Bone tumors originate from mesenchymal cells and are caused by a variety of external and internal factors, resulting in a general term for benign and malignant tumors of bone tissue itself and other structures attached to bone. Malignant bone tumors may originate in bone or metastasize to bone from other places, and may invade and destroy surrounding tissues and organs or metastasize distantly. Benign tumors can also cause damage depending on their location and size, which can be harmful to human health.
I. Why is bone tumor a dangerous tumor?
People lack the understanding of bone tumor, and the early clinical symptoms of patients fail to attract attention and are often misdiagnosed as injury, infection or arthritis, etc. 60% of patients with malignant bone tumor are already in the middle and late stage when they are diagnosed, and 50% of them are delayed because they cannot get timely diagnosis and standardized treatment, and when the diagnosis is confirmed, the tumor is often very large, and it is difficult to be removed surgically or metastasis has already occurred, and they face the double risk of being forced to amputate their limbs due to postoperative local recurrence or the risk of distant metastasis. They face the double threat of life threatening amputation due to local recurrence or distant metastasis.
How to detect bone tumor in early stage?
Pain and swelling of limbs are the main symptoms of bone tumor. Early onset of the disease, patients often have irregular hidden pain and discomfort in the limbs, which is not related to movement, intermittent at first, but later develops into continuous and obvious at night. Benign masses grow slowly, while malignant bone tumors grow rapidly, with varicose skin veins on the tumor surface, increased skin temperature, and may have joint swelling and activity disorders. Tumors of pelvis or sacrum are not easily detected in early stage, but there are pain and numbness in the perineum, constipation and urination disorder. When patients have the above symptoms and tend to worsen, they should go to the bone tumor specialist of each hospital in time.
How to diagnose and treat bone tumor?
The diagnosis and treatment of bone tumor includes clinical, imaging and pathological diagnosis, radiotherapy and chemotherapy, and comprehensive treatment with limb preservation surgery.
Firstly, the diagnosis can be established by puncture biopsy. If the extent is relatively limited, it can be removed by surgery; usually chemotherapy and radiotherapy should be combined before and after surgery to reduce recurrence and metastasis.
1.Puncture biopsy
The classification and diagnosis of bone tumor are extremely complicated, and it is difficult to make a correct diagnosis by clinical examination and imaging alone, so biopsy is the necessary way to diagnose most of bone tumors. Biopsy is a necessary way to diagnose most bone tumors. Biopsy is divided into puncture biopsy and incisional biopsy.
Puncture biopsy is the use of thick trocar needle to extract the diseased bone tissue, which has the advantages of low cost, small trauma and quick recovery, and chemotherapy drugs can be applied the day after puncture.
Incisional biopsy is often performed after a failed puncture biopsy and the incision is approximately 6-200 px,
The incision is about 6-200 px, which is very traumatic and the recovery is slow. After some hospitals carry out incisional biopsy, it brings difficulties to the second extensive resection of the tumor to preserve the limb, so that patients lose the opportunity to preserve the limb.
2. Combined with diagnosis
Bone tumors have complex origin and various types, so it is difficult to make a clear diagnosis by clinical, imaging or pathology alone, and the misdiagnosis rate is high. Therefore, the combination of clinical, imaging and pathology is the best method to diagnose bone tumor, which is recognized and proven in practice at home and abroad.
Every Thursday, the bone tumor center of Sun Yat-sen University regularly conducts the diagnosis by combining the three disciplines and discussing the difficult cases provided by other hospitals and clinicians, pathologists and imaging doctors together, which greatly improves the accuracy of diagnosis and reduces the misdiagnosis rate. treatment plan.
3.Neo-adjuvant chemotherapy
Chemotherapy is one of the important means to treat malignant bone tumor by killing tumor cells in the body with drugs, which greatly improves the prognosis of patients. The application of neoadjuvant chemotherapy (preoperative chemotherapy) has greatly increased the possibility and success rate of limb-preserving reconstructive surgery for malignant bone tumors, and it can be said that chemotherapy is the cornerstone of successful treatment for malignant bone tumors.
4.New technology of chemotherapy care
PICC is a catheter placed in the central vein through the peripheral vein puncture at the elbow. It can effectively protect patients’ peripheral blood vessels, reduce the pain of repeated punctures, reduce phlebitis and venous sclerosis, and reduce the risk of chemotherapy drug leakage and surrounding tissue necrosis. The catheter is easy to maintain and can be left in place for the entire treatment process, and can be used for a variety of intravenous treatments such as infusion, blood transfusion and blood collection, which improves the quality of patient survival and is the preferred intravenous treatment channel for chemotherapy patients. Our nurses have mature PICC catheter placement and nursing skills, and have successfully placed PICC catheters for more than 300 patients, performed daily maintenance of catheters, conducted hospital-wide nursing consultation, and dealt with related difficult problems, so as to achieve “one needle treatment” for our oncology chemotherapy patients and eliminate the pain caused by repeated venipuncture. It provides strong technical support for the whole chemotherapy process.
Misunderstanding of diagnosis and treatment
If “minor surgery” or incisional biopsy is done under the condition of unknown diagnosis, patients will lose the chance of limb-saving surgery and long-term survival. Irregular chemotherapy is more likely to induce chemotherapy resistance, delaying the best time for treatment and leading to treatment failure. Appropriate application of traditional Chinese medicine for adjuvant treatment after surgery can regulate blood and qi and enhance immune function; however, if one hopes to rely solely on external application of local Chinese medicine and internal Chinese medicine as a “cure”, it will only delay the treatment time and eventually lead to lung metastasis and death.
V. Suggestions
The earlier sarcoma is found, the higher the cure rate is, and standardized and comprehensive treatment is the key to cure sarcoma. The first diagnosis and treatment is directly related to whether the patient can retain the function of the limbs, and the best time for treatment is the first surgery. The best time for treatment is the first surgery. A comprehensive individualized treatment plan based on surgery combined with radiotherapy is adopted to enable patients to receive radical treatment. The First Affiliated Hospital of Sun Yat-sen University has its professional characteristics in treatment, which can make patients get fast and accurate diagnosis and treatment, and its safe limb preservation rate reaches over 90% and 5-year survival rate is about 70%.
Follow-up
Follow-up, is a strict part of the treatment process. Only with regular follow-up can the corresponding complications be dealt with in time and the possible recurrence and metastasis be detected in time, and proper treatment can be taken at the early stage of tumor recurrence to avoid unnecessary amputation and loss of function.
Each bone tumor has its peak recurrence period and different recurrence characteristics, and malignant bone tumors generally require lifelong follow-up. When patients are discharged from the hospital, they should follow up regularly and regularly according to the doctor’s instruction, which is not only beneficial to their own treatment, but also helpful to medical workers to accumulate medical information, conduct medical research, promote the progress of medical science and contribute to the final victory over bone tumor.
Out-of-hospital medical advice for malignant bone tumor chemotherapy patients
The following medical instructions must be carried out during chemotherapy for patients with malignant bone tumor, otherwise the consequences are serious.
1. Every 3 days during the out-of-hospital period, go to the local hospital to check the blood routine, focusing on the observation of white blood cells and platelets; 7-10 days after chemotherapy (counting from chemotherapy drugs), the white blood cells and platelets will drop to the lowest. The white blood cells are basically safe above 2.0 x 109 /L, but if they fall to 2.0 x 109 /L within 5 days after chemotherapy, use the white blood cell injection or observe closely (check the blood routine every other day); if the white blood cells fall to 2.0 x 109
/If the white blood cell drops below 2.0 x 109/L, immediately administer a white blood cell injection and monitor the patient closely (check blood count every other day). If platelets drop below 50 x 109/L, return to the hospital.
2 Oral medication 3 times a day during out-of-hospital period: Lysozyme 20mg, Shark’s liver alcohol 50mg, and 1 tablet of Sun Cun. The commonly used leukocyte-producing injection is Gireffin 75ug.
3. Generally speaking, patients with osteosarcoma should rest for 2-3 weeks and patients with other tumors should rest for 3 weeks. Consult the doctor in charge for the specific time.
4.If you experience severe vomiting or mouth ulcers or cannot drink soup during the out-of-hospital period, go to the nearest local hospital for infusion treatment or return to the hospital for consultation.
5.If you have any other serious discomfort, go to the nearest local hospital or return to our hospital for treatment.
6. Pay attention to more rest and eat more nutritious food during the out-of-hospital period.