What is a benign bone tumor?
In simple words, a bone tumor which is non-cancerous i.e. which does not have the potential to spread to other regions of the body or invade other local tissues is called a benign bone tumor
What are the types of benign bone tumors?
There is a large variety of benign bone tumors ranging from harmless tumors – which don’t require any treatment, to some very aggressive tumors – which consistently need vigorous treatment. In-between these extremes exist a range of tumors, which may or may not warrant treatment, depending on the situation.
There is a large variety of benign bone tumors (including some bone lesions which are more appropriately called as ‘tumor like conditions’). A large number of them are harmless and may never cause any problem throughout the person’s life.
However, some types of bone tumors consistently require treatment, e.g. Giant Cell Tumor (GCT) of bone, etc. These are known as benign aggressive bone tumors.
Some bone tumors may or may not require treatment, depending on the situation, e.g. Osteochondroma, Enchondroma, etc. Some bone tumors probably never require any treatment, e.g.aFibrous Cortical Defect, smallNon-Ossifying Fibroma, etc.
What are the symptoms of benign bone tumors?
When symptomatic, the symptoms of benign bone tumors are no different from that due to malignant bone tumors. The most common symptoms are pain and/or swelling. Some patients may present with a pathological fracture. A bone tumor in the region of a joint often causes restriction in the range of movement and function of the joint, either due to a mechanical obstruction caused by the swelling or due to pain.
When they cause symptoms, the symptoms of benign bone tumors are no different from that due to malignant bone tumors. The most common symptoms are pain and/or swelling. The pattern and nature of pain is highly variable.
Some of the benign aggressive bone tumors may show a rapid evolution in the intensity and duration of pain, quite like that of a malignant tumor. Many patients may report having a swelling for a long time, which has remained unchanged in size and shape.
In a number of these cases, the swelling may be painless and may remain so indefinitely. In patients with benign aggressive bone tumors, the swelling may show rapid growth along with associated pain, which may eventually become distressing. Such a situation may cause suspicion of a malignant process.
Some patients may present with apathological fracture. This is often seen in cases of benign aggressive bone tumors like GCT of bone, ABC of bone, etc. or in cases with cystic or fibrous tumors of bone like Simple Bone Cyst, Fibrous Dysplasia, etc. In some cases this fracture may occur through a joint (called an intra-articular fracture).
Besides the possibility of an intra-articular fracture, a bone tumor in the region of a joint far more commonly causes restriction in the range of movement and function of that joint, either due to a mechanical obstruction caused by the swelling or due to pain.
However, as already mentioned earlier, a large number of benign bone tumors are asymptomatic and may be detected only incidentally when an X-ray of that region is taken for some other reason, e.g. for an injury, etc.
How is a benign bone tumor detected?
A benign bone tumor is often discovered incidentally in X-rays which are done for some other reason, e.g. following an injury, etc. Besides that, a benign bone tumor is most commonly detected when a patient reports to his/her doctor with some unusual pain or swelling in his/her body. Uncommonly, some patients may present with a pathological fracture.
Bone Tumor DetectedBesides being discovered accidentally in an X-ray or some other radiological imaging done for some unrelated complaint (hence called as an ‘incidentally found’ bone lesion), a benign bone tumor is most commonly detected when a patient reports to his/her doctor with some unusual pain or swelling in his/her body.
Uncommonly, some patients may present with a ‘pathological fracture’. A detailed history and clinical examination helps in localizing the problem and also in deciding the further line of investigation. The simplest and most important investigation to detect and identify a benign bone tumor is a regular plain X-ray.
The other investigations of value are MRI, Bone scan, CT scan and PET scan. However, all these investigations are generally done, if necessary, after viewing the X-ray. The need for these other investigations will be decided by the doctor treating you.
How is a benign bone tumor diagnosed?
Diagnosis of a benign bone tumor is done in the same way as that of a malignant bone tumor; i.e., by clinical examination, blood investigations, radiological studies (X-ray, MRI, etc.) and pathological investigations (biopsy, etc.).
Diagnosis of a benign bone tumor is done in the same way as that of a malignant bone tumor; i.e. by clinical examination, blood investigations, radiological studies and pathological investigations. In some benign bone tumors, which are clearly identifiable on X-ray (especially in cases where treatment is not required), biopsy is not necessary.
There are some benign bone tumors that may be treated without biopsy, as their clinical presentation and radiological imaging are so typical that it cannot be any other condition, e.g. Osteoid Osteoma, Osteochondroma, Simple Bone Cyst, etc. However, there are many other situations where a biopsy is mandatory;
like for example,
- When the disease appears aggressive in nature and has caused bone destruction,
- When the clinical presentation and radiological appearance of the tumor is not conclusive, and treatment appears essential,
- When it is suspected that it could be a malignant disease, or a malignant transformation in a benign condition, etc
What is the treatment for a benign bone tumor?
The most important modality to treat benign bone tumors which need treatment is surgery. Other methods of value are RadioFrequencyAblation (RFA), Embolization procedures and Sclerotherapy.
When treatment is indicated, the most important modality to treat benign bone tumors is surgery. Rarely, small and difficult to reach benign bone tumors may be treated by ‘Radiofrequency Ablation’ (RFA). In RFA, heat is generated at the tip of a probe that is inserted into the tumor under image guidance (fluoroscope or CT scan).
This local heat, which is generated due to ionic agitation and resultant friction caused by a high frequency alternating current flowing through the electrodes at the tip of the probe, kills the tissues around the probe tip.
Some aggressive benign tumors, which are in areas or situations where surgery is difficult or impossible, may be treated by ‘Embolization procedures’, in which the blood supply to the tumor is cutoff, by injecting or inserting materials that block blood vessels, into the blood vessels supplying them (thus depriving them of nourishment and therefore, causing the tumor to shrink or stop growing).
This is done using special catheters (inserted from a blood vessel in the thigh or arm), which are guided under x-ray imaging, to reach the blood vessels supplying the tumor. This procedure may have to be repeated a few times, at intervals of weeks or months.
Sometimes, embolization procedures may be done just prior to the surgery, to lower the vascularity of the tumor (reduce the amount of blood flowing through the tumor), so as to reduce the loss of blood during the surgical treatment. ‘Sclerotherapy’ is a technique very commonly used in the treatment of vascular disorders like varicose veins, hemorrhoids, etc.
In this technique, a chemical irritant is injected into the affected vessel/vascular malformation. This chemical initiates an inflammatory reaction in the walls of the vein/vascular malformation and also causes the blood in it to clot. This effectively closes the vein/vascular malformation which becomes hardened (sclerosed) and turns into scar tissue, thus treating the problem.
The same technique has been extended to treat vascular malformations/tumors of the bone. Sclerotherapy has been found to be useful in the treatment of select cases of ABC of bone, hemangioma of bone, etc.
Dr. Chetan Anchan
Dr. Chetan Anchan is an expert and well-known orthopedic surgeon and oncologist from Mumbai. He has vast experience in treating all types of Malignant and Benign, Bone and Soft Tissue Tumors, and Skeletal Metastases.
Dr. Chetan holds an extensive expertise in managing and treating various bone malignancies.
Faq’s – Patient Guide
Frequently Asked Question On Benign Bone Tumor
Does this disease pose a health risk to other members of the family?
Certainly not. This is not a contagious disease or any sort of infection. There is no health risk to any member of the family whatsoever.
Can a benign bone tumor pose a threat to a patient’s life or limb?
In most cases, benign bone tumors pose no such threat. However, if they grow very large, such a possibility may exist.
In most cases, benign bone tumors pose no such threat. However, if they grow very large (which can only happen if a growing tumor is neglected), such a possibility may exist. This situation usually occurs with the aggressive kind of benign bone tumors like GCT of bone, Aneurysmal Bone Cyst (ABC), etc. This can especially be a serious issue if the tumor arises in a location which is difficult to treat, e.g. in the spine, sacrum, etc.
Is there a role for chemotherapy and radiotherapy in treatment of benign bone tumors?
There is no established role of chemotherapy in the treatment of benign bone tumors. Radiotherapy is avoided as much as possible; but it may be used very rarely, as a last resort, in some situations where all other treatment options have failed.
There is no established role of chemotherapy in the treatment of benign bone tumors. Radiotherapy is avoided as much as possible, asit can sometimes lead to the formation of asarcoma in the treated area. Very rarely, radiotherapy may be used as a last resort in the treatment of a benign aggressive bone tumor, where all other treatment methods have failed, or where no other option of treatment exists or is viable.
This often happens when the disease occurs in areas, which are difficult to treat surgically, e.g. in the sacrum, spine, etc.
Is follow-up necessary in cases of benign tumors?
Regular long-term follow-up after the treatment is not necessary in all benign bone tumors. However, there are certain types of tumors for whicha regular follow-up is mandatory, e.g. in cases of benign aggressive bone tumors like GCT of bone‚ ABC‚ etc. These tumors have a significant risk of local recurrence despite adequate treatment.
It is necessary to detect any recurrence of the tumor early‚ as it can be treated effectively when it is small, with minimal disturbance of the surrounding normal tissues/structures. The need for follow-up and its regularity is best advised by your treating doctor.