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Terms in this set (49)
A mature bone cell. Maintains the calcium matrix
Cells that dissolve the bone, in other words cells that remodel the bone
Cells that from the bone, it also secrete the matrix
The most common site for primary bone sarcoma
The main shaft of the bone
Knoblike portions at either end of the bone
Thin layer of hyaline cartilage cover the joint
Hard dense covering of the bone
Area in long bones where rapid cell proliferation and remodeling activity
The 2 most common locations for bone tumors (Osteosarcoma)
Distal Femur, and proximal tibia
A condition caused by an abnormal parathyroid gland, resulting in Loss of calcium from bones
Infection of the bone or the bone marrow
Excessive and abnormal bone reabsorption and formation
Risk factors of bone tumors
A. 2 common suppressor genes RB1, TP53
B. Areas of prolonged growth or over stimulated metabolism
C. In most cases patient with Ewing's sarcoma have been found to have a translocation affecting chromosome 11 and 22
Important tool for a diagnosis and prognosis of a bone tumor
Grade for bone cancer
G1 for low and G 2 for high grade
Benign bone tumors
Osteomas, Osteoblastoma, Osteochondromas. Usually treated surgically
The most common osseous malignant bone tumor. More prevalent in tall people. Paget's disease is also a factor
Most common site of osteosarcoma
Arms, legs and pelvis.
Peak incidence of osteosarcoma
Young adults aged 20 to 30
usually develops in cartilage. it is the next most common diagnosed in adults between age 30 to 60
A bone malignancy rarely occurs in bone tissue. Found mostly in Distal femur, Proximal tibia, and Proximal humerus.
Prognostic factors are: Grade, Location, new or secondary lesion. Overall poor prognosis
Giant cell tumors
Usually develops in the bone of the legs or arms. It arises in the metaphysis or epiphysis of the long bones in young adults and have a high propensity for recurrences
A malignant disease of plasma cells. Abnormal resorption of bone causes painful osseous lesions. Arising in the B - Cell lymphocytes of the bone marrow.
Usually in children / adolescents
Metastatic bone disease
Lesions occur most often in spine and pelvis. Common primary sites tends to metastasize are prostate, breast, lung, kidney, and thyroids.
2 of the parameters that indicate a bone lesion's level of advancement
1. Classic sunburst pattern caused by outward growth of bone
2. Osteoblastic or osteolytic pertaining to bone forming cells
Radiation therapy for osteosarcoma
1. Not the treatment of choice because these tumors are radioresistant
2. Preoperative radiation and chemo has been used where surgery wasn't possible.
3. Palliative RT used for pain control or or temporary control of metastases.
A malignant mesanchymal neoplasm that produce cartilage, but no osteoid and may occur in any cartilage - forming bone.
Factors for Chondrosarcoma
1. Histologic grade of tumor ( Most important) with grade scale of 1 - 3 and 3 being the worst
2. Location: If tumor located peripherally, it is more surgically accessible. However if it is in pelvis, sacral area, head and neck surgery my not be possible
1. Post operative RT 66 to 70 Gy with a shrinking - field technique (AKA BOOST)
2. Aggressive surgical procedure using wide or radical excision
3. This tumor has a high incidence rate of recurrence.
Malignant Fibrous Histiocytoma
Arise from Histiocytes ( Type of macrophage found in loose connective tissue. Extremely aggressive tumor and metastases to the lung.
Malignant fibrous histiocytoma treatment
Wide surgical excision followed with RT. Tumors are radiosensitive curable doses 50 - 60 Gy. Trials limited surgical procedures combined with pre and post operative chemo and definitive RT
Giant Cell Tumors most common site
1. In and around the knee
2. Distant femur
3. Proximal tibia
Giant Cell Tumors
1.Treated locally because they rarely metastases.
2. This is a low grade tumor
Giant Cell Tumors RT treatment
RT Dose range from 45 to 55 Gy pratracted over 5 to 6 weeks.
Giant Cell Tumors prognostic factors
Depends on the location and histology ( low grade located in the extremity
1. Second most common primary pediatric bone tumor after osteosarcoma
2. Usually arises in the bone, but occasionally found in soft tissue
Ewing's Sarcoma risk factor
Age ( between 10 and 18 ) Race ( rare in blacks ) Genetic factor ( anomalies of chromosome 22)
Ewing's Sarcoma most common site bone involvement
Ewing's Radiation Technique
1. Irradiate th entire bone to 4500 cGy with two boost of 500 cGy
2. Tailored portals (standard of treatment) bony involvement plus 5cm margin to 4500 cGy , boost 2 cm 5 -10 cGy
Chemo and Ewing's sarcoma
Ewing's sarcoma is extremely sensitive to chemo
Ewing's most aggressive area that surgery might be limited
Pelvis and Spine
The most important prognostic factor listed for Ewing's bone sarcoma
The extend of the disease at the time of diagnosis
1. Myeloma is a low growth fraction tumor with only a small percentage of tumor cell in the cycle at anytime
2. Characterized by an increased proliferation of plasma cells.
3. Appears as lytic lesions ( bone destruction)
Multiple Myeloma treatment RT
1. TBI used for unresponsive patient
2. 30 Gy in controlling the pain inmost patient ( Relief of spinal cord compressions )
Metastatic bone disease
Not curable, prognosis depends on primary site, histology, and degree of metastases at the time of diagnosis.
2. Treatment is usually palliative.
3. Appear as an Osteoblastic lesion characterized by an increased radiographic density.
Metastatic bone disease treatment
Strontium 89 has provided excellent results in bone - pain relief for patients with prostate and breast cancer metastatic to bone
Metastatic Bone lesions appearance sites
Vertebral bodies, Pelvis bones, and ribs.
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