Do Not Underestimate Bone Pain That Keeps You Awake and Does Not Ease With Medication!

Bone pains are discomforts that occur once or several times in every person's life and are often ignored.

Yeditepe University Hospitals Orthopedics and Traumatology Specialist A warned that these pains may be confused with growing pains and therefore may be late in diagnosis.

Malignant bone cancers, which start in the cells that make up the bone and are called "osteosarcoma" in medical language, are mostly seen between the ages of 10-14 and after the age of 65. Pointing out that these malignant tumors, which are seen in the part of the thigh and tibia where they form the knee joint, are often seen during the growth period, Yeditepe University Koşuyolu Hospital Orthopedics and Traumatology Specialist added that for this reason, the pain can be confused with growing pains, and this may cause a delay in diagnosis.

Stating that early diagnosis, appropriate treatment, and regular follow-up are very important for osteosarcoma, which is a highly aggressive tumor, Orthopedics and Traumatology Specialist said, "In these pains that develop without any trauma, usually affect the same area, do not disappear  with resting or taking medication, it is necessary to consult a physician without losing time."

Rare but Aggressive

Reminding that osteosarcoma is rarer than other tumors, Orthopedics and Traumatology Specialist said, "It constitutes  0.2 percent to 1 percent of all cancers and 2.4 percent of childhood cancers. The incidence rate is 4-6 per million per year. Despite its rarity, osteosarcoma has an aggressive course and a high tendency to metastasize. On the other hand, 20-25 percent of patients have radiologically detectable metastases. It metastasizes most frequently to the lungs (80%). The second most common site of metastasis is other bone regions."

Genetic Predisposition is Important

Although the factors in the formation of osteosarcoma are not yet clearly known, certain risk factors are thought to be linked to the disease. Stating that defined genetic factors are among the risk factors, Orthopedics and Traumatology Specialist continued his words as follows "Retinablastoma and p53 tumor suppressor genes have been shown to be effective in osteosarcoma formation. In addition, the risk of osteosarcoma increases in Li-Fraumeni, Rothmund Thomson, Bloom, and Werner syndromes. In addition, factors such as Page's disease, chondrosarcoma, and previous radiotherapy, especially in secondary osteosarcoma, can also cause osteosarcoma development." 

"Bone Tumors May Not Present Symptoms Until They Become Detectable"

Stating that apart from genetic factors, gender, racial and ethnic differences are also among the important risk factors, Orthopedics and Traumatology Specialist emphasized that osteosarcoma is 1.5 times more common in men compared to women on average and that it is more common in black/auburn races than in white races.

Stating that tumors seen in the bones are mostly benign and can be detected incidentally in X-ray, MRI, or tomography examinations taken for other reasons, Yeditepe University Koşuyolu Hospital Orthopedics and Traumatology Specialist said, "Osteosarcoma is diagnosed with the patient's clinical history, physical examination, and evaluation of the necessary radiological examinations. X-rays are evaluated in the first plan as radiologic examinations. X-rays are very useful for diagnosis. In addition, contrast-enhanced MRI, including the whole bone, is necessary to evaluate the spread of the tumor, its relationship with surrounding soft tissue, vascular and nerve structures, and the presence of skip metastases (spread to different areas within the same bone). Thorax tomography and whole-body bone scanning are performed to reveal whether there is lung spread."

Treatment Has Yielded Encouraging Results in Recent Years

Underlining that great advances have been made in the treatment of osteosarcoma in recent years, Orthopedics and Traumatology Specialist said, "After the necessary examinations are examined and the diagnosis is confirmed by biopsy, the treatment is evaluated in tumor councils where orthopedic oncology, oncology, radiology, radiation oncology, and pathology departments come together with multidisciplinary work."

Stating that the treatment is performed with a three-stage method including pre-surgical chemotherapy, surgery, and post-surgical chemotherapy, Assoc. Prof. Dr. Başdelioğlu said, "Until the recent past, the only treatment was surgical removal of the tumorous limb, that is, amputation. However, today, limb-sparing surgical treatment is applied in all cases where surgery is possible. Limb preservation rates are above 90% after pre-surgical chemotherapy. The cancer is removed in one piece, including the previously performed biopsy pathway, without seeing any tumor tissue and without entering the tumor, with a certain amount of clean tissue around it. The resulting defect is reconstructed with biological and non-biological methods based on tumor localization and patient assessment. Thus, 5–10-year survival rates have reached satisfactory rates compared to the past in patients receiving combined chemotherapy before and after surgery."


23 February 2023

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