Action and Diagnosis Protocol for Musculoskeletal Tumors in the Tumor Service of the CCOI Frank Pais

Carlos Gonzalez de Varona1, Alicia Tamayo Figueroa*2, Ragnar Calzado Calderon2, Vilma Rondon Garcia3, Maria Emilia Santiesteban Fuentes4 and Jose Enrique Perez Gonzalez1 1Asistent profesor, Medicine integral general and Ortopedic/traumatology first degree, Cuba 2Auxiliar profesor, Ortopedic/traumatology second degree, Cuba 3Radiology Department second degree, Cuba 4Internal medicine/intensive terapy master, Cuba


Introduction
Bone tumors are not common. Statistics indicate an incidence of ten cases of malignant primary bone tumor per million inhabitants per year, while benign tumors are much more frequent. Among benign bone tumors, the most frequent are: Osteochondroma, Enchondroma, Giant Cell Tumor (GCT) and Osteoid Osteoma. In the case of the malignant, the most frequent is multiple myeloma followed by Osteosarcoma, Chondrosarcoma and Ewing's sarcoma.
In pseudotumor lesions, the most frequent are: solitary bone cyst, aneurysmal bone cyst and metaphyseal fibrous defect.
Musculoskeletal oncology is a multidisciplinary specialty for which the work in our service has not been possible without the joint effort and dedication of orthopedic surgeons, radiologists, clinicians and pathologists.

Development
Knowing how to diagnose in time and knowing how to guide a patient is on countless occasions the salvation of a life or the preservation of a part of the human body. The simplest classification in terms of tumors, as we all know, is benign or malignant, but as studies on tumors have developed, it has become known of the need for a classification more in line with the current situation in the study of tumors and After multiple attempts we have that the WHO for practical purposes recommends that the following be used [1][2][3][4][5][6][7][8][9][10]. k) Functional thyroid studies [11][12][13][14][15][16][17][18][19][20].

Imaging Diagnosis
A. Conventional simple radiology in at least two views. In these you can define: 1. Numbers of bone lesions.

Location and situation.
3. Effect of the injury on the bone.

2.
Marginal resection (by the reactive zone of the tumor).

3.
Wide resection: resection of the entire tumor with a small margin of normal tissue.

4.
Radical resection: Amputation of the limb to the level that is necessary as well as the amputation of fingers and joints in the beam, disarticulation in both the upper and lower limbs.

5.
Placement of tumor prostheses for proximal femur and knee tumors.

A.
Osteochondroma: It is carried out en bloc resection including the base to avoid recurrences when: 1. Compressive symptoms appear.
2. Increase in size after the physis is closed.

En bloc resection and bone transport with external fixator
or tumor prosthesis.
In our environment we do not use cryotherapy or lavage of the cavity, radiotherapy is in disuse because it produces sarcomatous degeneration of the tumor and we have no experience in embolization of the vessels.
En bloc resection with transportation guarantees a low 3) Ewing's sarcoma: Chemotherapy + radiotherapy.

4) Surgery only in sacrificial bones associated with
preoperative chemotherapy to decrease the size of the tumor and make surgery easier.  including a malignant one, on this type of lesion must be taken into account, which requires strict monitoring.

Conclusion
Establish a protocol for diagnosis and action in the event of a suspected tumor that allows us to evaluate the patient as soon as possible to avoid unnecessary sacrifices. Trains orthopedic surgeons in the management of tumor lesions. Request the competition for related specialties whenever necessary, knowing in advance that teamwork is essential in this area.

Conflict of Interest
None.