1.How to confirm the diagnosis of bone tumor?
Because of the low incidence of bone tumor and the inexperience of general orthopedic surgeons, it is easy to misdiagnose, so bone tumor should be diagnosed by bone tumor specialist. The diagnosis of most bone tumors is complicated and sometimes there are certain difficulties because different bone tumors can have similar manifestations, benign bone tumors can become malignant; some bone tumors histological examination shows benign differentiation, but clinically they are highly malignant and often appear lung metastasis at early stage. There are also some lesions with clinical, x-ray or pathological manifestations similar to bone tumors. Generally speaking, the diagnosis of bone tumor must emphasize the combination of clinical, imaging manifestations and pathology, and comprehensive analysis, in order to make a correct diagnosis. Therefore, if there are symptoms such as pain and swelling and bone tumor is suspected, the first step is to go to a specialist and let them answer the following questions.
(1) Whether it is a bone tumor or not.
(2) benign bone tumor versus malignant bone tumor.
(3) primary bone tumor versus metastatic bone tumor.
2.What are the common symptoms of bone tumor?
Pain, mass and dysfunction are considered as the three main symptoms of bone tumor, especially malignant bone tumor.
(1) Pain: In the case of minor trauma or no trauma, there is obvious pain, especially at night, which is persistent and has the tendency of progressive aggravation. Pain is the most significant symptom of rapidly growing tumor. Pain does not necessarily indicate that the tumor is malignant, but some benign tumors, such as osteoid osteoma, can cause pain in response to the growth of bone. Sudden and severe attack of pain is likely to be a pathological fracture.
(2) Mass: Generally, masses appear locally in bone and bone joints. Slow-growing tumors or tumor-like lesions rarely have obvious swelling and are not detected until dysfunction occurs or pathological fracture occurs. Benign tumors often appear as solid masses without pressure pain; while rapidly growing malignant tumors grow faster as diffuse swelling, and the masses have adhesions with adjacent tissues, poor mobility, hard texture and less clear borders (just the opposite of benign bone tumors), and the tumor surface is uneven and has pressure pain.
(3) Dysfunction and compression symptoms: If the tumor is near the joint, the activity function will be restricted, and it will be painful when moving, and there will be swelling and pressure pain. Tumors in the spine, no matter benign or malignant, can compress the spinal cord and cause paralysis.
In addition, skin and local vascular signs may appear: if the tumor is rich in blood vessels, skin color may have obvious changes, skin may be warm and superficial veins may be angered.
3.What are the early symptoms of bone tumor?
The early symptoms of malignant tumor in bone joint may also be very mild and not paid attention to. In order to achieve early detection of malignant bone tumor, special attention should be paid to the following cases and further examination.
(1) When adolescents suddenly develop unexplained pain around the knee joint with progressive aggravation.
(2) In case of acute osteomyelitis such as fever, limb pain, swelling and leukocytosis, adolescents should be alerted to the possibility of Ewing’s sarcoma and osteosarcoma.
(3) Multiple endophytic chondrosarcomas and multiple osteochondrosarcomas are prone to malignant changes, and should be reviewed regularly to prevent malignant changes when there are the above-mentioned lesions.
(4) Elderly people with unexplained limb pain and low back pain, which tend to worsen progressively, should be alert to the possibility of metastatic bone tumors. Especially when there is a history of lung cancer, kidney cancer, breast cancer, etc., we should be more alert.
(5) When there is swelling, local mass, pain in soft tissues of limbs, and pressure pain in tendon membrane, fascia and adjacent areas of joints, consider the possibility of synovial sarcoma, and do not easily mistake it for benign lesions such as arthritis, cyst, fibroma, etc.
In short, pain is the most common symptom of bone tumor, persistent pain and progressive aggravation should be alerted to bone tumor!
4.What is the difference of symptoms between benign and malignant bone tumors?
Benign bone tumor usually develops slowly and has no obvious early symptoms, pain and swelling are not obvious, only when it grows to a certain extent near the joint, it may cause mild functional disorder or deformity. Benign bone tumor usually has a solid, fixed mass, growing on the side of the bone end, with clear boundary, smooth surface and no pressure pain.
Malignant bone tumors develop rapidly, with pain first, followed by swelling, and persistent pain, usually without remission period, and increasingly severe symptoms. The boundary of the mass is not clear, the skin temperature is high, the pressure pain is obvious, and there is joint movement obstacle.
5.What are the early manifestations of spinal tumor?
Most of the spinal tumors are insidious and not easy to be detected. They may have different symptoms because they are located in different parts of the body.
Benign spinal tumors have a long course and slow development, and generally have no systemic symptoms, so they are easily ignored. If nerve is compressed, corresponding neurological symptoms may appear, such as leg pain, hip pain, etc.
Malignant spinal tumor has short course and fast development. It often starts with back or lumbar pain, heavy at night, and soon appears with paralysis symptoms such as urinary and fecal disorder, numbness and weakness of limbs.
6.What are the early manifestations of pelvic tumor?
Low back and leg pain is the only symptom of most pelvic tumors in early stage: most of the patients have low back and leg pain as the first symptom, which is mostly dull pain or vague swelling pain with long-term persistence and progressive aggravation, and the pain is aggravated at night. Local mass is an important early sign of most tumors: the mass can be located on the body surface or convex to the pelvis. Patients may experience constipation, urinary frequency, urinary urgency or urinary and fecal dysfunction, and some male patients may experience sexual dysfunction. In the early stage, most patients had been transferred to various hospitals due to back and leg pain or urinary and bowel dysfunction, suspected to be chronic back and leg pain, sciatica, lumbar disc herniation, cystitis, proctitis, constipation, hemorrhoids, prostatitis, and cauda equina syndrome. Therefore, for patients with long-term symptoms mentioned above, appropriate imaging should be performed to detect the etiology.
7.Which fractures should be suspected as pathological fractures?
Pathologic fractures are fractures that occur on the basis of certain diseases. The common diseases are as follows: disorders of bone metabolism such as rickets, primary hyperparathyroidism and severe osteoporosis; disorders of bone and cartilage development; benign bone tumors and tumor-like lesions, among which the most likely to occur pathological fracture are: giant cell tumor of bone, isolated bone cyst, aneurysmal bone cyst, bone fibrous heteroplasia, etc.; malignant bone tumors, among which the most likely to occur pathological fracture are. Osteosarcoma, fibrosarcoma, malignant fibrous histiocytoma of bone (MFH), multiple myeloma, primary lymphoma of bone, and bone metastases.
Pathological fracture should be suspected if the external force causing the fracture is very mild when it occurs; pathological fracture should be considered if there is already pain and swelling in the area before the fracture. Patients with a history of other tumors such as breast cancer and lung cancer should be suspected of pathologic fracture when a fracture occurs. In addition, pathological fracture has its characteristic manifestations on X-ray, CT and other examinations, and puncture biopsy should be performed to confirm the diagnosis if necessary.
8.What should I do if the results of various examinations are inconsistent?
Various examination results can have different results due to different time and different period of the disease represented. The most common reason for the actual situation is the human factor, the same test result, different doctors come to different conclusions, including pathology, expert opinion may be different, or even come to the opposite conclusion. This makes patients very confused. In fact, the final diagnosis of bone tumor needs to be made by clinicians by combining clinical manifestations, imaging manifestations and histopathological examinations of patients, which is why we have to do multiple laboratory tests on patients. This is the reason why we have to do multiple laboratory tests on patients. The diagnosis of disease is partly based on objective indicators and partly based on doctors’ experience. Therefore, clinicians have to combine clinical, imaging and pathological examination results to reach a clear diagnosis. The inconsistency of individual examination results is not because of any mystery of the disease itself, but just the different perception of people.