Musculoskeletal Tumors
"The origin of osteosarcoma is in some cells that can be altered by the growth of the child. It is a tumor linked to growth".
DR. MIKEL SAN JULIÁN ARANGUREN
SPECIALIST. SARCOMAS AREA
What is a musculoskeletal tumour?
A musculoskeletal tumour is a growth of cancer cells in bone or muscle tissue. A bone tumour is an abnormal proliferation of cells of a particular strain within a bone. They are divided into 2 groups: malignant or benign, depending on their ability to spread (metastasise) to other organs and tissues.
Within benign lesions, there is also a particular group called paratumoural lesions, which are not tumours per se but resemble them. An example of such lesions are bone cysts.
Depending on the cell lineage from which the tumour originates, both malignant and benign tumours are classified into bone-forming, cartilage-forming, giant cell tumours, etc. Each of these tumours has a different prognosis and treatment.
At the Clínica Universidad de Navarra, in the last 25 years we have treated a thousand primary malignant bone tumours. In osteosarcoma, the most common, the survival rate is 74% at 10 years. Ninety percent retain the upper limb. In the treatment of Ewing sarcoma, the survival rate at our centre is 65%.
The Clínica Universidad de Navarra also has experience in the treatment of soft tissue sarcoma, associated with surgical resection using brachytherapy.
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Symptoms of musculoskeletal tumour
The most common symptom of bone and other musculoskeletal tumours is pain in a limb.
It is usually a constant pain, also at night, so that it wakes the patient up. The most frequent location is the knee of a growing child, although it can also appear in the bones of the trunk, pelvis, etc.
It is sometimes accompanied by a rapidly growing lump. It is not usually accompanied by general malaise, fever or other symptoms.
The duration of these symptoms is highly variable, but they usually last a few weeks or months because, unlike benign tumours, they grow rapidly.
Having nocturnal pain is not synonymous with having a sarcoma, but almost all sarcomas begin this way.
The most common symptoms are:
- Pain in the limb
- Pain at night
- Swelling and swelling of the limb
Do you have any of these symptoms?
If you suspect that you have any of the above symptoms,
you should consult a medical specialist for a diagnosis.
Types of thyroid cancer
The cause of most malignant tumours of the skeleton is unknown. However, we know that cancer is a genetic disease, not because it is transferred from parents to children (although this sometimes happens), but because its origin lies in some alteration of the genes that control cell multiplication.
Currently, much progress is being made in the study of these alterations and it is hoped that in the near future action will be taken on the genes that cause it. Countless genetic studies are carried out on the samples obtained from each patient for this purpose.
In some sarcomas (the name for malignant tumours of the musculoskeletal system), the specific genetic alteration that has produced them is known. New laboratory techniques in this field have led to great advances in the diagnosis and prognosis of these lesions and, in the future, will allow more specific treatment for each tumour.
With these genetic studies, some sarcomas can be diagnosed with certainty in less than 24 hours and it can also be determined whether the sarcoma is more or less likely to respond to treatment.
Prognosis of musculoskeletal tumours
The type of tumour, the location, the size, the presence or absence of metastasis at the time of diagnosis, the response of the tumour to chemotherapy, etc. are factors of great importance in establishing a prognosis.
It is essential that the diagnostic process and the start of treatment be as rapid as possible. Delays can compromise the patient's survival.
If a malignant bone tumour is suspected, the most sensible thing to do is to go to an experienced centre, where survival and the chances of limb preservation are greater than in other centres.
At the Cancer Centre Clínica Universidad de Navarra, the survival rate for osteosarcoma is 74% at 10 years, with a limb preservation rate of over 90%.
In the case of osteoid osteoma, percutaneous treatment under CT scan control has led to cure after the failure of open surgery. The same is true for conservative surgery of soft tissue tumours, which in many cases achieves cure.
How are musculoskeletal tumours diagnosed?
The diagnosis of musculoskeletal tumours requires the expertise of a specialised multidisciplinary team. Key imaging tests include plain radiography, which is essential for a first assessment, and magnetic resonance imaging (MRI), useful to determine the local extent of the lesion.
In addition, computed tomography (CT) is used to detect possible lung metastases, bone scintigraphy to identify bone metastases or multifocal lesions, and positron emission tomography (PET) to assess distant lesions and tumour metabolism.
Biopsy is crucial for definitive diagnosis and should be performed by the team treating the patient, preferably by needle puncture techniques to minimise the risk of tumour dissemination.
Tratamiento de los tumores musculoesqueléticos
The numerous medical advances in the diagnosis and treatment of bone tumors allow the limb to be maintained.
A bone tumor is an abnormal proliferation of cells within a bone. In most malignant tumors of the skeleton, the cause is unknown.
Much progress is being made in the study of gene alterations in order to be able to act on them in the near future. Countless genetic studies are being carried out for this purpose on samples obtained from each patient.
The most frequent symptom is constant pain in a limb. The most common location is the knee of a growing child, although it can also appear in the bones of the trunk, pelvis, etc. Sometimes, it is accompanied by a lump that grows quickly.
The diagnosis must be based on the clinical history, images and biopsy. It is essential that the diagnosis and the beginning of treatment be as fast as possible so as not to compromise the survival of the patient.
The treatment of these tumors must also be based on three pillars: surgery, chemotherapy and, sometimes, radiotherapy, for almost a year, although with intermittent hospital admissions. Currently, the possibilities of keeping the limb unamputated are very high.
Within the benign lesions, there is a particular group called paratumoral lesions. These are not strictly speaking tumors, but rather an abnormal proliferation of cells. An example of these lesions are bone cysts.
The osteoid osteoma is a benign bone tumor characteristic of children and adolescents. It is very small in size (like a pea) and causes continuous pain, predominantly nocturnal, which is improved with anti-inflammatory drugs (e.g., aspirin®).
Surgical removal of the tumor has been the classic treatment. However, percutaneous treatment under CT control is on the rise: percutaneous resection or radiofrequency thermocoagulation.
It has the advantages of reducing surgical risk and facilitating correct localization of the lesion. In addition, recovery is much faster (it can be performed on an outpatient basis), does not require immobilization or use of crutches afterwards, etc.
Soft tissue tumors are rare and there are few expert centers.
The delay in diagnosis, the appearance of a recurrence or metastasis can worsen the prognosis, which a specialized center can cure.
They appear in muscle, ligaments, fat, blood vessels, etc., usually in a limb. The most frequent are liposarcoma, malignant fibromo histiocytoma and synovial sarcoma.
The main symptom is a lump in the soft parts of a limb. They are usually painless. As it increases in size it may hurt, especially when pressing on the muscles and nerve endings.
It is diagnosed by means of magnetic resonance. If a lesion is confirmed, a biopsy is performed. And if the tumor is aggressive, a thoracic CT scan is performed to rule out pulmonary metastases.
The treatment is surgical. The Clinic is one of the few accredited centers in Europe to perform hyperthermia with TNF, which has demonstrated a high rate of local control of the disease.
The treatment of some types of sarcoma has also benefited from new drugs, such as STI-571 (Glevec®).
In addition, the introduction of brachytherapy into the treatment protocol makes it possible to reduce the dose of external radiation, thereby reducing the side effects arising from it.
Important lines of research are being developed in molecular biology focused on diagnosis.
Where do we treat them?
IN NAVARRA AND MADRID
The Sarcomas Area of the
Cancer Center Clínica Universidad de Navarra
The Sarcomas Area is one of the most prestigious centers in the world in this field. Its team of professionals is internationally recognized in this field of medicine.
In our center, all diagnostic tests (including biopsy) can be performed, usually in less than 24 hours. We also have teams of highly trained professionals in intra-arterial chemotherapy, brachytherapy, isolated limb perfusion, etc.
Diseases we treat
Why at the Clinica?
- Integral evaluation of the patient.
- Cutting edge technology.
- Expert professionals who are an international reference.
Our team of experts in musculoskeletal tumours
