Primary and secondary tumours of bone

Bone tumours often present insidiously and the symptoms may mask other, far more common orthopaedic conditions. Diagnosis is often delayed and this may have a detrimental effect on treatment. In the teenage patient, lesions in bone are likely to be primary malignant bone tumours or benign lesions. With increasing age, lymphoma, myeloma and metastases become more likely. Investigating a suspicious lesion of bone requires a defined protocol to ascertain the most likely cause and to prevent inappropriate treatment. In an older patient with a suspected lesion of bone, history, examination and simple investigations (e.g. blood tests, chest radiograph) will often lead to a diagnosis of metastases (from breast, bronchus, prostate, thyroid or kidney) or myeloma. Biopsy is indicated if these diagnoses have been excluded and the lesion is solitary (as confirmed by bone scan). Biopsies should be done using a minimally invasive technique (needle biopsy), but must be interpreted by an experienced bone pathologist. Treatment of primary bone tumours is chemotherapy (for osteosarcoma and Ewing's sarcoma) and surgical resection. Overall, cure rates are about 55-60% at 5 years. Management of metastatic bone disease is aimed at relieving pain and restoring mobility for the remainder of life. Survival can vary greatly for different tumours, and knowledge of prognostic factors can be helpful in planning surgery.