BONE AND SOFT TISSUE TUMORS: SYMPTOMS, DIAGNOSIS AND TREATMENT

Musculoskeletal tumors are formations that develop in bones and soft tissues, such as muscles. They can be benign (non-cancerous) or malignant (cancerous), and their behavior depends on their type. Malignant tumors (sarcomas) include bone sarcoma, soft tissue sarcoma, and metastatic carcinoma that has spread to the bones from other organs.

SYMPTOMS OF MUSCULOSKELETAL TUMORS

• Persistent pain in the affected bone
• Swelling or tenderness near the affected area
• Pathological (easy) fractures
• General fatigue and weakness

Soft tissue sarcoma often has no early symptoms, but at a later stage it may present as a lump or swelling and cause pain if it presses on a nerve or muscle.

DIAGNOSIS OF MUSCULOSKELETAL TUMORS

Making an accurate diagnosis requires a combination of imaging methods and laboratory tests. The most commonly used approaches include:

• X-rays: primary method for detecting bone changes and assessing bone structure.
• Computed Tomography (CT): provides detailed images of bones and surrounding tissues; also used to assess whether there is spread to the lungs, liver, or other organs.
• Magnetic Resonance Imaging (MRI): accurately visualizes the outlines and extent of the tumor, including involvement of muscles, vessels, and nerves, aiding treatment planning.
• Bone Scintigraphy (bone scan): a nuclear medicine method that shows whether there is spread to other bones and the degree of damage to the primary tumor.
• PET-CT: combines anatomical and functional information, allowing detection of metastases distant from the original focus.
• Tissue Biopsy: a mandatory diagnostic method; involves taking a sample from the tumor for histological examination and definitive determination of the type and nature of the formation.

CAUSES AND RISK FACTORS

In most cases, the cause of bone tumors is unknown. Some factors that may increase risk include:

• Genetic factors (hereditary syndromes such as Li-Fraumeni, retinoblastoma)
• Previous radiation therapy - especially in childhood
• Other bone diseases - e.g., Paget's disease
• Rapid bone growth - more common in children and adolescents
• Secondary bone tumors - bone metastases are common in breast, lung, prostate, kidney, and thyroid cancer.

TYPES OF BONE TUMORS

Benign bone tumors

• Osteochondroma: the most common benign bone tumor, usually in the long bones of the arms and legs.
• Enchondroma: develops in the cartilage within the bone, most commonly in the hands and feet.
• Giant cell tumor: benign but locally aggressive and growing at the ends of long bones.
• Osteoid osteoma: a small tumor, common in young people, that causes nighttime pain.

Malignant bone tumors

• Osteosarcoma: the most common primary malignant bone tumor, often around the knee.
• Chondrosarcoma: originates from cartilage, more common in adults.
• Ewing's sarcoma: predominantly affects children and young people; can develop in bones or soft tissues.
• Chordoma: a rare, slow-growing malignant tumor that most commonly appears at the base of the skull or spinal column.

Metastatic bone tumors

These occur when cancer from another part of the body (breast, lung, prostate, kidneys, thyroid) spreads to the bones. They are not primary bone cancer but are classified as bone metastases.

TREATMENT OPTIONS

Treatment of bone and soft tissue tumors is a complex and multidisciplinary process that depends on the type of tumor, its localization, stage, and the overall health condition of the patient. The main approaches include:

• Surgical treatment: can range from minimally invasive techniques (curettage, arthroscopy) to extensive operations with reconstructions. The goal is to remove the tumor and preserve function.
• Chemotherapy: often used for malignant tumors, in combination with other therapies.
• Radiation therapy: applied for hard-to-reach localizations or in combination with surgery/chemotherapy.
• Targeted therapy: medications directed at specific molecular or genetic abnormalities.
• Radiofrequency ablation (RFA): a minimally invasive procedure used primarily for small benign tumors.
• Cryotherapy: destroys tumor tissue through freezing.
• Bone marrow transplantation: for some oncohematological diseases, e.g., multiple myeloma.
• Palliative care: for advanced tumors when the goal is symptom control and improvement of quality of life.
• Observation: for small and slow-growing benign tumors.

Timely and accurate diagnosis is key to choosing the right treatment strategy. It is recommended that patients discuss all options with their medical team and, if needed, seek a second opinion to make an informed decision about their health.

Remember, early diagnosis is of essential importance for treatment success. If you have concerns, do not hesitate to consult a specialist for competent medical advice.