Bone Cancer

Sheber Anaya And Westly

James S. San Juan
BSN4
What is Bone Cancer?
Bonecancer is an uncommon
cancer that begins in a bone. Bone
cancer can begin in any bone in
the body, but it most commonly
affects the long bones that make
up the arms and legs.

Several types of bone cancer exist.

Some types of bone cancer occur
primarily in children, while others
affect mostly adults.
 Theterm "bone cancer" doesn't
include cancers that begin
elsewhere in the body and spread
(metastasize) to the bone. Instead,
those cancers are named for
where they began, such as breast
cancer that has metastasized to
the bone.
AJCC Staging for Bone
Cancer Primary Tumor (T)
TX Primary tumor cannot be assessed
T0 No evidence of primary tumor
T1 Tumor 8 cm or less in greatest
dimension
T2 Tumor more than 8 cm in greatest
dimension
T3 Discontinuous tumors in the primary
bone site
Regional Lymph Nodes (N)
NX Regional lymph nodes cannot
be assessed
N0 No regional lymph node
metastasis
N1 Regional lymph node metastasis
M stages of bone cancer
M0: The cancer has not spread anywhere
outside of the bone or nearby lymph
nodes
M1: Distant metastasis (the cancer has
spread)
M1a: The cancer has spread only to the
lung
M1b: The cancer has spread to other sites
(like the brain, the liver, etc.)
Stages
Stage I: All stage I tumors are low grade and have
not yet spread outside of the bone.
Stage IA: T1, N0, M0, G1-G2: The tumor is 8 cm or
less.
Stage IB: T2 or T3, N0, M0, G1-G2: The tumor is
either larger than 8 cm or it is in more than one
place on the same bone.
Stage II: Stage II tumors have not spread outside
the bone (like stage I) but are high grade.
Stage IIA: T1, N0, M0, G3-G4: The tumor is 8 cm or
less.
 Stage IIB: T2, N0, M0, G3-G4: The tumor is larger than
8 cm.
Stage III: T3, N0, M0, G3-G4: Stage III tumors have not
spread outside the bone but are in more than one
place on the same bone. They are high grade.
Stage IV: Stage IV tumors have spread outside of the
bone they started in. They can be any grade.
Stage IVA: Any T, N0, M1a, G1-G4: The tumor has
spread to the lung.
Stage IVB: Any T, N1, any M, G1-G4 OR Any T, any N,
M1b, G1-G4: The tumor has spread to nearby lymph
nodes or to distant sites other than the lung (or both).
SIGNS/SYMPTOMS:

Common signs of this type of cancer

include:
Bone pain (in motion, at rest, or when
lifting objects)
Bone fractures.
Swelling.
Redness.
Limping.
Limitation of motion of joints.
Diagnostic Exam

X-rays - Most bone

cancers show up on
x-rays of the bone.
The bone at the site
of the cancer may
appear ragged
instead of solid. The
cancer can also
appear as a hole in
the bone.
 Computed tomography (CT) scans - They
help tell if your bone cancer has spread
into your lungs, liver, or other organs.
These scans also show the lymph nodes
and distant organs where metastatic
cancer might be present.
 Magnetic resonance imaging (MRI) scans -
MRI scans are often the best test for outlining
a bone tumor. They are also particularly
helpful for looking at the brain and spinal
cord. MRI scans are a little more
uncomfortable than CT scans.

Radionuclidebone scans - It can find

metastases earlier than regular x-rays. Bone
scans also can show how much damage
the primary cancer has caused in the bone.
 Positronemission tomography (PET or PET) scans -
PET scans use glucose (a form of sugar) that
contains a radioactive atom. A special camera can
detect the radioactivity. Cancer cells absorb a lot
of the radioactive sugar because of their high rate
of metabolism. PET scans are useful in looking for
cancer throughout your entire body.

Surgicalbone biopsy - In this procedure, a surgeon

needs to cut through the skin to reach the tumor in
order to remove a small piece of tissue. This is also
called an incisional biopsy. If the entire tumor is
removed (not just a small piece), it is called
an excisional biopsy.
 Needle biopsy- There are 2 types of needle
biopsies: fine needle biopsies and core needle
biopsies. For both types, a local anesthetic is first
used to numb the area for the biopsy. For fine
needle aspiration (FNA), the doctor uses a very thin
needle attached to a syringe to withdraw a small
amount of fluid and some cells from the tumor
mass. In a core needle biopsy, the doctor uses a
larger needle to remove a small cylinder of tissue
(about 1/16 inch in diameter and 1/2 inch long).
Many experts feel that a core needle biopsy is
better than FNA to diagnose a primary bone
cancer.
Biopsy- A biopsy is a sample of tissue taken from a
tumor so that it can be looked at under a
microscope. This is the only way to know that the
tumor is cancer and not some other bone disease.
Nursing Interventions for Bone
Cancer
1). Pain management
Psychological pain management techniques (deep breath
relaxation techniques, visualization, and guided imagery) and
pharmacological (providing analgesic).

2). Teach effective coping mechanisms

Motivation clients and families to express their feelings, and give
moral support and encourage families to consult a psychologist or
clergy.

3). Provide adequate nutrition

Decreased appetite, nausea, vomiting often occur as a side effect
of chemotherapy and radiation, so it should be given adequate
nutrition. Antiemetic and relaxation techniques can reduce
gastrointestinal reactions. Parenteral nutrition can be carried out in
accordance with the indications of the doctor.
 4). Health education
Patients and families are given health education on the likelihood
of complications, treatment programs, and wound care
techniques at home (Smeltzer. 2001: 2350).

5) If necessary; traction, Traction Treatment Principles

Provide comfort measures (eg frequently change position,
back massage) and therapeutic activity.
Give the drug as an indication of examples; analgesic
muscle relaxant.
Give local heating as indicated.
Give strength in early bandage / replacement in
accordance with the indications, use aseptic technique
correctly.
Keep linen remains dry, free of wrinkles.
Encourage the client to use loose cotton clothing.
Encourage the client to use stress management, for
example: guided imagery, deep breathing.
Assess the degree of immobilization produced.
Identification signs or symptoms that require medical
evaluation, eg edema, erythema.
Complications
of bone
metastases
from malignant
melanoma
September 2017
Jamal Zekriab,Maria
Marples,Dominic
Taylor, KiranKandukurti, Lucy
Mc Parland, Janet E.Brown
 Introduction
Metastatic bone disease (MBD) carries significant morbidity for
patients with cancer. MBD from malignant melanoma (MM) is
understudied. We examined the characteristics, morbidity,
management and outcome of MBD in patients with MM.

Methods
Patients with metastatic MM managed at two referral cancer
centres in England were identified. Those with bone
metastases (BMs) were selected. Patient and disease
characteristics including skeletal related events (SREs) were
extracted from medical records. The Kaplan Meier method
was used to calculate median survival.
 Results
Five hundred and eighteen patients with metastatic
MM were managed between years 2000 and 2008.
Eighty nine (17.2%) patients had BMs and are the
subject of this study. Median age at diagnosis was 53
years and 55% were males. BMs were identified at
the time of diagnosis of metastatic disease in 68.5%
patients. Sixty-six (74.2%) had multiple bone lesions
and 80.9% had axial skeleton involvement. One
hundred and twenty nine skeletal related events
occurred in 59 (66.3%) patients (50 radiotherapy, 28
hypercalcaemia, 20 bone fractures, 18 spinal cord
compression and 13 orthopaedic surgery). The
annual skeletal morbidity rate was 2.5.

Median survival from diagnosis of BMs was 17.3 weeks

and was 5.6 weeks from the first episode of
hypercalcaemia.
Conclusion
Our findings show that BMs occurs in 4.1% of
patients with all stages MM and in 17.2% of
patients with metastatic disease. Two thirds of
patients with BMs experience one or more SRE
indicating a significant morbidity burden.
Generally, these patients have a dismal
survival and hypercalcaemia in particular is a
terminal event. Early use of available bone
modifying agents should be considered for
these patients with the opportunity to be
included in future studies investigating novel
agents targeting BMs.
References:
JamalZekri -MariaMarples-DominicTaylor KiranKandukurti-
LucyMcParland Janet E.Brown Weston Park Hospital,
Sheffield S10 2SJ, England, UK Al-Faisal University, King
Faisal Specialist Hospital & Research Centre, Jeddah,
Saudi Arabia St James's Institute of Oncology, St James's
University Hospital, Leeds LS9 7TF, UK Weston Park
Hospital, Sheffield S10 2SJ, England, UK Clinical Trials
Research Unit, Leeds Institute of Clinical Trials Research,
University of Leeds, Leeds LS2 9PH, UKfAcademic Unit of
Clinical Oncology, University of Sheffield, Weston Park
Hospital, Sheffield S10 2SJ, England, UK

http://www.sciencedirect.com/science/article/pii/S221
2137417300581