{"id":5252,"date":"2024-12-11T17:33:52","date_gmt":"2024-12-11T16:33:52","guid":{"rendered":"https:\/\/irccs.com\/patologie\/bone-tumors\/"},"modified":"2026-07-17T16:44:39","modified_gmt":"2026-07-17T14:44:39","slug":"bone-tumors","status":"publish","type":"pathology","link":"https:\/\/inoc.it\/en\/pathology\/bone-tumors\/","title":{"rendered":"Bone Tumors"},"content":{"rendered":"\n<h2 class=\"wp-block-heading\"><span  id=\"pathology\" class=\"h2_anchor\"><\/span>Pathology<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Bone tumors can arise directly from the cells that form the skeleton, giving origin to <strong>primary bone tumors<\/strong>, or more frequently, the bone can be involved as a site of <strong>metastasis<\/strong>, when cancer cells from other organs spread to the bone and form <strong>secondary bone tumors<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Primary bone tumors may be <strong>benign<\/strong>, characterized by local growth without metastatic potential, or <strong>malignant<\/strong>, capable of invading surrounding tissues and spreading to distant organs, particularly the lungs.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>The Numbers in Italy<\/strong><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Primary bone tumors are rare, with approximately <strong>350 new cases per year<\/strong> in Italy, corresponding to about <strong>1 case per 100,000 people<\/strong>. They most commonly affect young individuals, with an average age of around <strong>20 years<\/strong>, and approximately <strong>50% of cases diagnosed before the age of 60<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">While primary malignant bone tumors are rare, <strong>metastatic bone disease is increasing<\/strong>, mainly due to improved survival of patients with other cancers.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Types<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Bone cells can give rise to different types of primary tumors. The main malignant forms include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Osteosarcoma<\/strong><\/li>\n\n\n\n<li><strong>Ewing&#8217;s sarcoma<\/strong><\/li>\n\n\n\n<li><strong>Chondrosarcoma<\/strong><\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"symptoms\" class=\"h2_anchor\"><\/span>Symptoms<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Bone tumors may present with <strong>persistent pain and localized swelling<\/strong>, although these symptoms are not always specific. In some cases, tumors may limit <strong>joint mobility<\/strong> or weaken bone structure, increasing the risk of <strong>pathological fractures<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">When the <strong>spine<\/strong> is involved, neurological symptoms may occur, including <strong>radiating pain, sensory deficits, or reduced muscle strength<\/strong>. Systemic symptoms such as <strong>fever or generalized fatigue<\/strong> may also be present.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"risk-factors\" class=\"h2_anchor\"><\/span>Risk Factors<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The exact causes of bone tumors are not fully understood. However, several risk factors have been identified:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Age and growth phase<\/strong>: osteosarcoma most frequently occurs in children and adolescents during periods of rapid bone growth<\/li>\n\n\n\n<li><strong>Radiation exposure<\/strong>: previous high-dose radiotherapy may increase risk<\/li>\n\n\n\n<li><strong>Prior cancer treatments<\/strong>: certain chemotherapies or stem cell transplantation may predispose to development<\/li>\n\n\n\n<li><strong>Genetic factors<\/strong>: alterations in <strong>TP53<\/strong> and <strong>RB1<\/strong> genes increase risk<\/li>\n\n\n\n<li><strong>Hereditary conditions<\/strong>:\n<ul class=\"wp-block-list\">\n<li>patients with <strong>retinoblastoma<\/strong> have a higher risk of osteosarcoma<\/li>\n\n\n\n<li>patients with <strong>multiple hereditary exostoses<\/strong> have increased risk of chondrosarcoma<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"diagnosis-and-examination\" class=\"h2_anchor\"><\/span>Diagnosis and Examination<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Patients who access the multidisciplinary bone cancer program usually arrive already with a diagnosis. At this stage, the <strong><a href=\"#gruppo-interdisciplinare\">Interdisciplinary Care Group (ICG)<\/a><\/strong> takes charge of the person, assessing the symptoms present and the risk of any complications that could compromise quality of life.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Diagnostic Tests<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Imaging studies include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Conventional radiography<\/strong>, as first-line evaluation<\/li>\n\n\n\n<li><strong>CT scan<\/strong>, for detailed assessment of bone structure<\/li>\n\n\n\n<li><strong>MRI<\/strong>, to evaluate soft tissue extension<\/li>\n\n\n\n<li><strong>PET scan<\/strong>, to assess metabolic activity and detect metastases<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">The choice of imaging depends on the clinical context and diagnostic question.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Definitive Diagnosis<\/strong><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">A <strong>biopsy<\/strong> is always required for definitive diagnosis. It may be performed using <strong>CT-guided, ultrasound-guided, or surgical techniques<\/strong>. The sampled tissue is analyzed by the <strong>pathologist<\/strong> using histological, immunohistochemical, and, when necessary, molecular techniques.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">This step is essential for defining tumor type and guiding individualized treatment planning.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"therapies\" class=\"h2_anchor\"><\/span>Therapies<\/h2>\n\n\n\t<div id=\"block_6a5a3fd6d6133\" class=\"accordion-block acf-block\">\n\t\t<div class=\"my-4 lg:my-6\">\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Orthopedic Surgery<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p><b>Orthopedic oncology<\/b><span style=\"font-weight: 400;\"> is dedicated to the management of tumors of the <\/span><b>musculoskeletal system<\/b><span style=\"font-weight: 400;\">, both <\/span><b>primary and secondary<\/b><span style=\"font-weight: 400;\">, as well as <\/span><b>benign and malignant lesions<\/b><span style=\"font-weight: 400;\">, through surgical and non-surgical approaches.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">In recent years, due to the complexity and specificity of these diseases, orthopedic oncology has developed as a <\/span><b>distinct subspecialty within orthopedics<\/b><span style=\"font-weight: 400;\">.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The primary objective of this discipline is the <\/span><b>complete removal of tumor-affected bone segments<\/b><span style=\"font-weight: 400;\">, combined with <\/span><b>reconstruction procedures<\/b><span style=\"font-weight: 400;\"> that allow the patient to preserve <\/span><b>mobility, daily function, and social independence<\/b><span style=\"font-weight: 400;\">, thereby maintaining the best possible <\/span><b>quality of life<\/b><span style=\"font-weight: 400;\">, alongside achieving effective <\/span><b>disease control<\/b><span style=\"font-weight: 400;\">.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The choice of the most appropriate therapeutic strategy, including reconstructive techniques, is always based on <\/span><b>multidisciplinary evaluation<\/b><span style=\"font-weight: 400;\"> involving all relevant specialists. In some cases, it may be appropriate to <\/span><b>delay surgery<\/b><span style=\"font-weight: 400;\"> in favor of medical or radiation treatments, while in other situations surgery should be performed promptly, for example to reduce the risk of <\/span><b>pathological fracture<\/b><span style=\"font-weight: 400;\"> or due to proximity to critical anatomical structures.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Only through close <\/span><b>multidisciplinary collaboration<\/b><span style=\"font-weight: 400;\"> is it possible to optimize outcomes, achieve effective <\/span><b>pain control<\/b><span style=\"font-weight: 400;\">, and preserve affected structures, all of which are essential to ensuring the patient\u2019s <\/span><b>quality of life<\/b><span style=\"font-weight: 400;\">.<\/span><\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Radiotherapy<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p><a href=\"https:\/\/inoc.it\/en\/medical-area\/radiotherapy\/\"><b>Radiation therapy<\/b><\/a><span style=\"font-weight: 400;\"> consists of the use of <\/span><b>high-energy radiation<\/b><span style=\"font-weight: 400;\"> to destroy cancer cells. Treatment is delivered at the <\/span><b>Radiotherapy Division<\/b><span style=\"font-weight: 400;\"> in consecutive daily sessions from <\/span><b>Monday to Friday<\/b><span style=\"font-weight: 400;\">, over cycles that may range from a single session to approximately <\/span><b>10\u201315 sessions<\/b><span style=\"font-weight: 400;\">, depending on the treatment intent and prescribed dose.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Radiotherapy is widely used in <\/span><b>bone metastases<\/b><span style=\"font-weight: 400;\"> due to its well established <\/span><b>analgesic effect<\/b><span style=\"font-weight: 400;\">.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">It is also indicated for the <\/span><b>prevention of pathological fractures<\/b><span style=\"font-weight: 400;\">, taking advantage of its effect on <\/span><b>bone stabilization<\/b><span style=\"font-weight: 400;\">, as well as in cases of <\/span><b>compression of critical structures<\/b><span style=\"font-weight: 400;\"> by tumor tissue, such as the <\/span><b>spinal cord<\/b><span style=\"font-weight: 400;\">.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">It may also have a <\/span><b>postoperative role<\/b><span style=\"font-weight: 400;\">, for example after a <\/span><b>decompressive laminectomy<\/b><span style=\"font-weight: 400;\">, a surgical procedure aimed at relieving compression of the spinal cord and\/or nerve roots. In this setting, radiotherapy is used to <\/span><b>sterilize residual tumor tissue<\/b><span style=\"font-weight: 400;\"> in the treated area.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">In selected cases, radiotherapy may be delivered with <\/span><b>curative intent<\/b><span style=\"font-weight: 400;\">, particularly when there are a limited number of bone lesions and long-term disease control is still achievable. In these situations, advanced techniques such as <\/span><b>stereotactic radiotherapy<\/b><span style=\"font-weight: 400;\"> are used. This approach delivers <\/span><b>high-dose, highly focused radiation<\/b><span style=\"font-weight: 400;\"> over a limited number of sessions, typically between <\/span><b>one and five<\/b><span style=\"font-weight: 400;\">.<\/span><\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Interventional Radiology<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p><b>Interventional radiology<\/b><span style=\"font-weight: 400;\"> is a subspecialty of medical radiology that uses <\/span><b>image guidance<\/b><span style=\"font-weight: 400;\"> (ultrasound, CT, fluoroscopy) to perform <\/span><b>minimally invasive diagnostic and therapeutic procedures<\/b><span style=\"font-weight: 400;\">, providing alternatives to traditional surgery for several conditions, including bone diseases.<\/span><\/p>\n<p>&nbsp;<\/p>\n<h3><b>Main Procedures in Bone Interventional Radiology<\/b><\/h3>\n<p><b>Bone biopsy<\/b><b><br \/>\n<\/b><span style=\"font-weight: 400;\">This procedure involves the collection of <\/span><b>bone tissue samples<\/b><span style=\"font-weight: 400;\"> suspected of tumor involvement under <\/span><b>ultrasound or CT guidance<\/b><span style=\"font-weight: 400;\">. It is usually performed on an outpatient basis under <\/span><b>local anesthesia<\/b><span style=\"font-weight: 400;\"> and uses a specialized cannula to obtain a small core of tissue without the need for surgical incision.<\/span><\/p>\n<p><b>Vertebroplasty and osteoplasty<\/b><b><br \/>\n<\/b><span style=\"font-weight: 400;\">These techniques involve the percutaneous insertion of <\/span><b>small cannulas under radiological guidance<\/b><span style=\"font-weight: 400;\"> to inject bone cement or resins into <\/span><b>fractured or weakened bone areas<\/b><span style=\"font-weight: 400;\">, with the aim of preventing further deterioration and reducing pain. These procedures are often combined with <\/span><b>radiotherapy and medical treatments<\/b><span style=\"font-weight: 400;\">. In selected cases, they may be associated with the percutaneous placement of screws or prosthetic devices. Vertebroplasty can also be used in <\/span><b>non tumor related fractures<\/b><span style=\"font-weight: 400;\"> to control pain and improve stability.<\/span><\/p>\n<p><b>Thermoablation and cryoablation<\/b><b><br \/>\n<\/b><span style=\"font-weight: 400;\">These procedures consist of the targeted destruction of tumor cells using probes that deliver <\/span><b>high temperatures (thermoablation)<\/b><span style=\"font-weight: 400;\"> or <\/span><b>very low temperatures (cryoablation)<\/b><span style=\"font-weight: 400;\">. They are typically used in patients with a <\/span><b>limited number of lesions<\/b><span style=\"font-weight: 400;\">, particularly when radiotherapy is not feasible, and may be combined with vertebroplasty or osteoplasty for structural support.<\/span><\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Pain Therapy<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p><span style=\"font-weight: 400;\">Pain associated with <\/span><b>bone metastases<\/b><span style=\"font-weight: 400;\"> is the most frequent type of cancer related pain, affecting approximately <\/span><b>one third of patients<\/b><span style=\"font-weight: 400;\">. It has a major impact on <\/span><b>quality of life<\/b><span style=\"font-weight: 400;\">, limiting mobility and increasing the risk of <\/span><b>neurological complications<\/b><span style=\"font-weight: 400;\"> and <\/span><b>pathological fractures<\/b><span style=\"font-weight: 400;\">.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Bone pain typically includes three components: <\/span><b>baseline pain<\/b><span style=\"font-weight: 400;\">, <\/span><b>spontaneous pain<\/b><span style=\"font-weight: 400;\">, and <\/span><b>movement induced pain<\/b><span style=\"font-weight: 400;\">.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Management is <\/span><b>multimodal<\/b><span style=\"font-weight: 400;\"> and may include <\/span><b>systemic analgesics, bisphosphonates, chemotherapy, radiotherapy, orthopedic interventions, and neuromodulation techniques<\/b><span style=\"font-weight: 400;\">.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">There are no specific pharmacological guidelines exclusively for bone metastases; therefore, treatment follows <\/span><b>World Health Organization (WHO)<\/b><span style=\"font-weight: 400;\"> and <\/span><b>European Society for Medical Oncology (ESMO)<\/b><span style=\"font-weight: 400;\"> recommendations.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Evaluation of treatment efficacy is based on <\/span><b>patient reported pain levels<\/b><span style=\"font-weight: 400;\">, <\/span><b>quality of life<\/b><span style=\"font-weight: 400;\">, and overall <\/span><b>clinical judgment<\/b><span style=\"font-weight: 400;\">.<\/span><\/p>\n<p>&nbsp;<\/p>\n<h3><b>WHO Analgesic Ladder<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">The WHO approach is organized into a three step ladder:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Step 1<\/b><span style=\"font-weight: 400;\">: non opioid analgesics such as <\/span><b>paracetamol and NSAIDs<\/b><span style=\"font-weight: 400;\">, with or without adjuvant therapies<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Step 2<\/b><span style=\"font-weight: 400;\">: weak opioids for mild to moderate pain, including <\/span><b>codeine, tramadol, and tapentadol<\/b><span style=\"font-weight: 400;\">, with or without adjuvants<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Step 3<\/b><span style=\"font-weight: 400;\">: strong opioids for moderate to severe pain, including <\/span><b>morphine, methadone, fentanyl, buprenorphine, oxycodone, and hydromorphone<\/b><span style=\"font-weight: 400;\">, with or without adjuvant therapies<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">This ladder may be extended:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Step 4<\/b><span style=\"font-weight: 400;\">: opioid rotation or change in administration route, such as <\/span><b>subcutaneous or intravenous continuous infusions<\/b><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Step 5<\/b><span style=\"font-weight: 400;\">: invasive procedures in refractory cases, including <\/span><b>intrathecal pumps, spinal cord stimulation, or cordotomy<\/b><\/li>\n<\/ul>\n<h3><b>Adjuvant Therapies<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">Analgesic drugs, both non opioid and opioid, may be combined with:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Corticosteroids<\/b><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Antiepileptics<\/b><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Local anesthetics<\/b><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Antidepressants<\/b><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Antiemetics and laxatives<\/b><span style=\"font-weight: 400;\">, depending on symptoms and side effects<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Anti inflammatory drugs may be used in early stages or combined with opioids in severe pain, with careful consideration of the patient\u2019s clinical status.<\/span><\/p>\n<p>&nbsp;<\/p>\n<h3><b>Principles of Effective Pain Management<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">According to WHO principles, effective analgesic therapy should:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Prevent pain through regular scheduled dosing<\/b><span style=\"font-weight: 400;\">, reserving \u201cas needed\u201d dosing for breakthrough pain<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Prefer the oral route of administration whenever possible<\/b><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Be promptly adjusted when efficacy decreases<\/b><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Be individualized in dose, drug selection, and route of administration<\/b><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">A properly managed pharmacological approach can control pain in more than <\/span><b>90% of patients with bone metastases<\/b><span style=\"font-weight: 400;\">.<\/span><\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\n\t<\/div>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"ongoing-support\" class=\"h2_anchor\"><\/span>Ongoing Support<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">At INOC &#8211; Istituto Nazionale Oncologico Candiolo, continuous support is provided <strong>before, during, and after treatment<\/strong>, ensuring that each patient is accompanied throughout the entire care and recovery pathway.<\/p>\n\n\n\t<div id=\"block_6a5a3fd6d628b\" class=\"accordion-block acf-block\">\n\t\t<div class=\"my-4 lg:my-6\">\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Supportive and Palliative Care<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p><span style=\"font-weight: 400;\">Cancer patients often have <\/span><b>complex needs<\/b><span style=\"font-weight: 400;\"> that extend beyond the treatment of the disease itself and require comprehensive,<\/span><b> multidisciplinary care.<\/b><\/p>\n<p><span style=\"font-weight: 400;\">At INOC &#8211; Istituto Nazionale Oncologico Candiolo, patients who need additional support have access to specialists from a range of disciplines, ensuring personalized management of cancer-related symptoms and associated conditions. Services may include nutritional counseling, physical rehabilitation, pain management, and support for other medical needs that may arise during the course of treatment and recovery.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The goal is to <\/span><b>improve quality of life, promote overall well-being, and provide comprehensive care<\/b><span style=\"font-weight: 400;\"> tailored to each patient\u2019s individual needs.<\/span><\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Management of Side Effects<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p class=\"isSelectedEnd\">Treatment for <strong>bone tumors<\/strong> may be associated with side effects that can affect a patient&#8217;s <strong>quality of life<\/strong> to varying degrees. Many of these effects can be <strong>prevented, reduced, or effectively managed<\/strong> through appropriate supportive care, targeted interventions, and healthy lifestyle measures.<\/p>\n<p>At <strong>INOC \u2013 Istituto Nazionale Oncologico Candiolo<\/strong>, patients are supported by a dedicated <strong>multidisciplinary team<\/strong> of physicians, nurses, and allied health professionals who work together to help prevent and manage treatment-related side effects throughout the course of care. The team provides personalized guidance, symptom management, and ongoing support to help patients maintain the best possible quality of life during and after treatment.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Psychological Support  <\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p><span style=\"font-weight: 400;\">The impact of cancer also extends to the <\/span><b>psychological sphere<\/b><span style=\"font-weight: 400;\">. A cancer diagnosis is often a <\/span><b>traumatic event<\/b><span style=\"font-weight: 400;\"> that affects all aspects of a person\u2019s life and may generate <\/span><b>anxiety, fear, anger, and depression<\/b><span style=\"font-weight: 400;\">.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">At the <\/span><b>Canciolo Cancer Institute<\/b><span style=\"font-weight: 400;\">, alongside advanced medical therapies, the care pathway always includes <\/span><b>specialized psycho-oncological support<\/b><span style=\"font-weight: 400;\">, helping patients cope not only with treatment but also with the delicate phases of <\/span><b>physical and psychological recovery<\/b><span style=\"font-weight: 400;\">.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Patients may also participate in <\/span><b>psychological support groups<\/b><span style=\"font-weight: 400;\">, where they can share experiences with others who are facing or have faced a similar condition.<\/span><\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Direct Access to Specialists<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p><span style=\"font-weight: 400;\">To ensure timely support and provide prompt answers to questions or concerns, INOC &#8211; Istituto Nazionale Oncologico Candiolo offers a dedicated assistance service for all patients.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">From <\/span><b>Monday through Friday<\/b><span style=\"font-weight: 400;\">, between <\/span><b>8:00 a.m. and 5:00 p.m.<\/b><span style=\"font-weight: 400;\">, patients can contact the <\/span><a href=\"https:\/\/irccs.com\/en\/medical-area\/oncology-day-hospital\/\"><span style=\"font-weight: 400;\">Oncology Day Hospital<\/span><\/a><span style=\"font-weight: 400;\"> Secretariat at <\/span><b>+39 011 993 3775<\/b><span style=\"font-weight: 400;\"> to request an urgent consultation.<\/span><\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Social Work Services<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p><span style=\"font-weight: 400;\">The Social Work Service at INOC &#8211; Istituto Nazionale Oncologico Candiolo provides <\/span><b>information, guidance, and support to patients and their families<\/b><span style=\"font-weight: 400;\"> regarding access to community services and the welfare and social security benefits available under current legislation.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">During dedicated consultations, social workers assist with matters such as disability recognition, access to aids and prosthetic devices, employment-related benefits and leave, and other social support services.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The service is available on <\/span><b>Wednesdays and Fridays from 9:00 a.m. to 1:00 p.m.<\/b><span style=\"font-weight: 400;\"> and can be contacted at <\/span><b>+39 011 993 3059<\/b><span style=\"font-weight: 400;\">.<\/span><\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\n\t<\/div>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"multi-disciplinary-team\" class=\"h2_anchor\"><\/span><strong>Multi Disciplinary Team<\/strong><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Every cancer requires a <strong>multidisciplinary approach<\/strong> at all stages of disease management. At INOC &#8211; Istituto Nazionale Oncologico Candiolo, this is provided by a team of specialists from various clinical and surgical departments, known as the <strong>GIC <\/strong>(Interdisciplinary Care Group or MDT). The GIC ensures that each patient is supported throughout the diagnostic and therapeutic process, including arranging and coordinating examinations and maintaining communication with the patient and their family.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">For each patient, the GIC (MDT) defines and shares a personalized care pathway based not only on the type and stage of the tumor but also on the patient\u2019s individual characteristics. The goal is to achieve the best possible outcomes both oncologically and functionally, while maintaining a high quality of life.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The Group<strong> also collaborates closely with the Institute\u2019s researchers<\/strong> to provide patients with rapid access to the latest innovations in screening, diagnosis, and treatment.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"clinical-divisions\" class=\"h2_anchor\"><\/span>Clinical divisions<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">At INOC &#8211; Istituto Nazionale Oncologico Candiolo, the diagnostic and therapeutic pathway for chronic myeloproliferative syndromes is managed through a coordinated multidisciplinary approach involving several specialized clinical divisions, including:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/inoc.it\/en\/medical-area\/oncologic-surgery\/\" type=\"medical-area\" id=\"5163\">Oncologic Surgery<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/inoc.it\/en\/medical-area\/medical-oncology\/\" type=\"medical-area\" id=\"5169\">Medical Oncology<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/inoc.it\/en\/medical-area\/oncology-day-hospital\/\" type=\"medical-area\" id=\"5183\">Day Hospital<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/inoc.it\/en\/medical-area\/laboratory-analysis\/\" type=\"medical-area\" id=\"5113\">Analytical Laboratory<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/inoc.it\/en\/medical-area\/pathologic-anatomy\/\" type=\"medical-area\" id=\"5118\">Anatomical Pathology<\/a><\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"why-choose-us\" class=\"h2_anchor\"><\/span>Why choose us<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">At INOC &#8211; Istituto Nazionale Oncologico Candiolo, patients with bone cancer patients are treated in a <strong>highly specialized<\/strong> manner, thanks to the synergistic work of the dedicated <a href=\"https:\/\/inoc.it\/en\/pathology\/bone-tumors\/#multi-disciplinary-team\">Interdisciplinary Care Group (GIC)<\/a>.<br><\/p>\n\n\n\t<div id=\"block_6a5a3fd6d6339\" class=\"accordion-block acf-block\">\n\t\t<div class=\"my-4 lg:my-6\">\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Clinical Experience and Tailored Approach<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p><span style=\"font-weight: 400;\">Thanks to the large number of cases treated each year, INOC &#8211; Istituto Nazionale Oncologico Candiolo is a <\/span><b>national reference<\/b><span style=\"font-weight: 400;\"> center for the care of this disease. This extensive experience allows us to manage even the most complex cases, always using a <\/span><b>personalized approach<\/b><span style=\"font-weight: 400;\">, tailored to the clinical and individual profile of each patient.<\/span><span style=\"font-weight: 400;\">\u00a0<\/span><\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Imaging Technologies and Advanced Diagnostics<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p class=\"isSelectedEnd\">The development of an effective treatment plan begins with an <strong>accurate and timely diagnosis<\/strong>. Patients have access to <strong>state-of-the-art imaging technologies<\/strong>, enabling precise assessment of the <strong>extent and characteristics of the disease<\/strong>.<\/p>\n<p>The Institute also provides <strong>advanced diagnostic and laboratory testing<\/strong>, including <strong>molecular and genomic analyses<\/strong>, which play a key role in identifying the <strong>biological and genetic features of the tumor<\/strong>. These insights support <strong>personalized treatment planning<\/strong>, helping clinicians select the most appropriate therapeutic strategy for each patient.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Minimally Invasive Surgical Techniques and Multidisciplinarity<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p><span style=\"font-weight: 400;\">When appropriate, surgeries are performed using <\/span><b>minimally invasive<\/b><span style=\"font-weight: 400;\">, laparoscopic or robotic <\/span><b>techniques<\/b><span style=\"font-weight: 400;\">. These approaches involve the use of camera-equipped instruments introduced into the abdomen through small incisions, thus reducing surgical trauma. <\/span><b>Benefits<\/b><span style=\"font-weight: 400;\"> to the patient include <\/span><b>shorter hospital stay times, faster recovery, and lower risk of complications compared with traditional open surgery.<\/b><\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Clinical Research and Access to Trials<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p><!-- \/wp:heading --><\/p>\n<p><span style=\"font-weight: 400;\">As an IRCCS (Scientific Institute for Research, Hospitalization, and Healthcare), INOC &#8211; Istituto Nazionale Oncologico Candiolo combines clinical care with a strong focus on scientific research. Patients can be considered for <\/span><b>participation in active clinical trials<\/b><span style=\"font-weight: 400;\">,<\/span><span style=\"font-weight: 400;\"> offering access to innovative therapies not yet available in standard practice. This integration of care and research is a distinctive strength that translates into tangible benefits for patients.<\/span><\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Care and Support Every Step of the Way<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p><span style=\"font-weight: 400;\">The Interdisciplinary Care Group<\/span> <span style=\"font-weight: 400;\">(GIC or MDT) <\/span><b>supports the patient at every stage<\/b><span style=\"font-weight: 400;\">: from diagnosis, through treatment, to follow-up. Special attention is paid to<\/span><b> nutritional support, psychological health and reintegration into daily life.<\/b><span style=\"font-weight: 400;\"> The organization of checkups, examinations, and treatment is designed to ensure <\/span><b>continuity, serenity, and a humane, caring<\/b><span style=\"font-weight: 400;\"> approach to each patient\u2019s needs.<\/span><\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\n\t<\/div>\n","protected":false},"featured_media":0,"template":"","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"class_list":["post-5252","pathology","type-pathology","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.1 - 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