Definition and Overview
Musculoskeletal tumors are masses that develop or spread to the musculoskeletal system, which includes the bones, joints, ligaments, muscles, and nerves, leading to body pain that can be excruciating.
These tumors are generally classified into two groups: muscle and bone tumors and they may be considered benign, which means they are painful but do not spread to other parts of the body or malignant or cancerous. If they are malignant, the doctor will determine whether it is primary cancer wherein the cancer cells originated in any part of the system or secondary cancer, which means the cancer has begun in another area of the body but the cells have spread to the system.
According to American Cancer Society, primary bone cancers are actually rare, accounting for less than one percent of all primary cancer cases. Metastasis therefore becomes one of the leading causes of musculoskeletal cancers. The death rate is quite high. Of almost 3,000 people who will be diagnosed with bone cancer, around 1,500 of them will die.
Causes of Condition
Despite the rapid technological advances and scientific breakthroughs on tumors or masses, less is still understood as to their actual cause. However, they develop due to the proliferation of musculoskeletal cells.
The body is composed of millions of cells that undergo a variety of changes and stages. The cells are expected to mature and die to give way for the new cells. This is important so the body continues to maintain its vitality. Cells are programmed to die in a process known as apoptosis. The problem with tumor development is that, for some reason, this ability tends to be switched off. In the process, the present cells continue to divide and grow while new ones are produced. They can group together forming tumors or they travel through the bloodstream (as in the case of cancer cells), lodge themselves in other parts of the body, and grow there.
Musculoskeletal tumors can occur to anyone at any age, particularly those who meet the following risk factors:
Age – Children are susceptible to these types of tumors, and usually, the problem is triggered by a genetic mutation that can begin during conception. These mutations can also possibly lead to inherited syndromes, which increase the risk of tumor development. For instance, children with a genetic mutation of the p53 gene, which is a tumor suppressor, may be diagnosed with Li-Fraumeni syndrome that enhances the risk of osteosarcoma, as well as other types of cancers including breast.
On the other hand, older people, particularly 60 years old and above, are at risk of Paget’s disease, which is characterized by the disturbed normal cellular cycle and renewal, leading to bone deformity among others. Those diagnosed with Paget’s disease may develop osteosarcoma.
Treatments – Cancer patients who have been exposed to radiation or chemotherapy drugs may also develop tumors, which can be either benign or malignant.
Many people assume that injury to the bone can potentially lead to malignant tumors, but studies do not support this. Rather, some researchers point out that the weight upon birth as well as height can have an impact—that is, babies born heavier than the general population or those who are taller than other people their age are prone to certain types of bone cancer.
Pain is the most classic symptom of musculoskeletal tumors. In the case of bone tumors, the pain may occur due to the weakening of the bone structure that can result to small fractures. For those with tumors on the spine, the pain may be caused by the compression of the nerves as the tumor grows and takes more space in the spinal cord.
Other possible symptoms are:
- Blurry vision
- Decreased range of mobility
- Swelling of the affected body area
- High white blood cell count
- Loss of appetite
- Sudden weight loss
- Fever and sweats
Who to See and Treatments Available
Patients with musculoskeletal tumors are commonly referred by their general physicians to an orthopedist, who specializes in the musculoskeletal system. During treatment, the orthopedist is expected to work closely with other health care providers including radiologists, pathologists, and oncologists.
The best way to diagnose a tumor is through MRI, CT scan, and PET scan as these can provide the most detailed description and image of the tumor. However, in many cases, a regular X-ray can already detect the presence.
Once the tumor is identified, the doctor may request for a biopsy wherein a sample of the tissue is obtained and sent to the pathology lab. A pathologist then determines whether the sample contains malignant or benign cells. If the cells are cancerous, the patient is referred to an oncologist.
Whether it’s malignant or benign, one of the first lines of treatment is the surgical removal of the tumor to restore normal body movements and reduce pressure on other affected organs and nerves. It’s important that all tumors are removed to decrease the risk of recurrence.
If the tumor is large or complex to be removed immediately, the doctor will start the treatment by reducing its size as much as possible. This can be accomplished through chemotherapy and radiation. In chemotherapy, chemo drugs are delivered to the body usually through IV line to kill cells. The latest clinical trials are now working on targeted therapies, wherein only certain proteins or malignant cells are managed to spare healthy cells and reduce side effects. Radiotherapy uses radiation to blast off and kill cancer cells. Once the tumor is reduced in size, it may already be safe to operate and remove it.
Sometimes the tumor is already embedded deeply into the bone. In this case, the doctor may perform a limb salvage surgery where the tumor and the bone are removed and the latter replaced with a bone graft. If it’s cancer, the affected limb may have to be amputated to prevent the spread of cancer.
- AAOS: "Bone Tumor.
- "National Cancer Institute: "Bone Cancer: Questions and Answers."
- American Cancer Society: "What Is Bone Cancer?"