Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Bone Tumors (Benign and Malignant)


Related Terms

  • Benign Bone Tumors
  • Chondrosarcoma
  • Ewing's Sarcoma
  • Malignant Neoplasm of Bone and Articular Cartilage
  • Osteoblastoma
  • Osteosarcoma

Differential Diagnosis

  • Benign bone tumors
  • Bone marrow disorders (e.g., leukemia, multiple myeloma, or lymphoma)
  • Fracture callus
  • Glomus tumors
  • Metastatic neoplasm
  • Osteomyelitis
  • Osteoporosis
  • Paget's disease of the bone
  • Primary metastatic tumors in other organs

Specialists

  • Clinical Psychologist
  • Hematologist
  • Oncologist
  • Orthopedic (Orthopaedic) Surgeon
  • Pathologist
  • Physical Therapist
  • Radiologist
  • Radiology Oncologist

Comorbid Conditions

  • Allergic reactions to treatment medications
  • Bacterial infection
  • Chronic disease (e.g., diabetes and heart disease)
  • Metastatic cancer elsewhere in body (e.g., breast, uterus, prostate, lung)
  • Overweight or underweight

Factors Influencing Duration

Factors influencing the length of disability include the type and stage of disease at initial presentation, the presence of concurrent infection, the type of treatment received, the individual's overall health and response to treatment, and the presence of any complications.

Medical Codes

ICD-9-CM:
170 - Malignant Neoplasm of Bone and Articular Cartilage
170.0 - Malignant Neoplasm of Bone and Articular Cartilage; Bone: Ethmoid, Frontal, Malar, Nasal, Occipital, Orbital, Parietal, Sphenoid, Temporal, Zygomatic, Maxilla (Superior), Turbinate, Upper Jaw Bone, Vomer
170.1 - Malignant Neoplasm of Bone and Articular Cartilage; Mandible; Inferior Maxilla; Jaw Bone NOS; Lower Jaw Bone
170.2 - Malignant Neoplasm of Bone and Articular Cartilage; Mandible; Vertebral Column, Excluding Sacrum and Coccyx; Spinal Column; Spine: Vertebra
170.3 - Malignant Neoplasm of Bone and Articular Cartilage; Ribs, Sternum, and Clavicle; Costal Cartilage; Costovertebral Joint; Xiphoid Process
170.4 - Malignant Neoplasm of Bone and Articular Cartilage; Scapula and Long Bones of Upper Limb; Acromion; Bones NOS of Upper Limb; Humerus; Radius; Ulna
170.5 - Malignant Neoplasm of Bone and Articular Cartilage; Short Bones of Upper Limb; Carpal; Cuneiform, Wrist; Metacarpal; Navicular, of Hand; Phalanges of Hand; Pisiform; Scaphoid (of Hand); Semilunar or Lunate; Trapezium; Trapezoid; Unciform
170.6 - Malignant Neoplasm of Bone and Articular Cartilage; Pelvic Bones, Sacrum, and Coccyx; Coccygeal Vertebra; Ilium; Ischium; Pubic Bone; Sacral Vertebra
170.7 - Malignant Neoplasm of Bone and Articular Cartilage; Bones NOS of Lower Limb; Femur; Fibula; Tibia
170.8 - Malignant Neoplasm of Bone and Articular Cartilage; Short Bones of Lower Limb; Astragalus [Talus]; Calcaneus; Cuboid; Cuneiform, Ankle; Metatarsal; Navicular (of Ankle); Patella; Phalanges of Foot; Tarsal
170.9 - Malignant Neoplasm of Bone and Articular Cartilage; Bone and Articular Cartilage, Site Unspecified
198.5 - Secondary Malignant Neoplasm of Other Specified Sites; Bone and Bone Marrow
213 - Benign Neoplasm of Bone and Articular Cartilage
213.0 - Neoplasm, Bones of Skull and Face, Benign
213.1 - Neoplasm, Lower Jaw Bone, Benign
213.2 - Neoplasm, Vertebral Column, Excluding Sacrum and Coccyx, Benign
213.3 - Neoplasm, Ribs, Sternum, and Clavicle, Benign
213.4 - Neoplasm, Scapula and Long Bones of Upper Limb, Benign
213.5 - Neoplasm, Short Bones of Upper Limb, Benign
213.6 - Neoplasm, Pelvic Bones, Sacrum, and Coccyx, Benign
213.7 - Neoplasm, Long Bones of Lower Limb, Benign
213.8 - Neoplasm, Short Bones of Lower Limb, Benign
213.9 - Neoplasm, Bone and Articular Cartilage, Benign, Site Unspecified
238.0 - Neoplasm of Uncertain Behavior of Bone and Articular Cartilage

Overview

A bone tumor is an abnormal growth of cells within the bone that may be noncancerous (benign) or cancerous (malignant). A bone tumor may be primary, originating within the bone itself, or secondary, resulting from the spread (metastasis) of cancer elsewhere in the body, such as from the lung, breast, or prostate.

Benign bone tumors occur more frequently than malignant bone tumors. Benign bone tumors do not spread (metastasize) to other tissues or organs but remain localized within the bone. They are named according to the cell type of origin: bone cells (osteoblasts) may produce osteomas, cartilage cells (chondroblasts) may produce chondromas, and tumors arising from both bone and cartilage produce osteochondromas, which are the most common type of benign bone tumor. The majority of benign bone tumors require no treatment, and the remainder can usually be cured with surgical resection.

Malignant bone tumors may be primary or secondary. They rarely occur as a primary bone tumor (less than 1% of all malignant tumors) but more frequently result from metastasis (secondary bone cancer) from cancer originating elsewhere in the body. Primary bone cancer, or sarcoma, can originate in different types of bone or adjacent soft tissues (muscle, cartilage, nerves, fat, and connective tissue) anywhere in the body.

The most common types of sarcoma are osteosarcoma, chondrosarcoma, fibrosarcoma, and Ewing's sarcoma (the latter belongs to the Ewing family of tumors, which also includes peripheral primitive neuroectodermal tumors and extraosseous Ewing tumors). Osteosarcomas, the most common type, are bone-forming sarcomas that develop primarily at the ends of the bones at the growth plates of children and young adults and affect the knees, upper arms, and pelvis. Chondrosarcomas arise from cartilage and develop in the legs, arms, pelvis, and ribs; they may also develop from benign enchondromas and osteochondromas. Fibrosarcomas arise from connective tissue (muscle, ligament, or tendon) but may affect the bones of the jaw, arms, and legs. Ewing's sarcoma, the second-most-common type of bone cancer in children, develops most frequently in the middle (shaft) of long bones, and affects hips, long bones in the thigh and upper arm, and pelvis. The increased incidence of osteosarcomas and Ewing's sarcomas in teenagers supports the idea that bone neoplasms develop during rapid growth and that growing bone is susceptible to transformation (Baker). There are several other types of sarcoma, such as malignant giant cell tumors and chordoma; these rare tumors occur most often in adults over the age of 30.

Osteosarcomas, the most common type of malignant bone cancer, are classified according to the cells of origin, their size and appearance, and their degree of proliferation (mitoses). A low-grade tumor has few dividing cells and a mature cell matrix as viewed under the microscope; it is unlikely to spread to other parts of the body and carries an excellent prognosis. A high-grade tumor has multiple dividing cells and an immature cell matrix, indicating rapid proliferation; these tumors have a high likelihood of metastasis and usually require both surgery and chemotherapy. Intermediate-grade tumors have a variable prognosis.

Secondary bone cancer occurs when malignant cells from a primary cancer site, such as the kidney, lung, prostate, breast, or thyroid, spread (metastasize) to the bones; although cancer is present in the bones, the malignant cells are those of the organ of origin. Therefore, these secondary cancers are not referred to as bone cancer but instead reference the original organ from which it metastasized, such as metastatic lung cancer. Common sites of secondary bone cancer include the ribs, skull, pelvis, and vertebrae. These bone tumors may not be treated in the same way as primary bone tumors because they occur in the later stages of metastatic cancer of other organ systems. Sometimes, when metastasis of the primary tumor involves bone and other organ systems, only palliative treatment is given.

Two additional types of cancer may also develop within the bones: non-Hodgkin's lymphoma of the bone, and multiple myeloma, which develops in the plasma cells of the bone marrow.

Malignant bone tumors are staged using the American Joint Commission on Cancer (AJCC) tumor/node/metastasis staging system. Stages for tumor characteristics, the possible spread to lymph nodes, and metastasis to distant organs (TNM) are shown in increments, including T0 (no tumor evident), T1 (8-cm tumor), T2 (tumor larger than 8 cm), and T3 (tumor in more than one place on same bone); N0 (no spread) to N1 (spread to lymph nodes); and M0 (no distant spreading) or M1 (distant metastasis) ("Detailed Guide"). An alternate grouped TNM staging system uses Roman numerals I through IV, ranging from the absence of to incremental increases in metastasis. A grade will also be assigned, including G1 through G4, with lower numbers indicating low-grade tumors, and higher numbers indicating high-grade tumors ("Detailed Guide").

Incidence and Prevalence: According to the American Cancer Society, an estimated 2,570 new cases of malignant bone tumors would be diagnosed in 2009 in the US, with an estimated 1,470 deaths ("Detailed Guide").

The two most common types of primary bone cancer are osteosarcoma and chondrosarcoma, with each accounting for about 35% of primary bone cancers (“Detailed Guide”). In the US each year, 400 new cases of osteosarcoma are diagnosed, or 4.8 cases per 1 million individuals younger than age 20; the incidence among blacks is 5.2 cases per 1 million each year, and among whites it is 4.6 cases per 1 million each year (Mehlman).

Fibrosarcoma and malignant fibrous histiocytoma account for 2% of primary bone cancer, and chordoma accounts for 5%. Ewing's sarcoma of bone accounts for 10% of cases of primary bone cancer (“Detailed Guide”); about 2.9 cases are diagnosed per 1 million individuals, with the incidence in whites about 9 times that in blacks (Toretsky). Rare tumors, such as giant cell tumors, make up the remainder of primary bone cancers.

Source: Medical Disability Advisor



Causation and Known Risk Factors

Primary malignant bone tumors are rare, and in most cases a direct cause is unknown, although research has identified genetic associations. Gene mutations are shown in a significant number of individuals with osteosarcoma. Almost all Ewing's sarcomas (95%) involve a translocation between chromosomes 11 and 12, creating a fusion protein that predisposes the individual to abnormal cell growth (tumorigenesis) (Toretsky). Loss of tumor suppression mechanisms is also believed to increase risk.

Men are more likely than women to develop osteosarcoma, and more teenagers than adults will be affected (“Detailed Guide”). Osteosarcomas are most commonly diagnosed in individuals between the ages of 10 and 30 and between the ages of 60 and 80; they are rarely discovered in middle age ("Detailed Guide"). Those with hereditary retinoblastoma, preexisting bone disease, or Paget's disease also have increased risk.

Chondrosarcomas are unusual in those younger than 20 years of age; there is increasing risk from age 20 to age 75, and men and women are equally affected. Fibrosarcomas usually occur in middle-aged and elderly adults. Chondrosarcomas may also arise from benign lesions (e.g., enchondromas and osteochondromas) or in individuals with hereditary multiple exostosis or enchondromatosis (Ollier disease); the risk of malignant transformation in these individuals may be as high as 25% (Baker).

Ewing's sarcoma occurs primarily in children and teenagers, and is uncommon in adults over the age of 30; 27% of cases occur before age 10, 64% before age 30, and only 9% over age 30 (Toretsky). Blacks are at slightly higher risk than whites for this type of primary bone cancer, and it is rare in Asian Americans.

Excessive exposure to radiation, especially at a young age, and combinations of radiation and chemotherapy for treating prior cancer may increase risk of bone cancer. Individuals treated with certain kinds of anticancer drugs (alkylating agents) may be at increased risk for malignant bone tumors. Certain genetic risk factors may be associated with a propensity for the development of sarcomas. An overactive parathyroid gland is also believed to be a risk factor. Individuals who have had multiple benign tumors (osteochondromas), who have been diagnosed with Paget's disease, or who have a long-term bone infection (osteomyelitis) may also be more likely to develop primary sarcomas.

Source: Medical Disability Advisor



Diagnosis

History: Many benign bone tumors have no symptoms at all and may be found incidentally.

The most common symptom reported with malignant bone tumors is pain, especially pain that worsens with activity and at night. Other symptoms include swelling, stiffness, tenderness, or a mass that can be felt at the tumor site if the disease has advanced. Bone fractures not explained by trauma alone, resulting from loss of bone integrity (pathologic fractures), may have occurred. Individuals with Ewing's sarcoma, a rare malignant tumor of the bone, often report constitutional symptoms such as malaise, fever, and weight loss. Pallor and weight loss may also indicate poor general health stemming from underlying metastatic cancer in another organ. Individuals in later stages of the disease may complain of fever, weight loss, fatigue, difficulty moving, and pathologic fractures.

Physical exam: The exam may reveal swelling, decreased mobility in an affected joint, muscle wasting, a limp, or a palpable soft-tissue mass. Individuals with rare bone tumors may also present with an enlarged liver or spleen. If metastatic cancer is suspected but has not yet been diagnosed, a complete physical is usually performed to assess the presence of the tumor of origin in another organ system.

Tests: Definitive diagnosis of bone tumors, benign or malignant, depends on obtaining a biopsy of the tumor tissue. Percutaneous imaging-guided needle biopsy or bone marrow needle aspiration biopsy are able to accurately diagnose 90% of bone tumors by staining the tissue sample and examining the cells for size, shape, characteristics, and degree of mitosis (histopathologic examination) (Baker).

Diagnostic imaging, including plain x-rays, can yield information about the size and shape of the tumor, whether it is destroying bone or forming bone, the degree of permeation of the bone compartment, and the presence and type of periosteal reaction. Most bone tumors can be visualized on x-rays of the affected bone or joint. Magnetic resonance imaging (MRI) is especially useful to show details of normal versus tumor tissue.

If the results of needle aspiration biopsy confirm malignancy, preoperative tests may include a chest x-ray, brain and pulmonary computed tomography (CT), and MRI, as well as routine blood tests (complete blood count [CBC]; coagulation tests; and chemistry profile, such as alkaline phosphatase and lactate dehydrogenase levels that correlate with survival of individuals with osteosarcoma and Ewing's sarcoma) and urinalysis to determine the individual's overall condition and to help identify if metastasis is likely from a primary malignant tumor. Additionally, a bone scan (scintigraphy) may be performed to evaluate whether a malignant tumor has spread to other areas (metastasized) of bone.

When all diagnostic tests have been completed, staging of malignant bone tumors will be done.

Source: Medical Disability Advisor



Treatment

Some benign bone tumors may not require treatment, but will be assessed periodically to check for progress or regression. Other benign bone tumors may require open or radical surgery (resection). Benign tumors are resected using a bone-scraping procedure called curettage. This is usually able to remove the entire tumor and reduce the possibility of recurrence. Curettage is followed by reconstruction using a combination of bone grafts and stabilization to prevent fracture. The resection of some benign bone tumors may leave large deficits in the involved bone that may be filled with grafts from the individual's own bone (autograft), with cadaveric bone (allograft), or with synthetic bone substitutes (e.g., coralline hydroxyapatite).

Most malignant bone sarcomas are treated with a combination of therapies, including surgery, chemotherapy, and radiation. Advances in the treatment of malignant bone tumors include the use of pre- and postoperative multi-agent chemotherapy, making it possible to perform surgery that saves the limb from amputation (limb-salvage surgery) and offers long-term satisfactory results. The individuals being treated are usually given a course of preoperative (neo-adjuvant) chemotherapy. A response to chemotherapy that results in greater than 90% tumor cell or tissue death (necrosis) is considered a good response. Ideally, individuals with a good response to chemotherapy are considered good candidates for limb-salvage surgery. A poor response to chemotherapy may lead to amputation in up to 10% of cases (Baker). Surgery is followed by a course of postoperative chemotherapy. In many instances, adjuvant radiation is used in combination with chemotherapy for tumor control in the surrounding tissue. The use of proton beam radiation for chondrosarcoma of the skull can prolong progression-free survival. However, radiation is not often used for osteosarcoma treatment and is reserved for patients who are not candidates for surgery. Rehabilitation and physical therapy programs are often indicated after chemotherapy, radiation, or surgery.

Treatment for metastatic malignant tumors depends upon the primary tissue or organ in which the original tumor developed, how that cancer is being treated, and the individual's response to treatment. Though preoperative chemotherapy may be administered, the treatment of choice for the bone tumor involves surgery to remove the diseased portion of the bone and reconstruction of the affected arm or leg. Surgery may involve a complete removal of the bone (resection) or amputation.

Another type of surgical procedure, hyperthermic isolated limb perfusion (HILP), delivers heat and chemical agents to the tumor site through the vascular system. This technique, used only on extremities, has been shown to salvage limbs and reduce complications and healing time.

A metal prosthetic device or a bone graft from a cadaver may be inserted into a weakened bone segment to strengthen the limb. Tumor growth may be slowed with estrogen or hypothalamic hormone therapy.

Source: Medical Disability Advisor



Prognosis

Most individuals with benign bone tumors are completely cured with treatment.

The outcome for malignant tumors depends on the tumor grade, whether the tumor has invaded the center of the bone, and whether the cancerous cells have already spread to other areas (metastasized). Low-grade malignant tumors have an excellent prognosis. A small percentage of osteosarcomas, especially in young people, involve only the surface of the bone and generally are of a low histologic grade. Individuals with low-grade osteosarcomas are frequently treated with surgery only and have a better survival rate than individuals with higher-grade osteosarcomas. Advances in treatment and integrated care from orthopedic oncologists and pediatric and medical oncologists have improved the cure rate for osteosarcoma from 5% to 20% over the past 30 years (Baker). Most treatment failure is due to the presence of distant metastasis.

The 5-year survival rate for high-grade osteosarcoma (with bone metastases) is under 25% (Mehlman). The 5-year survival rate for nonmetastatic (low-grade) osteosarcoma is 60% to 70% ("Detailed Guide").

For chondrosarcoma, prognostic variables include the presence of metastatic disease and a high histologic grade of the disease. Individuals with chondrosarcomas that have spread to lymph nodes and other organs have a 5-year survival rate of 29% (Hide). The pelvis as a primary site of disease also carries a worse prognosis than peripheral sites because surgery may not be an option. Individuals with low-grade, stage I tumors that have not metastasized have a 90% survival rate (Hide).

For Ewing's sarcoma, the most important prognosis variable is the extent of metastasis at diagnosis, as the number of initial metastases almost directly correlates to prognosis. About 80% of patients have localized disease initially, and 20% present with metastases to lungs, bone, and/or bone marrow. Other prognostic factors include the size of the primary tumor and whether the tumor is situated in a central or peripheral location such as in the extremities. The expected survival rate is 70% for nonmetastatic disease at the time of diagnosis (Toretsky). A less favorable long-term survival rate of lower than 25% is expected for individuals whose cancer has spread (Toretsky).

Source: Medical Disability Advisor



Rehabilitation

Rehabilitation for individuals with bone tumors depends on the location of the tumor, whether the tumor is benign or malignant, and whether limb-salvage surgery or amputation is required. If surgery was required, rehabilitation may include therapy to regain range of motion, strength, and functional mobility following limb-sparing surgery, or fitting of a prosthesis and movement retraining following amputation. If the bone tumor affects a lower extremity, the physical therapist will also focus on training for proper ambulating (walking) at the appropriate time. Occupational therapy will help individuals arrange their homes and organize their lives in ways that support their physical and mental well-being, and will provide activities to relieve the boredom of inactivity.

Supportive rehabilitation allows the individual to gain some control over the ordinary activities of life and to cope emotionally. This may take the form of group vocational rehabilitation and may help with the individual's transition back into the workplace. Palliative rehabilitation allows individuals in advanced stages of the disease to achieve some level of physical comfort, and provides emotional support and assistance in day-to-day functioning.

Source: Medical Disability Advisor



Complications

Some benign bone tumors may recur even after surgical removal (excision).

Complications of malignant bone tumors include muscle wasting, pathological fractures, and the risk of developing a secondary malignancy. If the bone tumor is secondary to metastatic cancer in another organ, the progressiveness (stage) of the original cancer can be a complicating factor.

Complications of primary bone cancer are related to metastasis, such as when a sarcoma spreads (metastasizes) to surrounding tissue, adjoining organs, other bones, or to more distant parts of the body. In Ewing's sarcoma and osteosarcoma, the most common sites of metastases are other bones and the lungs.

Limb-salvage surgery and amputation may involve significant body disfigurement and morbidity that may require additional surgery or treatment. Other complications related to treatment may include a temporary burn to the skin and fatigue from radiation therapy; nausea, vomiting, mouth sores, hair loss, and lowered resistance to infection from chemotherapy; and infection of the surgical site and possible blood clotting disturbances from surgery. Many older individuals find it difficult to tolerate surgery, chemotherapy, and radiation therapy because their overall health status is often poor.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Transfer to sedentary duties may be required for individuals who have undergone amputations. A leave of absence for surgery and postoperative therapy and rehabilitation may be required. Patients with amputation may require a prosthesis for improvement of ambulation in the workplace.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Is the tumor benign, primary, or metastatic?
  • Does individual complain of pain? Does it worsen at night?
  • Is swelling, stiffness, or tenderness present?
  • Can individual feel a mass at the tumor site?
  • Has individual had a bone fracture?
  • On exam, were swelling, decreased mobility in a joint, or muscle wasting evident?
  • Does individual limp?
  • Does individual have an enlarged liver or spleen?
  • Were x-rays, bone biopsy, and bone marrow testing done? Chest x-ray, CT, MRI, and bone scan?
  • Have biopsy and histopathologic examination confirmed the type of tumor and stage of the cancer?
  • Were conditions with similar symptoms ruled out?
  • Does individual have primary or secondary bone cancer?
  • Is there a history of excessive exposure to radiation?
  • Does individual have any inherited genetic risk factors? Additional risk factors for primary bone cancer, such as Paget's disease, overactive parathyroid gland, long-term osteomyelitis, radiation and chemotherapy treatments for other conditions, or previously fractured bones? Does individual have any risk factors for secondary bone cancer, such as cancer in the kidney, lung, prostate, breast, or thyroid?
  • Does individual complain of pain in the bones and joints not necessarily associated with movement? Is it dull and constant or felt only when pressure is applied? Does individual complain of fever, weight loss, fatigue, impaired mobility, or pathologic fractures?
  • Were blood and urine tests done? Bone scan?
  • Has the bone cancer metastasized? Which organ systems are affected?

Regarding treatment:

  • If treatment is not needed, does individual have regular follow-up?
  • Was surgical resection necessary?
  • Was a bone graft done? Was bone stabilized?
  • Has individual had pre- and postoperative chemotherapy? Radiation therapy?
  • Was amputation or limb-salvage surgery necessary?
  • Is individual a candidate for prosthesis?
  • Did individual receive antibiotics, if necessary?
  • If indicated, is individual receiving hormone therapy or removal of hormone-producing organs?

Regarding prognosis:

  • Is individual active in rehabilitation?
  • Can individual's employer accommodate necessary restrictions?
  • Does individual have any conditions that may affect ability to recover?
  • Has the tumor recurred?
  • Has individual had any pathological fractures? Muscle wasting?
  • Did a second malignancy develop?
  • Have any complications developed, such as metastasis or the tumor encompassing an area that confounds or does not allow for its removal?
  • Does individual have any treatment complications, such as a temporary burn to the skin, fatigue, nausea, vomiting, mouth sores, hair loss, lowered resistance to infection, infection of the surgical site, or possible blood clotting disturbances, from the surgery?
  • Has individual sustained body disfigurement or morbidity that may require additional surgery or treatment?

Source: Medical Disability Advisor



References

Cited

"Detailed Guide: Bone Cancer." American Cancer Society. 13 May. 2009. 9 Sep. 2009 <http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_Is_bone_cancer_2.asp?sitearea=CRI>.

Baker, Laurence H. "Bone Tumors: Primary and Metastatic Bone Lesions." Cecil Medicine. Eds. Lee Goldman, et al. 23rd ed. Saunders Elsevier, 2007. MD Consult. Elsevier, Inc. 9 Sep. 2009 <http://www.mdconsult.com>.

Hide, Geoff. "Chondrosarcoma." eMedicine. Eds. Michael A. Bruno, et al. 4 Dec. 2008. Medscape. 9 Sep. 2009 <http://emedicine.medscape.com/article/388869-overview>.

Mehlman, Charles T., and Timothy P. Cripe. "Osteosarcoma." eMedicine. Eds. Miguel A. Schmitz, et al. 28 Mar. 2008. Medscape. 9 Sep. 2009 <http://emedicine.medscape.com/article/1256857-overview>.

Toretsky, Jeffrey A. "Ewing Sarcoma and Primitive Neuroectodermal Tumors." eMedicine. Eds. Samuel Gross, et al. 17 Jun. 2008. Medscape. 9 Sep. 2009 <http://emedicine.medscape.com/article/990378-overview>.

Source: Medical Disability Advisor






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