Symptom of bone cancer. How long do people live with bone cancer? Neoplasms in the ilium: enostosis, osteoid - osteoma, hemangioma, enchondroma, osteochondroma

Osteosarcoma

This is the most common neoplasm that develops primarily and affects the bones of the upper and lower limbs. The risk group consists of young people under thirty years of age. This form is rarely diagnosed in patients after forty years of age. It is characterized by an aggressive course, rapid development of metastases and an extremely low degree of differentiation of its own cellular structures.

Chondrosarcoma

This is an oncological neoplasm that originates from cartilage tissue, which is located on articular surfaces bones. Its most common localization is the ribs, pelvic joints, and the girdle of the upper limb. The risk group in this case is the elderly. The development of this tumor is associated with constant trauma at the site of its origin. The spine and intervertebral discs, in turn, are affected extremely rarely. Despite the fact that there is a large accumulation of chondrocytes.

Fibrosarcoma

It is the most commonly identified pathology bone tissue. Development originates from soft connective tissue structures such as periosteum, ligamentous apparatus, and cartilage. The most typical location is the area upper limbs and wings lower jaw. Most often, female patients between the ages of thirty and forty are affected.

Chondroma

Chondroma grows from cartilage tissue; they represent a fairly aggressive class of tumors. There are both bones growing inwards and outwards, which are called Ec- and En-chondromas.

Ewing's sarcoma

It can develop in absolutely any bone structure of the human body. Most typical place its localizations are considered tubular bones lower or upper extremities, pelvic bones, collarbones. The prognosis for this disease is generally unfavorable, because metastasis is very early due to its close location to the lymphatic and blood vessels. Secondary damage to other organs and tissues develops even before the manifestation of the characteristic clinical symptoms. Metastases most often develop in the brain. The risk group consists of children and adolescents whose bone growth zones are actively working.

The pelvic bones are organs of secondary ossification that pass through the stage of cartilage in a child only after he is born. This suggests that the pelvic bones, hip bones, and hip joint can be affected by osteosarcoma arising from bone elements, as well as from cartilage tissue.

Pelvic cancer femur

It also exists from flat epithelial cells (, adenoid cystic carcinoma) and connective tissue cells (chondrosarcoma, angiosarcoma and others).

Attention! The hip joint is formed at the junction of the bones: the femur and the pelvis. This oncological process is called either hip cancer, but not cancer hip bone, since it does not exist in the human body.

A little about the anatomy of the pelvic bones

The section of the skeleton connecting the torso and legs is called the pelvis. Bone pelvic girdle consists of two sections: large upper and small. The pelvis is formed by two innominate bones, the sacrum and the coccyx. The joints connect them into a ring, forming the pelvic cavity. Sarcoma pelvic bones or bone cancer can be localized in each of the constituent bone elements of the cavity, the hip joint. It connects the legs through the femur and the pelvic acetabulum.

Attention! In children under 16 years of age, the pelvic bone is made up of three separate bone elements. These are the bones: ilium, ischium and pubis. Cartilage connects them together. At an older age, three bones fuse into a single bone conglomerate.

The pelvis not only bears the entire weight of the torso, head, upper limbs, provides support and promotes movement, but also protects the organs located in the cavity: , . In these organs it can develop as a secondary cancer resulting from metastasis of bone tumors. Conversely, a secondary disease (bone cancer) often develops from metastases from the pelvic organs.

Informative video:

Sarcomas of the pelvic bones: the most common types of tumors

The modified WHO classification distinguishes the following types of sarcomas of the pelvic and femoral bones: osteosarcoma, chondrosarcoma, Ewing's sarcoma, fibrosarcoma and fibrous histiocytoma. There are also other types of bone tumors, but they are very rare.

Bone tumor belongs to a heterogeneous group of cancer of the pelvic bones, with differentiation towards hyaline cartilage, elements of myxomatosis, ossification and calcification. Chondrosarcoma can be primary or secondary. The tumor usually grows towards the bone marrow space. As a result of the oncological process, cartilaginous lobules acquire a histologically irregular shape and size. They are separated by fibrous tissue or bone beams. The degree of malignancy is determined by the severity of the cells, the size of the nuclei, hyperchromatosis, the presence of mitoses and necrosis.

The development of peripheral (periosteal) chondrosarcoma occurs on the bone surface, and not in the bone marrow cavity. It contains a mesenchymal component and resembles a differentiated cartilaginous tumor (enchondroma, low-grade chondrosarcoma) when combined with malignant fibrous non-cartilaginous histiocytoma (osteo-, fibro-, rhabdomyosarcoma).

Mesenchymal bicomponent chondrosarcoma consists of undifferentiated round small cells (as in Ewing's sarcoma) and islands of hyaline cartilage of intermediate differentiation.

Clear cell chondrosarcoma consists of fields of light cells, sometimes pinkish, like chondroblasts. They are located around islands with hyaline cartilage, which has varying degrees maturity. Often include low-grade chondrosarcoma foci, multinucleated giant cells, bone woven, and aneurysmal bone cyst-like areas.

Osteogenic sarcoma of the pelvic bones is the most common. It can be classical, telangiectatic, small cell, superficial, multifocal, parossal (superficial with a high degree of malignancy), intracortical. The malignancy of the formations can be low and high. It affects the male population to a greater extent (up to 60%) at the age of 25 years. Osteogenic sarcoma of the femur occurs most often. In 91%, long bones are affected.

Osteosarcoma classic

This type consists of a wide variety of cells: spindle-shaped, sharply anaplastic polymorphic, epithelioid (similar to plasma cells), oval, small round, light, mono- and multinucleated giant. Two or more cell types may combine to cause hip cancer. When diagnosing, osteoid should be identified with fibrin and amyloid, since fibrin consists of a dense amorphous intercellular pinkish mass.

Since classical osteosarcoma produces cartilage and/or connective tissue, it is divided into three types:

1. chondroblastic, with a chondroid matrix from hyaline cartilage located between elements without cartilage;
2. fibroblastic, with a minimal amount of osteoid, it consists of spindle-shaped cells;
3. osteoblastic sclerotic variant: osteoid and bone represent the matrix.

Classic osteogenic sarcoma of the thigh and hip joint has subtypes similar to osteoblastoma, chondromyxoid fibroma, clear cell, and rich in giant cells.

Osteogenic sarcomas never form from patellar cells.

Small cell osteosarcoma

Small cell and sarcoma are recognized by small round cells and a certain amount of osteoid - the main diagnostic marker. Central small cell osteosarcoma, with a core of collagen-producing spindle cells, has low malignancy. The cells are located between the beams of the bone. In the presence of high cellular differentiation, the tumor is similar to fibrous dysplasia or desmoplastic fibroma. Secondary oncological processes develop against the background of Paget's disease, radiation, and after surgery.

Osteosarcoma parosteal (periosteal)

This rare tumor occurs in 4% of all cases of sarcomas. It develops over a long period of time and is located on back surface femoral bones, has low malignancy. Can be found in the bones of the pelvis, scapula, and. Development occurs outside the bone, but there is a close connection with the underlying bone tissue and periosteum. Often the tumor is covered by a capsule, but it is possible that it can grow into the nearest muscle tissue.

Due to the similarity of structure with soft tissue analogues, it is required differential diagnosis to distinguish from (if there are giant cells) and desmoplastic fibroma with a lower number of cells and number of mitoses.

Occurs in long tubular, femur and pelvic bones. It is characterized by a long, asymptomatic period, which is why fibrosarcoma is discovered only after six months to a year, or even more. Metastases occur within the first 5 years. The affected area includes lungs, bones, soft fabrics. The X-ray picture shows lytic foci that are located in the center or along the edge of the bone. The tumor spreads along the axis, along the bone marrow canal. The presence of an extraosseous component is characteristic; no periosteal reaction is observed.

To make an accurate diagnosis, a biopsy with morphological examination is required. In this case, it is often necessary to resort to open trepanobiopsy in order to obtain enough material, since it is not always possible to determine the type of tumor from the material obtained by the puncture method. Fibrosarcoma is similar in structure to fibroma and fibrous histiocytoma.

This tumor often develops in soft tissue. It may initially affect the pelvic organs, and then spread to the bones. It often occurs in the lower part of the femur. Morphologically it consists of fibroblastic and histiocytic components. Characterized by pronounced polymorphism and lack of signs of differentiation, which makes fibrous hysitocytoma very malignant. On the X-ray picture, as a rule, one can see an osteolytic lesion located eccentrically. The tumor destroys the cortical bone and grows into the surrounding soft tissue.

The tumor is classified equally as a benign formation (due to its slow development and rare metastasis outside the oncological process) and a malignant formation due to the development of complications and frequent relapses. It is rare (1%) and develops from residual cells of the embryonic notochord. In the male population 40-60 years old, the sacrum, which belongs to the pelvic bones, is affected.

Chordoma comes in three forms:

1. chondroid, less aggressive;
2. undifferentiated, prone to the spread of metastases and more aggressive;
3. ordinary.

The formation consists of round small cells and has different neuroectodermal differentiation. Primary and adult/PNET occurs in 68%, the remaining percentages are secondary tumors. The formation cells are PAS-positive. Recognized by the presence of the CD99 marker and characteristic necrosis.

This type of tumor very often affects the bones of the hip and pelvis. It is classified as grade 4 malignancy. Ewing's sarcoma is distinguished by its rapid growth rate and aggressiveness: already in the first year the tumor reaches large sizes, spreads deep into the bone and soft tissue, and begins to form distant metastases.

Due to its similarity to other small cell malignancies, Ewing sarcoma is difficult to differentiate. To make a diagnosis after a biopsy, immunohistochemical analysis and light microscopy are performed.

Stages and grade of malignancy of bone sarcoma

To determine malignancy and histological staging, there is a TNM classification.

T – primary oncological process (magnitude of tumor formation):

• Tx – it is impossible to determine the size of the tumor;
• Then – there is no data on the size of the tumor;
• T1 – malignant tumor does not exceed 8 cm;
• T2 – formation exceeds 8 cm;
• T3 – 2-3 unrelated tumors were detected.

N – regional (local) lymph nodes:

• Nx – regional lymph nodes were not examined;
• N0 – no data on lymph node involvement;
• N1 – defeat regional lymph nodes.

M – distant metastases:

• Mx – it is impossible to study metastases;
• M0 – no data on metastases;
• M1 – metastases detected:
  • M1a – pulmonary;
  • M1b - other localizations.

G - histological staging (grade of malignancy):

• Gх – no data;
• G1 – high tumor differentiation (low malignancy);
• G2 – moderate differentiation;
• G3 – low differentiation (high malignancy);
• G4 – undifferentiated formation.

Additionally, for hollow organs, the degree of germination of their walls has been introduced:

• P – penetration;
• P1 – does not extend beyond the mucous membrane;
• P2 – the formation has grown into the submucosa;
• P3 – growths into muscles were detected;
• P4 – there are germinations serous membrane and going beyond the organs.

The classification is divided because the T-stage is influenced by the largest diameter of the cancer formation, and not by its extent on the periosteum. To take into account metastases, the T3 stage was introduced, and the M1 stage was divided into pulmonary metastases and other distant ones. More than 80% of bone sarcomas belong to the second stage.

Bone sarcoma stages and malignancy (G):

• IA - T1N0M0 G1, 2(low);
• IB - T2N0M0 G1, 2 (low);
• IIA -T1N0M0 G3, 4(high);
• IIB - T2N0M0 G3, 4(high);
• III - T3N0M0 any G;
• IVA - any T, N0, M1a, any G;
• IVB - any T, N1, any M, any G.

In addition to 4 degrees of malignancy, only 2 can be used: low and high. These data are presented in the table

Note! Ewing's sarcoma is graded as G4.

Causes of cancer of the pelvic and hip bones

What causes sarcoma of the hip joint? Unambiguous causes of oncology are under study.

Presumably the causes of bone cancer or the negative factors influencing the occurrence of formations are as follows:

• rapid growth of bone tissue in adolescents;
• injuries received;
• carcinogens and radiation;
• harmful chemicals;
• viral diseases and precancerous bone conditions (Paget's disease, fibrous dysplasia);
• benign tumors, which over time can transform into malignant ones (enchondroma, chondroma, osteoclastoma, etc.).

Symptoms and manifestations of sarcoma of the pelvic and thigh bones

Despite the increased malignancy, rapid progression and metastasis, symptoms of sarcoma of the pelvis and hip joint may not appear in the first stages of the malignant process. Patients may feel discomfort and slight pain in the area of ​​the sacrum, coccyx, buttocks, which is mistaken for radiculitis. Sometimes the temperature rises slightly.

With the growth of the tumor and increased load on the pelvis or thigh (standing for a long time, fitness, sports, running, walking), the pain gradually increases, swelling appears, mobility and range of motion are limited. The manifestation of symptoms indicates an advanced process and even metastasis.

Painful symptoms of cancer can be supplemented by a bone fracture as a result of a fall, push, or load in an awkward position of the lower extremities. It is problematic that long-term pain is associated precisely with bone injuries, and not with a malignant tumor. Microtraumas often occur in children, but the duration of local signs often does not correlate with the volume of injuries.

Therefore, in each case of prolonged persistent pain, it is necessary to conduct an X-ray study. An x-ray will show how much the cortex and medulla are damaged and the continuity of the bone is disrupted. The following symptoms of pelvic bone cancer are also visible on the x-ray:

• Codman triangle;
• osteosclerotic and osteolytic zones.

When located close to the skin, bumps can be noticed, the skin becomes thinner, and vascular patterns appear on it. Gradually, compression of the vessels and nerves at the site of tumor growth occurs or they shift. It is also possible to compress the pelvic organs and disrupt their functions.

Informative video: hip joint hurts, what to do and how to treat?

Diagnosis of hip cancer

How to determine cancer of the hip joint, pelvic bones and thigh?

Mandatory research methods include:

• X-ray of the affected bone;
• layer-by-layer visualization of the primary tumor and the entire anatomical area using MRI and using contrast agent;
• biopsy of the primary sarcoma;
• scintigraphy of the bone skeleton (3-phase or single photon emission CT /SPECT/);
• laboratory tests to assess the possibility of surgery and chemotherapy;
• angiography to determine the condition of blood vessels in the tumor zone.

Diagnosis of sarcoma of the pelvic bones and hip includes radiography and CT chest which are carried out to detect metastases, if necessary - positron emission tomography using 18F-fluorodeoxyglucose (FDG-PET).

During imaging of the primary malignant process, the bone and joints are completely examined to identify possible metastases. The medullary canal and soft tissues are also examined. Tissue is taken for biopsy: a piece of the tumor is excised and histological examination and immunohistochemistry are performed. Molecular genetic studies are carried out from fresh material.

Spiral CT is used to search for metastases in the lungs, three-phase scintigraphy is used to search for bone metastases. An unfavorable factor is elevated alkaline phosphatase or LDH in the blood. Lactate dehydrogenase is an enzyme that promotes the oxidation of glucose and the formation of lactic acid and its salts in cells during respiration.

Treatment of pelvic bone cancer

Treatment of sarcoma of the pelvic bones includes the main methods: surgery and chemotherapy. Radioactive irradiation is used only in special cases, since it does not give a pronounced effect.

Approximate treatment plan:

• the primary tumor is removed by resection of the neoplasm, along with the surrounding tissue;
• remove existing metastases;
• carry out polychemotherapy;
• Additionally, if necessary, the focus is irradiated.

Treatment of sarcoma of the pelvic and thigh bones is performed in accordance with the principles of therapy:

• For all high-grade sarcomas, combined therapy is used: PCT and surgery. Chemistry is necessary due to high probability occult dissemination, hidden bleeding or tumor spread;
• if it is impossible to perform surgery, radiation therapy is carried out even with limited effectiveness;
• Treatment of periosteal osteosarcomas, central and low-grade tumors is performed only surgically, if there are no additional factors in the form of extensive metastasis or inoperability;
• Chemistry for craniofacial osteosarcomas and tumors of intermediate malignancy is prescribed individually, since their metastasis is less common than that of classic bone sarcomas.

Chemotherapy for cancer of the pelvic bones and hip joint

Local treatment of cancer of the hip joint, pelvic bones and thigh (primary oncological process) with chemicals is carried out over a course of 8-12 months. Chemotherapy is divided into preoperative (induction) and postoperative (adjuvant). The first lasts several weeks. It allows you to reduce tumors and improve subsequent surgical intervention. Postoperative chemotherapy lasts several months. Its goal is to destroy the remains of cancer cells in the body.

If surgery is performed at the very beginning of treatment, subsequent chemotherapy will also be effective with the same composition of drugs and course duration without dividing it into pre- and post-surgery. High results receive when included in polychemotherapy: (ADR), high-dose Methotrexate, with the inclusion folic acid(HDMTX), Cisplatin (DDP) and Ifosfamide (IFO). They are partially combined with other means. In accordance with the international study EUROMOS, these cytostatics are used in several ways. Treatment is carried out:

1. A = ;
2. Ai = Doxorubicin + ;
3. AP = Doxorubicin + ;
4. IE = Ifosfamide + Vepezide;
5. M = + Leucovorin;
6. ifn = pegylated Interferon α-2b - 0.5-1.0 μg/kg subcutaneous injection.

There are several generally accepted chemotherapy regimens. They are selected individually, depending on the type of tumor and its stage. Doses are calculated for each person individually. If necessary, they are adjusted, medications can be changed and discontinued.

If patients cannot tolerate side effects (especially those aged 40 years or older) or there is a possibility of complications, high doses Methotrexate is not used. If a secondary sarcoma is detected, the toxicity of anthracyclines during previous treatment is taken into account. If possible, surgery is performed (surgical fixation and immobilization in the presence of sudden fractures and severe pain), without using previous chemistry. This way you can save the limb and carry out ablative (rapid) treatment.

If it is of low malignancy and is located near the periosteum, it metastasizes less than classic osteosarcoma, adjuvant chemotherapy aimed at eliminating occult metastases is prescribed individually. In such cases it cannot be absolute indication for use. There is no consensus on the use of chemistry as an addition to surgical intervention in the treatment of craniofacial osteosarcoma. When metastasis is rare, it often recurs. There is an opinion among doctors that chemotherapy and surgery improves local control and survival of patients.

Surgery

Surgery is the preferred type of treatment for bone pathologies. For complete and safe surgical removal of the tumor, its location and size are taken into account. They try to remove the tumor without damage, the edges are excised to the area of ​​healthy tissue. Marginal removal with a dissected pseudocapsule or the tumor itself should be excluded.

When performing an operation with preservation of the organ, subsequent reconstruction of the defect in the bone is performed, for example, a metal hip joint is implanted. Children are given endoprostheses, but later have to undergo several operations as their bones continue to grow.

With some tumors, for example, fibrous histiocytoma, it is necessary to remove a large area of ​​soft tissue due to deep growth of the tumor in them. Then the defects are closed plastically. If there are doubts about the preservation of the functions of the limb, then doctors recommend amputation.

The best long-term results for most types of bone cancer are observed when surgery is combined with chemotherapy. In this way, it is possible to achieve long-term remission of the disease.

Treatment for fibrosarcoma mainly includes surgical removal, because radiation therapy and chemistry, although they help reduce pain, do not show effectiveness. Often the entire femur has to be removed because the tumor has spread to the bone marrow.

With Ewing's sarcoma, surgery is often impossible, since at the time of diagnosis the patient already has multiple metastases. To treat such patients, introducing new chemotherapy regimens with megadoses. Total body irradiation and stem cell transplantation are also performed.

Metastases from primary cancer and during relapses are removed with therapeutic purpose. If metastases are in the lungs, a thoracotomy is performed. Both lungs are examined if organ damage is suspected on one side. This way you can detect metastases that were undetected during a previous examination.

Radiation therapy for sarcoma of the pelvis and hip joint

If the tumor is operable, radiation is not used, since even when combined with chemotherapy it does not provide a reliable effect. But for inoperable or partially operable sarcomas, irradiation is performed. If inoperability is detected by scintigraphy (functional imaging), then it becomes possible to use targeted internal radiation. For this, Samarium-153-Ethylene-Diamine-Tetramethylene-Phosphonate, Sm-153-EDTMP is used. To achieve a tumoricidal effect (lethal to cancer cells) from radiation, high myeloablative doses of Sm-153-EDTMP are used. After this, hematopoietic stem cells are injected.

Carrying out monitoring and follow-up

It is mandatory to carry out:

• before surgery: repeated visualization of the lesion, radiography of the sternum (skeletal scintigraphy, MRI dynamics, FDG-PET);
• after surgery: histological assessment of resection margins and tumor response to chemotherapy;
• after completion of therapy: radiography and layer-by-layer visualization of the primary sarcoma, radiography and CT (spiral) of the sternum, scintigraphy of the skeleton, late complications are diagnosed;
• at follow-up (completion of information collection): a chest x-ray is taken, the primary tumor focus is examined and late complications are diagnosed.

In some cases, the following is carried out:

• before surgery: angiography, CT scan of the sternum;
• at follow-up: CT scan of the sternum, scintigraphy of the skeleton, ultrasound of the primary tumor, with a possible relapse - FDG-PET.

Studies during and after treatment are necessary for local control of the tumor and diagnosis of possible dissemination. It is also possible to detect acute and chronic effects of therapy in a timely manner. The tumor follow-up scheme includes studies after therapy for bone sarcoma.

The main studies (one month after chemotherapy) include:

• systemic, including CT and radiography of the sternum;
• local, including radiography, CT or MRI* (±ultrasound*);
• assessment functional work organs using echocardiography, audiogram, laboratory tests**.

During the first 1-2 years the following is carried out:

• chest x-ray every 1.5-2 months;
• radiography (±ultrasound*) every 16 weeks.

Over the course of 3-4 years:

• systematic chest radiography - with an interval of at least 2-4 months;
• local radiography (±ultrasound*) – at least 4 months.

Over the course of 5-10 years, an X-ray of the sternum is examined:

• systematically - after 6 months
• locally – due to suspected metastases*.

The functional functioning of the organs is checked by echocardiography and laboratory tests every year for 2-10 years and an audiogram is performed***.
After 10 years, a chest x-ray is examined - after 6-12 months (systemically) and locally - only if suspected*. Echocardiography is performed every 24 months. Anamnesis is collected during each examination of patients.

Note:

1. * in accordance with individual indications;
2. ** hemogram with leukocyte formula is included in laboratory tests. In this case, the following is determined in the blood: Na, K, Ca, Mg, phosphate, bilirubin, transaminases, alkaline phosphatase, LDH, creatinine, urea nitrogen, albumin; phosphate and creatinine are determined in urine (glomerular filtration is calculated);
3. ***if the audiogram is normal, upon completion of therapy further research may stop.

Life expectancy for sarcoma of the pelvis, hip joint, femur

The five-year prognosis for sarcoma of the pelvis and hip joint is as follows:

• with a localized form of sarcoma – 70%;
• in case of oncological process after chemotherapy – 80-90%.

Adjuvant and neoadjuvant chemotherapy and radiotherapy, radiotherapy as a complement to operations, new approaches to treatment with gentle methods increase survival and chances in patients with pulmonary metastases.

Life expectancy, as well as the amount of treatment, depends on the tumor mass. Patients are divided into groups. The first favorable group (low risk) includes patients with a tumor weighing less than 70 ml, the second intermediate group includes patients with a tumor weighing 71-150 ml. The third group is at high risk; their tumor size is 150 ml or more. The development of secondary metastases begins when the tumor mass is 200 ml or more.

Auxiliary prognosis factors include:

• level indicators alkaline phosphatase: high level worsens disease prognosis;
• tumor localization: with a central location of the tumor and in the proximal part of the thigh, the prognosis improves.

When dividing patients into groups, intensive treatment is prescribed, which can improve the prognosis.

In the low-risk group, 97% of patients survive for 5 years or more with adequate treatment. From the high-risk group and when determining the histological response of grade 5-6 - 17% of patients. In the intermediate risk group, 67% of patients survive. In case of relapses, 5-year survival after complex therapy may be 25%.

Disease prevention

There is no specific prevention of cancer of the pelvic bones and hip joint. If you are injured in the hip, pelvis or hip joint with pain syndromes, you should consult a doctor for an examination without waiting for them to subside.

Fibrous dystrophy, exostosis of bone and cartilage, chondroma, deforming osteosis (Paget's disease) can transform into a bone tumor (in 15% of cases). It is necessary to promptly treat precancerous bone pathologies and visit an orthopedic traumatologist annually for a follow-up examination. They will help to detect malignancy early and prescribe timely treatment.

If a person has already fallen ill and has undergone a course of complex treatment for high-grade sarcoma, then follow-up examinations by an oncologist and hardware examination should not be neglected. They are carried out every 3 months in the first two years after therapy. Then - with an interval of 4 months in the third year, with an interval of 6 months in the 4-5th year, and in the following years - at least 1 time in 12 months.

Must be adhered to healthy image life: play sports, strengthen the body, adhere to a balanced, fortified healthy diet.

Informative video:

Pelvis: Symptoms are hidden at first, but as the tumor grows they begin to appear. There is a concept of pelvic cancer. This is an oncological disease in which tumors grow in bone structures or pelvic organs. Malignant neoplasms can appear in the ovaries (in women), bladder, prostate gland(in men).

Characteristics of pelvic bone cancer, types of pathology

A tumor located in the pelvic organs is called sarcoma. What is pelvic bone cancer? This is an oncological process that initially develops in the bones. Pelvic bone cancer can occur in anyone, but it is worth noting that pathologies of this nature are not common.

A distinction is made between osteosarcoma and chondrosarcoma. Osteosarcoma is a malignant formation in which tumor cells actively grow. This education consists of bone tissue.
Chondrosarcoma is another form of oncology. It is an aggressive formation consisting of small cartilaginous structures.

Pelvic bone cancer manifests itself in different ways: much depends on the stage of the disease. If we compare osteosarcoma and chondrosarcoma, it is worth saying that chondrosarcoma is more common. Adults and children are susceptible to this disease. As handrosarcoma progresses, active proliferation of tumor cells occurs. The danger of the disease lies in early metastasis.

Clinical picture of osteosarcoma

On initial stages the disease is asymptomatic. Then the body temperature begins to rise, cramping pain in the pelvis occurs. The pain intensifies with physical activity. Over time, the tumor increases in size.

If you perform an ultrasound, you can see that the layers of bone tissue have become thinner, and the affected area seems to protrude outward. As osteosarcoma grows, pain increases. The tumor begins to put pressure on nearby organs.

Treatment involves chemotherapy. After a course of chemotherapy, surgery is prescribed: the purpose of the procedure is to remove pathological growths. To restore the functioning of the hip joints, it is necessary to undergo endoprosthetics.

What is chondrosarcoma? How does this disease manifest itself?

With this cancer, bones and cartilage are affected. Experts believe that men are susceptible to chondrosarcoma. Oncology of the pelvic bones can develop in people of different ages and gender. The progression of chondrosarcoma leads to pathological symptoms. Pain sensations occur in the pelvis, and they radiate to other organs. Chondrosarcoma is accompanied by swelling of the tissues of the hip joint. Because of this problem, a person experiences difficulty walking (sharp pain may be felt). With chondrosarcoma, protrusion of cartilage tissue occurs in the affected area. Treatment involves taking cytotoxic drugs. Subsequently, surgery is scheduled to remove the tumor.

Symptoms of the disease depend on its degree, as well as on the belonging of cancer cells to a certain type. There are well-differentiated and poorly differentiated chondrosarcoma. Highly differentiated develops gradually, from 3 to 7 years. The disease affects people over 30 years of age.

Many people do not even realize that they have chondroscoma. When the doctor studies the history of the pathology, he finds out the frequency of pain. First they are weak, then they are strong. Painful attacks may occur at night. If a person takes painkillers, such attacks subside. The peculiarity of the attack is that it does not disappear spontaneously (without pills). Over time, chondrosarcoma increases in size. Deformation of bones and cartilage in a specific area can be detected by palpation. In the place where the chondrosarcoma is located, the blood vessels dilate. If a person suffers from pain in the hip joint, and it intensifies with exercise and walking, you need to consult a doctor. Ignoring such signs makes the situation worse.

Chondrosarcoma is a rapidly progressing tumor. Its growth affects the functioning of the joints, in particular their mobility. Poorly differentiated chondrosarcoma is more acute, but may not cause symptoms at first. 3 months after formation, chondrosarcoma begins to manifest itself as pain in the hip joints. Unpleasant sensations occur at night. When taking painkillers, they may not stop. Poorly differentiated chondrosarcoma, in contrast to highly differentiated, is more difficult to treat. Analgesics may be ineffective in relieving pain.

The pain may increase and the person's skin temperature will increase. In the future, joints located nearby will be damaged (this will affect their mobility). As in the case of well-differentiated sarcoma, expansion occurs blood vessels. Poorly differentiated chondrosarcoma can occur in young people. The disease is dangerous because it often recurs. Unpleasant symptoms due to the fact that the tumor presses on the veins. If compression of the sciatic plexus occurs, pain in the pelvis and buttocks is observed. Neck Bladder may be compressed, then problems with urination will arise. If compression of the iliac vein occurs, unilateral edema of the extremities develops.

Metastasis of chondrosarcoma

Metastases form more quickly in poorly differentiated chondrosarcoma. The danger of metastasis is that malignant cells quickly penetrate the organs. These cells are carried by the bloodstream. Metastasis leads to damage to regional lymph nodes and neighboring tissues. Gradually, metastases penetrate the liver, lungs, and brain.

As for periosteal chondrosarcoma, it gives a special type of metastasis. A reactive region is formed around the tumor: it separates the chondrosarcoma from the tissues located nearby. Peripheral chondrosarcomas penetrate into this zone, then nodes are formed from malignant cells. IN in this case malignant cells are no longer associated with the main tumor. Metastases begin to grow into different tissues.

Diagnosis of the disease

The manifestation of chondrosarcoma is not specific. The diagnosis is made based on research, the doctor also takes into account clinical picture. If a patient is diagnosed with central chondrosarcoma, an x-ray will show a lesion with unclear contours. The tumor may be speckled. The image shows that the bone around the affected area appears to be swollen.

Peripheral chondrosarcoma looks like a lumpy formation with poorly defined contours. In this case, the tumor is located on the outer part of the bone. The picture shows the seals.

If you look at the cortical layer of the bone, you can notice irregularities. To confirm the suspected diagnosis, the doctor prescribes a biopsy. A tumor fragment is taken from different areas.

Histological examination helps determine the degree of malignancy. X-rays and biopsies provide an accurate diagnosis. In other situations, diagnosis involves MRI and osteoscintigraphy. To identify metastases in the lungs, you need to do a chest x-ray.

How is the treatment carried out?

The patient is hospitalized in the oncology department. It is important to say that chondrosarcoma is resistant to chemotherapy. There are cases when radiation therapy is ineffective.

Symptoms of pelvic bone cancer

The pelvis is the largest and strongest bone structure in human body. However, the bones of the pelvic ring - the paired pubis, ilium, and ischium - can also undergo malignancy and become the site of localization of malignant neoplasms, which are both primary foci and metastases of tumors of other organs and tissues.

Causes and risk factors for developing pelvic bone cancer

The exact causes and mechanisms of development of cancer remain incompletely understood. Long-term studies give reason to assume that the process of cell malignancy is based on violations of DNA structures caused by both endogenous and exogenous causes. Predisposing factors for the development of malignant tumors are considered to be:

• hereditary predisposition;
• diseases that provoke pathological growth of bone tissue, for example, Paget's disease;
• genetically determined diseases such as Rothmund-Thompson and Li-Fraumeini syndromes;
• bone marrow transplant;
• mechanical damage and trauma to bone tissue: fractures, cracks, fistulas, etc.;
• exposure to ionizing radiation in high doses.

It is worth noting: the presence of even several factors is not a prerequisite for the development of cancer, and at the same time, in a number of patients, pathology develops in the absence of all of the above reasons.

Types of pathology

Depending on the location of the tumor and the type of cells forming the tumor, several types of cancer are distinguished:

• Osteosarcoma is the most common type of malignant neoplasm in the pelvic bone tissue. The tumor is formed directly from bone cells.
• Chondrosarcoma is the second most common malignant tumor of the pelvic bones, represented by cartilage tissue cells.
• Ewing's sarcoma (diffuse endothelioma) is a small cell tumor of high malignancy, characterized by particular aggressiveness, a tendency to rapid growth and active formation of metastases. Ewing's sarcoma of the ilium is more common than other types of tumors in children and people under 25 years of age.
• Fibrous histocytoma is a tumor composed of cells connective tissue, affects mainly ligaments and tendons, including at the place of their attachment to bone tissue.
• Giant cell tumor has a low tendency to form metastases, but often recurs, forming in the same place.

Stages of the disease

The stages of a malignant disease are determined depending on several factors, including the size of the tumor, the rate of its growth and development, the presence of metastases in other organs and tissues, the degree of damage to local lymph nodes. It is customary to distinguish 4 stages oncological pathologies bone tissue:

• Stage 1 – the neoplasm cells are well differentiated, the tumor itself does not exceed 8 cm in size, does not extend beyond the bone, the pathology is single or there are several small lesions.
• Stage 2 – the tumor has more than high degree malignancy, the cells become undifferentiated, but they do not grow into the surrounding tissues, remaining within the bone structure.
• Stage 3 – the presence of several lesions formed by undifferentiated cells.
• Stage 4 – the tumor extends beyond the bone tissue, metastases form in local lymph nodes, other tissues and organs.

Clinical picture

The first and main symptom malignant tumor pelvic bone is pain that can radiate to the hip, lower back, groin. At first, the pain is mild, but as the disease progresses, it tends to increase. The pain intensifies after exercise and at night, and cannot be relieved with conventional analgesics. Over time, other symptoms and manifestations of pelvic bone cancer appear:

• swelling of tissues in the affected area;
• thinning skin at the site of tumor localization, manifestation of the vascular network;
• unmotivated increase in body temperature;
• pathological fractures as a consequence of a violation of the bone structure.

In the later stages of tumors of the pelvic bones, dysfunction of the pelvic organs may develop due to compression of them and the blood vessels by the tissues of the tumor.

Diagnostics

If a malignant neoplasm of bone tissue is suspected, after collecting an anamnesis, a number of instrumental and laboratory tests are prescribed to clarify the nature of the tumor:

• radiography of the pelvic bones;
• MRI using a contrast agent for layer-by-layer visualization of tumor tissue;
• three-phase or emission scintigraphy, revealing metastases in the pelvic bone and other, more distant areas;
• an open biopsy of the primary tumor to determine the degree of its malignancy and the type of cells that form it.

Also held additional examination patient in order to establish general condition his health, since this factor must be taken into account when choosing a treatment strategy for the tumor.

Therapy methods

In the case of malignant changes in bone tissue, preference is most often given to complex treatment, which includes surgical removal lesion, chemotherapy and radiation therapy.

Surgery

The surgical method of treatment is the main one in relation to cancerous tumors pelvic bones. The operation is in progress the main objective which is the complete removal of the tumor, since even a few remaining cells with a high degree of probability can cause the formation of a new lesion. In relation to the pelvic bones, a wide excision (excision) of tissue is performed, followed by their replacement with an auto- or allograft.

After excision of tumor tissues along with the surrounding healthy ones, the biomaterial is examined for the “purity” of the edges: the presence or absence of pathological cells at the borders of the removed material.

If cancer cells not found in marginal sections, they speak of a “clean” edge; “dirty” edges indicate an unsuccessful operation.

Chemotherapy

Chemotherapy – system method drug exposure, in which a drug is introduced into the patient’s bloodstream. The advantages include the possibility of influencing distant and hidden foci and metastases, the disadvantages are whole line serious side effects. Osteogenic sarcoma and Ewing's sarcoma are especially sensitive to chemotherapy. Chondrosarcoma and other types of tumors are less sensitive.

When treating tumors of the pelvic bones, as a rule, polychemotherapy is used: not one specific drug is used, but several complementary ones. Treatment of the primary lesion takes on average from 8 to 12 months, during which several courses of drug administration are carried out.

Radiation therapy

Radiation therapy is not always used for tumors of the pelvic bones, since very high doses of radiation are required for exposure. However, for inoperable tumors that are prone to aggressive growth, such as Ewing's sarcoma, radiation therapy remains the main treatment method. For oncological diseases the following are used:

• intensity modulated radiation therapy,
• proton LT,
• directed internal irradiation.

Forecast

For oncological diseases, forecasting uses the criterion of 5-year survival, that is, the percentage of patients who lived 5 years or more after detection of the tumor. In a relationship osteosarcoma this figure is about 70%, for chondrosarcomas - 80% and higher.

Considering the criterion of five-year survival, it is necessary to keep in mind that many patients live much longer than this milestone, and cases of complete remission of the disease are also common, especially with early diagnosis and timely treatment.

Prevention

Since the exact causes and mechanisms of development malignant diseases bone tissue remain incompletely studied, and specific measures to prevent their development have not been developed. However, taking into account the fact that cells of benign neoplasms often undergo malignancy, one of the prevention measures should be their timely treatment or removal.

It is also necessary to act in relation to any diseases of bone tissue: chronic diseases increase the risk of developing tumors. It is worth avoiding injuries and damage to bone structures by observing safety measures when playing sports, especially extreme sports. Carcinogens, ionizing radiation (devices household appliances(and cell phones have nothing to do with this), toxic chemicals can trigger the development of the disease, so long-term exposure to them must be avoided.

The main preventative measure, as well as a necessary condition successful treatment malignant diseases remain early diagnosis. It is necessary to consult a doctor not only if you find alarming symptoms: It is important to undergo regular examinations, since in the early stages, when complete healing is possible, the cancer disease most often does not manifest itself.