What is a giant cell tumor: Symptoms and treatments

The giant cell tumor occurs mainly in the bones , although it can also develop in other components of the connective tissue, such as cartilage, muscles, and fat. It occurs when there is an alteration in cell division, causing them to multiply rapidly and form a mass of abnormal tissue. The cells involved in this case are of 3 types:

• Neoplastic cells of the stroma
• Multinucleated giant cells
• Precursor mononuclear cells

In 75% to 90% of cases, this tumor is located at the ends of the bones near the joint , especially in the long bones near the knee and wrist , and less frequently in flat bones such as the knee. shoulder and hip. As in other types of neoplasia, the specific cause of the giant cell tumor is unknown, but it is related to:

• Genetic alterations
• Long-term exposure to radiation therapy
• Having a family history of tumors
• History of bone disease

Many times it is not possible to identify that one suffers from a giant cell tumor until it has already begun to wear down the healthy tissue where it occurs or even be asymptomatic until it suffers from a pathological fracture, that is, when the bone breaks without have trauma or apparent reason.

Likewise, the symptoms may not be specific and of variable intensity , which also depends on the predisposition of each person. However, the common symptomatology of giant cell tumor is made up of:

• Progressive and constant pain in the affected area, which tends to decrease with rest.
• Swelling in the joint with the tumor.
• Difficulty in moving the affected part.
• Muscle weakness around the area with the tumor.
• Presence of a definite abnormal lump or mass.
• Tingling or numbness in the area around the tumor, because it can press on a nerve as it grows.

When the giant cell tumor is diagnosed, the only option is surgical intervention to remove it and try to preserve the greatest amount of tissue and the functionality of the compromised structure. To do this, the location and area occupied by the tumor are compared with the Campanacci and Baldini radiological classification, where the type of surgical procedure to be applied is established according to certain characteristics of the tumor.

The criteria referred to by said classification in the first point is if there is a lesion within the limited marrow in the bones, the second point is the extensive thinning of the cortex and the third point is if there is a tear in the outer layer of the bones. bones. Depending on the grade of the tumor and these categories, the surgery can be:

• Invasive
• Superficial
• Amputation may even be necessary

The techniques used in the treatment of giant cell tumors are:

Curettage or intralesional surgery

If the doctor decides to practice the curettage technique, this can be complemented with adjuvant treatment, especially cryosurgery or bone cement, the objective of which is to reduce the probability that the giant cell tumor will reappear. One of the advantages of this procedure is that it is not necessary to remove a section of the affected structure and its function is maintained.

To perform the curettage, first a cut is made in the skin to reach the part of the affected bone or connective tissue to later scrape the area of ​​the tumor and extract most of it. However, it is possible that remnants of tumor cells remain and to remove them the surgeon could apply cryosurgery , which generally consists of pouring liquid nitrogen into the scraping area, freezing and destroying said cells. Finally, to fill the gap that remains in the affected structure , bone cement can be used , which as it hardens produces heat and helps destroy tumor cells, or a bone graft.

Resection

This treatment for giant cell tumors is indicated when the characteristics of the damage agree with the second and third points of the Campanacci and Baldini classification. Because these are aggressive tumors, the control of tumor cells is a priority over preserving a section or all of the affected structure.

Resection consists of the removal of the area of ​​the bone or tissue where the tumor is located, as well as a part of the healthy tissue around and below the tumor, which is later analyzed to determine if it is free of tumor cells, if not. it means that these cells have spread and there may be a recurrence. Depending on the surgeon’s criteria and the grade of the tumor mass, removal can be partial , preserving the bone, or total , which would be amputation, although the latter occurs in few cases of giant cell tumor. After this surgery, the extracted section can be reconstructed. through a tissue graft, a limb shortening prosthesis, among other techniques.

Radiotherapy

In the treatment of giant cell tumor, radiation therapy is only suggested in certain situations , as high doses of radiation are generally needed to remove it, but in turn it can damage healthy tissues, including nerves in nearby areas. Also, these high discharges and the difficult elimination of tumor cells with this technique, there is a greater risk that the tumor will grow back or metastasize.

The surgeon may choose this treatment when the tumor is in a surgically inaccessible area , when it is not possible to remove all the tumor cells with surgery or if these cells are detected at the edge of the tissue that was removed after the surgical intervention. .

Even following a control, the prognosis of the giant cell tumor is uncertain and the degree of response may vary depending on the type of treatment, the location and aggressiveness of the tumor and the predisposition of each person. Likewise, despite being categorized as benign , it has the characteristic of being able to progressively progress towards a malignant tumor , transform into a sarcoma or produce metastasis, which is when it spreads to other parts of the body, frequently towards the lung. This has been recorded in approximately 10% of cases, developing in an average of 2 years.

In addition, it is considered by many specialists as a neoplasm of intermediate aggressiveness, since it tends to local recurrence , that is, it reappears some time after apparently having been eradicated. It has an incidence of 10% to 25% of patients with this disease and 71% of these occur within 2 years after having finished the treatment, but it is also possible that it appears up to 5 years after its elimination. Therefore, generally in this type of tumors a constant control and review is indicated for the next 10 years after surgery.

This article is merely informative, at FastlyHeal .com we do not have the power to prescribe medical treatments or make any type of diagnosis. We invite you to see a doctor in the case of presenting any type of condition or discomfort.

If you want to read more articles similar to Giant cell tumor: treatment , we recommend that you enter our Bones, Joints and Muscles category .