Basic Investigations

These are the basic investigations needed with most suspected primary tumours.


ESR High with sepsis and Myeloma, normal or moderate with most tumors
Alk Phosphatase High - if tumor rapidly replaces bone
FBC Leucocytosis with sepsis, (sometimes with Ewing's)
Chest X-ray Pulmonary mets. common in malignant bone tumors.
CT Scan Lung More accurate than CXR - will detect smaller pulmonary mets.
X-rays of lesion X-ray, features of bone tumor easily recognisable
Other imaging Modalities MRI excellent for soft tissue component CT scan - good alternative especially with bone forming lesions eg osteosarcoma


In addition the tumor will have to be staged. These investigations can be done at the oncology center to which the patient is referred.

    Staging Investigations
  • Magnetic resonance of tumour site
  • CT scan lungs - picks up smaller mets.
  • TC Scan - for other bony mets.
  • Biopsy

Once the local imaging is done a biopsy can be done and the histology of the tumour studied A Staging system such as that of Enneking is used to prognosticate and decide on management.


Most malignant bone tumors require surgery and chemotherapy. Radiotherapy is reserved for irresectable or marginally excised tumours.
Chemotherapy is usually started about 6 weeks preoperatively once the diagnosis has been confirmed by histology.


A wide surgical margin should be achieved.
Chondrosarcoma preop After block excision
Low grade Chondrosarcoma After block excision and vascularised fibula graft

To achieve this aim, either a en block excision with arthrodesis, or custom mage prosthetic joint is required or an amputation is needed. The patient needs postoperative chemotherapy too, in most cases. Resection arthrodesis for Ewing's

Block excision can also be usedfor the treatment of benign, but aggressive tumours e.g. giant cell tumour about the knee.

Custom replacement for giant cell tumor distal femur

Postoperative chemotherapy

Chemotherapy is also given postoperatively. Excised lesion is examined histologically to determine if the margins ate tumour free. Another factor looked at is the amount of tumour necrosis caused by the chemotherapy. If there was a good response the same regimen is given postoperatively. If the response was poor the chemotherapy agents are changed, with the hope that alternative drugs will be nore effective.

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