Giant Cell Tumor: Causes, Symptoms & Treatment

Giant cell tumor refers to a tumor on the bone. Giant cell tumor is also synonymously referred to by the medical term osteoclastoma. The dignity of the tumor is not clear in the majority of cases. The name giant cell tumor is derived from its typical appearance visible under the microscope. It shows large cells with multiple nuclei, which are called giant cells.

What is a giant cell tumor?

The origin of giant cell tumor is in those cells that are located between the giant cells. These cells have similarities to fibroblasts. In some cases, there is confusion of the giant cell tumor on the bone with a tumor on the tendon sheaths, which is also characterized by giant cells. In fact, however, two completely different diseases are present. The degree of malignancy of the tumor can be determined on the basis of mitoses and cells with pathological characteristics. A giant cell tumor often occurs in the so-called epiphyses, which are located inside the long tubular bones. The tumor is characterized by an aggressive growth behavior, which is why it is also considered a semimalignant disease. Often the giant cell tumor occurs near the knee joint, the proximal humerus or the distal radius. Approximately one in 7 tumors on the bones that is benign in character is a giant cell tumor.

Causes

The causes that lead to the formation of giant cell tumors are not fully understood by current medical science. Although various theories exist about potential reasons for the development of the tumor, no definite statements have been made to date. However, several studies and research projects are working to elucidate the causes of giant cell tumors.

Symptoms, complaints, and signs

A giant cell tumor is associated with various symptoms and complaints, which differ depending on the individual case. For example, pain and swelling in the affected area occur as part of the disease. Pathological fractures are also possible, which are favored by the giant cell tumor. In the majority of cases, giant cell tumors form in the area of the limbs. Only in 25 percent of cases do the tumors appear on the trunk. If giant cell tumors occur in the extremities, they are usually confined to the epiphysis on the large tubular bones. They are one of the most common non-malignant types of tumors on the bone. Due to their localization in the epiphysis, they very often occur near the joints, for example, the knee joint. In the majority of cases, adolescent patients or young adults develop this particular type of bone tumor. Often a lot of time passes before the giant cell tumor is discovered. This is because giant cell tumors generally grow very slowly, even if they are aggressive forms. They also do not cause pain in many individuals. In addition, giant cell tumors only rarely lead to the formation of daughter tumors in other parts of the body. However, giant cell tumors often grow into the surrounding tissue. It is also typical that giant cell tumors tend to form recurrences after surgical removal. Basically, individual symptoms are highly dependent on the particular location of the giant cell tumor. For example, pain in the joints is possible, and in some cases the ability to move is also impaired. In addition, effusions into nearby joints occur in some cases.

Diagnosis and course of the disease

Several investigational options are available for the diagnosis of giant cell tumors. It is at the discretion of the treating physician to decide on their use. Before clinical examinations are performed, the physician analyzes the medical history of the affected person. Subsequently, X-ray examinations, magnetic resonance imaging and a biopsy are possible. As a rule, imaging procedures are always used. The X-ray examination reveals so-called osteolytic areas, which indicate the giant cell tumor. The tumor leads to a widening of the affected bone, and soft tissue infiltration may also occur.

Complications

Giant cell tumor is usually benign. Very rarely, malignant severe progressions occur that lead to death. However, the tumor may grow aggressively locally and affect the affected bone tissue.This causes the bones to expand, which can often lead to joint pain with limited mobility, swelling, bone fractures and effusions in adjacent joints. Because giant cell tumor is usually benign but can cause local destruction of the bone structure, it is sometimes referred to as a semimalignant tumor. The local destruction of the bones can cause severe limitations in movement, which sometimes can only be treated by the use of artificial joints. To prevent these long-term consequences, treatment should be carried out at an early stage. As part of the therapy, the tumor is removed by curettage (scraping) of the bones. However, recurrence can occur in approximately 25 percent of cases. The giant cell tumor may also metastasize to the lungs. Unlike most other cancers, even the metastases are benign. However, the development of lung metastases is very rare. Metastases in other organs are observed even more rarely. As already mentioned, the tumor usually unfolds its destructive power only locally. Nevertheless, in individual cases the tumor may also degenerate and transform into a malignant sarcoma. In these few cases, the prognosis is very poor.

When should you see a doctor?

If swelling, limited mobility, and repeated fractures occur, there may be an underlying giant cell tumor. Medical attention is needed if symptoms do not subside or even become more severe. If severe pain or a bone fracture occurs, it is important to call the doctor immediately. People who have typical risk factors such as an unhealthy diet, consumption of nicotine or a weakened immune system must take advantage of regular preventive checkups. If the above-mentioned complaints occur in connection with a predisposition, a prompt visit to the doctor is recommended. The giant cell tumor is clarified by the family doctor or an orthopedist. Depending on the symptoms, dermatologists, internists and oncologists may also be consulted. The treatment takes place as an inpatient in a hospital. Afterwards, the physician will involve various physiotherapists and, if necessary, alternative medical practitioners who will support the patient in follow-up care. If similar symptoms reoccur after recovery, the physician must be informed to clarify complications such as recurrence or permanent bone damage.

Treatment and therapy

A giant cell tumor can be treated with various measures. Basically, treatment depends on the age of the patient as well as his or her medical history. Often, either resection or curettage is performed, in which the affected area is filled with bone cement. In some cases, it is necessary to replace or reconstruct the diseased joint. Generally, physiotherapy sessions are prescribed following surgical procedures to regain mobility and muscle strength. Several years of follow-up is usually required to quickly detect possible recurrences. In some cases, chemical agents such as phenol are also used to eliminate all tumor cells. Very rarely, in less than five percent of all affected individuals, metastasis occurs in conjunction with the giant cell tumor. In the majority of cases, this affects the lungs.

Prevention

With regard to effective measures and methods for the prevention of giant cell tumors, no definite statements are possible according to the current state of medical and pharmaceutical science. This is primarily because too little is known to date about the causes of giant cell tumor development. Also, in many cases giant cell tumors show no or only weak symptoms over a long period of time and are therefore often only detected at a late stage. It is therefore important to clarify symptoms quickly.

Follow-up

The location of the giant cell tumor influences the necessary follow-up care. Giant cell tumors occur primarily in epiphyseal regions. This means that they are close to the joint or extend into the joint. In 50 percent of cases, the tumor occurs in the knee region. The surgical removal of the diseased bone and joint substance therefore usually results in a restriction of mobility. Physiotherapy is usually prescribed to increase mobility after surgery and to strengthen the muscles. Giant cell tumors have a recurrence rate of 25 percent.Careful and regular follow-up by a physician over several years is therefore indicated. If the removed bone substance was filled with bone cement, this can be replaced during follow-up care. This is possible if the course of the disease has been monitored over several years and the risk of recurrence is considered to be low. The patient himself can also take measures that have a positive influence on the course of the disease. This includes attentive self-observation. If symptoms similar to those of the initial illness reappear, the patient should consult a physician. A healthy lifestyle is advisable to reduce the likelihood of recurrence. The sufferer should eat a balanced diet, exercise regularly and sufficiently, and avoid mental stress.

Here’s what you can do yourself

A giant cell tumor can often be removed surgically. First and foremost, the patient must follow the doctor’s instructions regarding diet, sparing and medication. In addition, it is important not to lift heavy weights in the days following surgery. If the operation is successful, a rapid recovery is likely, provided that the tumor has not yet spread. To ensure this, medical progress checks must be used and physical warning signals clarified. An active lifestyle with sufficient exercise and a balanced diet reduces the risk of disease. Appropriate changes also improve the quality of life and thus mental health, which is usually impaired after a tumor disease. Accompanying counseling sessions and participation in a self-help group are helpful. Giant cell tumors promise a good prognosis if they are detected in time. Therefore, the focus of treatment is on regular screening examinations. Patients who notice bleeding or pain as a result of surgery should consult the doctor and inform him about the complaints and symptoms. The same applies to unusual pain in other areas of the body. If a recurrence is suspected, medical advice is also needed.