Before giving information about Musculoskeletal System Tumors, let’s briefly touch on the subject of tumor.
Definition:
Tumor: It means swelling-mass. What should be in a tissue is the excessive growth of a cell or a cell that does not belong to that tissue. By occupying space, the mass may impair or weaken the function of the bone or skeleton and cause fractures by eliminating the load bearing feature.
Classification:
Tumors usually grow painlessly, but all tumors of a certain size cause pain by creating a compression effect or tissue damage. Skeletal system tumors are one of the most feared and disabling oncological problems as they cause loss of limbs from time to time.
Tumors are simply divided into two
1-Good-natured (benign)
2-Malignant (malignant)
The more gentle the treatment of benign tumors, the more comprehensive the surgical approach to a malignant tumor.
1-Benign tumors:
It is called as osteoma, chondroma, myoma, neuroma, which is slightly differentiated from the normal cell and proliferates in the tissue to which it belongs, without exceeding the tissue borders. When this tissue is removed, it usually does not recur.
Recurrent tumors are usually tumors originating from multinucleated cells different from the tissue to which they belong. They do not spread distantly, but as aggressive benign tumors, surgical treatments can spread as wide as malignant tumors. Rarely, radiotherapy, physical agents such as nitrogen or surgical treatment can be combined with drugs.
Tumors that occur with the proliferation of cells different from the tissue they originate form masses in the bones. A different cell growth in the soft tissue is called “Hamartoma”. Such benign structures replace bone cells in tissues such as bone and weaken bone. It can be cyst-like or soft tissue consistency. If these tumors are removed from the bone or tissue with their borders, the treatment is completed. (Fibroma, Angioma are simple bone cysts)
2- Malignant tumors
Tumors originating from bone tissue: It consists of cells that are completely differentiated, having an unlimited tendency to proliferate, regardless of whether they belong to the tissue they are located or not. If the cell source is epithelial, it is called carcinoma, and connective tissue (mesenchymal) is called sarcoma. They can spread to distant tissues through lymph or blood, re-colonize in organs and cause death by disrupting body functions. This percentagen kötü huylu tümörler, evreleme yapıldıktan sonra geniş cerrahiler ile tüm kompartman çıkartılarak tedavi edilmek zorunda kalınabilir. Uzuv kaybına sebep olabilirler.
Tumors that metastasize to the bone: Tumors with sarcoma characteristics that occur in the organs can spread to the bone tissues. They cause painful lytic lesions and mostly occur in the last stage of the disease.
Diagnosis:
After a good physical examination, tumors are determined by blood tests (whole blood, biochemistry), urine analysis, and radiological methods. Direct radiography is very valuable in revealing the bone structure in orthopedic tumors. Methods such as ultrasound and doppler are used in cases of soft tissue and vascular origin.
Magnetic resonance imaging is very valuable in soft tissue tumors and staging.
Bone scintigraphy is effective for determining areas with tumor activity, as well as very valuable for the definition of benign / benign aggressive / malignant.
The final stage of tumor diagnosis is revealed after cell analysis by biopsy. Biopsy can be performed before surgery by removing the cell taken from the area with a needle, or it can be revealed after the entire mass is removed during surgery. Mostly, in benign tumors, the entire tumor is removed without preoperative biopsy and sent to pathology. Rarely, a second surgery may be required for benign tumors.
Treatment of Tumors:
Growth rate and loss of function are taken into account in the treatment of benign tumors. Some tumors may remain painless and unnoticed without affecting the bone’s carrying function. Although these incidentally detected tumors are frightening, they can be followed up radiologically without biopsy, considering the location.
In cases where a definitive diagnosis cannot be made, pathology is revealed with needle biopsy and treatment is arranged. It is sufficient to remove benign tumors from the marginal border to the normal tissue junction. In cases where cells remain, the rate of cancer is determined according to the biopsy result. In this case, the treatment is similar to the malignant tumor treatment approach.
In aggressive benign tumors, the mass is removed by passing to the normal tissue border, but this does not exceed 1-2 cm.
In the treatment of malignant tumors, the tumor should be removed with a 5 cm normal tissue circumference. If there are satellite-satellite lesions in the same compartment, the border will go beyond them. When the entire compartment needs to be removed, if limb salvage methods are not sufficient, amputations and the patient’s life are tried to be saved without metastasis spread.
In malignant tumors, chemotherapy-radiotherapy treatments may be required before and after surgery, depending on the staging. Tumors are tried to be eradicated with a multidisciplinary approach.