophosphamide (VAC), alternating with ifosfamide (and mesna) and etoposide (IE).
If bone cancer does not respond to chemotherapy or recurs following cytotoxic agents can be used:
- ifosfamide and mesna, with or without etoposide;
- cyclophosphamide and topotecan (Hycamtin);
- Irinotecan (Camptosar) and temozolomide (Temodal).
Possible side effects of chemotherapy include bone cancer:
- bone marrow suppression;
- nausea and vomiting;
- loss of appetite;
- pain in the oral cavity;
- hair loss;
- constipation, diarrhea;
- skin rash;
- damage to organs (heart, lung, liver, kidney, bladder).
Treatment of osteosarcoma in the Assuta
The treatment program will depend on whether it is localized or metastatic tumor.
The tumor is only bone, may also be in the tissues adjacent to it. Allocate resectable and inoperable sarcoma.
Most of sarcomas have a high degree of malignancy, which means that they are able to grow rapidly and spread.
Localized resectable osteosarcoma
Resectable tumors can be surgically removed, the disease will not penetrate into other parts of the body. Surgery - basic treatment method in this case. Low-grade tumors usually is. Types of operations:
- Sparing surgery.
- rotary plastic
Chemotherapy can be offered with localized resectable osteosarcoma, usually before the operation, but also after to rid the body of remaining malignant cells.
Localized inoperable osteosarcoma
In this case, the cancer has not spread to other parts of the body, but the tumor can not be completely removed surgically. It may be too large or is located close to vital organs.
The primary bone cancer treatment in Israel are invited, usually chemotherapy. If the tumor is reduced to a resectable size, used surgery.
When osteosarcoma remains inoperable after cytostatic treatment, radiation therapy is used to control symptoms such as pain.
At the time of diagnosis have any secondary foci. Metastases generally affect the lungs.
First, in most cases refer to chemotherapy. If the surgeon believes that all metastatic tumors are resectable after cytostatic treatment of bone cancer in Israel, they are removed. It may take several surgeries to resect all the lesions.
If the tumors are inoperable, radiation used to control pain.
Recurrence of osteosarcoma
Osteosarcoma can return after treatment. In rare cases, the tumor arises on the site of the original focus - local recurrence. But most of the secondary tumor develops in the lungs.
If possible, the operation is carried out to remove the tumor or tumors. When osteosarcoma recurs in the same place - on the arm or leg - sparing surgery is recommended after the amputation. Treatment of bone cancer in Israel cytotoxic drugs may be proposed for recurrent osteosarcoma, to control tumor growth. Radiation therapy helps control the symptoms of the disease.
Treatment of bone cancer in Israel - chondrosarcoma
Surgery is used as the primary method of treatment of chondrosarcoma. Types of operations:
- Surgical resection.
- Sparing surgery. This technique is used when possible, in Kaposi's arm or leg.
- Ablation is carried out if sparing surgery can not be performed and the limb is not possible to restore.
- Curettage is used in low-grade tumors.
Radiation therapy can be offered at a chondrosarcoma. External radiotherapy is carried out before and after the operation:
- When tumors that can not be removed surgically because of their location.
- When high-grade tumors.
Treatment of bone cancer in Israel - Ewing's sarcoma
therapy program will depend on whether the tumor is localized or widespread.
Localized Ewing's sarcoma
The tumor is located in the bone, without prejudice to the nearest lymph nodes, can penetrate the soft tissue near the affected bone.
Chemotherapy is the primary treatment of localized Ewing's sarcoma. Treatment of bone cancer in Israel, cytotoxic drugs used in the majority of people, because there is often a hidden metastatic lesions. The cancer cells spread from the initial outbreak in other parts of the body in such small amounts that screening or other diagnostic tests can not detect them.
Chemotherapy with bone cancer performed before surgery or radiotherapy to eliminate micrometastases and possible existing micrometastases, reduce swelling. Also cytotoxic drugs given after surgery and radiation therapy to kill any remaining malignant segments.
Radiation therapy can be offered with localized Ewing's sarcoma.
- Radiotherapy is used instead of surgery, if in connection with the location the tumor is inoperable, or when surgery carries serious risks.
- Irradiation is given after surgery if the operating band edge contain cancer cells, or when the surgeon can not remove an adequate supply of tissue around the tumor.
Surgery is used for localized Ewing's sarcoma after chemotherapy:
- Sparing surgery.
Metastatic Ewing's sarcoma
Metastatic sarcoma metastasizes already at the time of diagnosis. Basically it is - the lungs, other bones or bone marrow.
First of all, as a rule, it is carried out chemotherapy for bone cancer. Also used radiotherapy to the original tumor and secondary foci. When lung metastases can be given to light irradiation. Surgery is used to remove visible foci Ewing's sarcoma.
Relapse Ewing sarcoma
In rare cases, relapse is observed in the original tumor - local recurrence. Typically, new foci arise in other parts of the body, most often - in the lungs.
Treatment of relapsed Ewing sarcoma depends on the location, extent relapse prior therapies, individual features of the patient's body.
It may be offered chemotherapy, radiation therapy to reduce the symptoms of bone disease.
Do I need further treatment? What does it involve?
Treatment is required. bone cancer sometimes metastasizes, particularly in the lungs, in addition, it can occur in the same place or in other bone tissues in the body.
After treatment, you should regularly consult a doctor immediately and report any unusual symptoms. Subsequent actions are due to type and characteristics of the disease. Patients often undergo diagnostics - regularly pass a blood test and perform X-ray examination. Those who are cured, especially in children and adolescents, there is an increased risk of developing another type of cancer later, for example, leukemia.