It’s alarming to see that giant cell tumours (GCT) of the bone account for about 30 per cent of all bone tumours seen in India. In the West, it accounts for about 5 per cent of all bone tumours. Most GCT of bone are benign (non-cancerous); however, even the benign form is locally aggressive, and is characterised by the weakening of the bone, leading to fractures.
These tend to occur more frequently around the knee followed by the wrist, but they can occur in other bones including the spine and the pelvis too. Dr Himakanth L, consultant orthopedic surgeon explains, “The problem is the uncontrolled growth of cells which has the ability to weaken the bone so much that it eventually breaks, thus allowing the pathological process to spread to the soft tissues surrounding the bone. GCT is more common in women than in men and often affects the 20-40 age bracket, but it can occur at any age.”
Statistically, around 1 to 6 per cent of benign tumour variants can metastasise to the lung. The natural history of the metastatic lesions is unpredictable. If the tumor has completely engulfed the nerves and blood vessels, amputation of the hand or the leg is required. At dedicated bone tumour units, the rate of amputation has come down to less than 2 per cent from a whopping 25 per cent over the last few decades.
There are a good number of surgical options that aim to preserve the functions of the hand. The tumour can be resected and the subsequent defect reconstructed to provide a functional hand or leg.
Generally, the surgical technique to be adopted depends on the aggressiveness of the recurrence, the anatomical region, the age of the patient, and the staging of the tumour.
