Extension to the joints may not occur for a great length of time. In many cases X-ray examination is the most reliable method of detecting the character of the bony change.
Treatment of all sarcomata is early and complete removal. This means in nearly all cases, amputation of the affected bone, and it is important that the amputation should be of the entire bone through the joint between the bone and the body, rather than amputation of the bone in continuity. The reason for this is, that even in sarcomata, which have not extended to the soft parts, very frequently there have occurred metastases of tumor-cells throughout the blood sinuses of the affected bone, often times at a distance of several inches from the site of the original primary tumor.
Carcinomata. Cancer of bone always is secondary to cancer in some epithelial organ. The infection may take place by direct extension through the blood or the lymphatics.
In cases of metastatic invasions of bone, spontaneous fractures oftentimes are the first symptom which calls attention to the fact that metastases have occurred.
Treatment. As in other malignant tumors, the indication is for absolute and radical removal whenever possible. Unfortunately, this very seldom can be done, because at the time the bone has become affected by extension to any great degree, radical operation is impossible. Many times, however, extensive operations must be undertaken for the removal of bone.
Cysts of Bone are rare lesions which practically always occur secondary to other lesions. They may occur as the result of the degeneration and softening of bone sarcomata. Some of the cases of bone cysts undoubtedly represent the entire destruction of sarcomatous processes. Occasionally echinococcus cysts of bone occur.
Treatment. Cysts of bone due to softening of the centre of sarcomatous tumors, like sarcomata themselves, are to be treated by complete removal, best usually by amputation. Cysts of bone not due to the presence of sarcomatous tissue, should be opened and drained in some cases. Cysts due to the presence of echinococcus, should be opened and drained, with the removal of every vestige of the echinococcus.