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Giant Cell Tumor Treatment Pune
At Sancheti Hospital, we specialize in Giant Cell Tumor treatment using advanced curettage, bone grafting, and reconstruction to preserve mobility.
Overview
A bone tumor diagnosis can be frightening, but understanding your condition is the first step toward effective treatment. Giant Cell Tumour of Bone (GCTB) is a unique condition that, while typically classified as a benign bone tumor (meaning it’s a non-cancerous tumor), can behave aggressively in the area where it develops.
GCTB represents about 4% to 5% of all bone tumors and affects approximately 1 to 2 people per million worldwide each year. This rare condition primarily impacts young adults between 20 and 45 years old, though it can occasionally affect children or older adults.
These tumors most commonly develop in the long bones of the body, particularly the thigh bone (femur), shin bone (tibia), and lower arm bone (radius). They typically grow at the ends of these bones, close to major joints. More than half of all Giant Cell Tumours of Bone occur around the knee joint. Less frequently, they can appear in the pelvis, spine, ribs, or skull.
The tumor gets its name from its microscopic appearance, which shows numerous “giant cells” formed when several individual cells fuse together into one large cell. While benign, GCTB is known for its locally aggressive behavior, meaning it can grow rapidly and cause significant damage to surrounding bone and soft tissues.
Symptoms
Giant Cell Tumours of Bone typically grow slowly, so symptoms may develop gradually or remain mild initially. Some patients may experience no symptoms at all (asymptomatic). However, when symptoms do appear, they usually result from the tumor’s growth affecting the bone and surrounding structures.
Common symptoms include:
- Bone Pain: The most frequent symptom, often worsening with activity due to mechanical weakening of the bone
- Swelling: A noticeable lump or swelling may develop near the tumor site
- Decreased mobility or reduced function in the nearby joint
- Fluid buildup in the joint closest to the tumor
- Tenderness when the affected area is touched
- Pathological Fracture: The tumor can weaken bone so much that it breaks without significant trauma, occurring in about 11% to 37% of patients at diagnosis
For tumors developing in the spine, particularly at the base where it connects to the pelvis, additional symptoms may include:
- Back pain
- Neurological effects like weakness or numbness in arms and legs
- Pins and needles sensations
Symptoms can vary widely between individuals and may progress slowly or appear suddenly. Sometimes symptoms may even disappear temporarily before returning. Because these symptoms are similar to other conditions, obtaining a correct diagnosis can be challenging.
Causes
The exact cause of Giant Cell Tumour of Bone remains unknown to medical researchers. These tumors appear to develop spontaneously without any apparent trigger, specific risk factor, or underlying condition.
However, research has identified important factors in tumor development. A key discovery involves a molecule called RANK-L (Receptor Activator of Nuclear factor-kappa B Ligand), which appears at high levels on the tumor’s giant cells. RANK-L plays a crucial role in bone breakdown and GCTB progression.
In healthy individuals, RANK-L helps with normal bone remodeling by forming and activating osteoclasts (cells that break down bone). In GCTB, tumor cells produce excessive RANK-L, stimulating the formation of giant cells that actively destroy healthy bone tissue.
Genetic research has also identified mutations in the H3F3A gene in over 90% of GCTB cases, which are believed to drive tumor development. These genetic changes occur in the tumor’s supporting cells and may contribute to the tumor’s growth and aggressive behavior.
Risk Factors
While the exact cause of Giant Cell Tumours of Bone is unknown, certain rare conditions have been identified as potential risk factors:
Paget’s Disease of Bone: This chronic bone disorder involves abnormal bone remodeling, causing bones to become enlarged and misshapen. In very rare cases, GCTB may develop as a complication, often affecting flat bones like the skull and pelvis.
Hyperparathyroidism: This condition involves overactive parathyroid glands, leading to calcium and bone metabolism imbalances. It may rarely increase the likelihood of developing multiple GCTBs throughout the body.
It’s important to note that these associations are extremely uncommon. The vast majority of Giant Cell Tumours of Bone develop spontaneously without any identifiable underlying cause.
Diagnosis
Diagnosis of Giant Cell Tumour of Bone typically begins when patients visit their doctor due to symptoms like bone pain or swelling. The initial evaluation includes a clinical examination and X-ray of the affected area. Due to the rarity of primary bone tumors, patients are usually referred to bone cancer specialists for further evaluation.
The diagnostic process involves several imaging tests:
- X-rays: Can reveal characteristic features but cannot definitively confirm the diagnosis
- CT scans: Provide detailed views of bone damage and soft tissue extension, helping distinguish GCTB from other tumors
- MRI scans: Excellent for assessing surrounding soft tissues and the extent of tumor spread
- Bone scans and PET scans: May be used to evaluate disease extent and monitor tumor activity
However, imaging alone cannot definitively diagnose GCTB. The most accurate confirmation method is a biopsy – a procedure where a small tissue sample is taken for microscopic examination by a pathologist. The pathologist looks for the distinctive giant cells and other specific features.
Accurate diagnosis can be challenging because giant cells appear in many other conditions. Doctors must carefully rule out other possibilities, including giant-cell rich osteosarcoma, bone cysts, and other tumors. Genetic testing for H3F3A gene mutations can help confirm the diagnosis and distinguish GCTB from similar conditions.
Stages
While GCTB is generally classified as a benign bone tumor, its local aggressiveness varies. The Campanacci grading system describes this variation based on the tumor’s appearance on imaging:
- Grade I (Latent): Tumors contained within the bone with well-defined borders and intact bone outer layer
- Grade II (Active): More extensive tumors within the bone with thinned but still present bone walls. Can be subdivided into IIA (without fracture) or IIB (with fracture)
- Grade III (Aggressive): Tumors that have grown beyond the bone into surrounding soft tissues, often with unclear borders suggesting rapid growth
Higher-grade tumors, particularly Grade III, are associated with increased risk of local recurrence due to difficulty in achieving complete tumor removal.
Treatment
The primary goal of GCTB treatment is complete surgical removal of the tumor while preserving as much normal bone appearance and function as possible. A team of specialists, including orthopedic surgeons, radiologists, and pathologists, works together to design the best treatment plan.
Surgical Options
Curettage: This procedure involves carefully scraping out tumor cells from the affected area. The resulting cavity is often filled with bone cement or bone graft material. Bone cement generates heat that helps destroy any remaining tumor cells. While less invasive and joint-preserving, curettage carries a higher risk of local recurrence (up to 50%).
Wide Surgical Excision: This more extensive procedure removes the tumor along with a margin of healthy surrounding tissue. This significantly reduces local recurrence risk to less than 5% but may have greater impact on bone appearance and function, often requiring reconstruction with bone grafts or metal implants.
Other Treatment Options
Denosumab Therapy: A major advance in GCTB treatment, Denosumab is a targeted drug that specifically blocks RANK-L function. By inhibiting RANK-L, it eliminates giant cells and stops bone breakdown, allowing bone healing. Denosumab is often used before surgery to shrink tumors and strengthen bone, making surgical removal easier and less invasive.
Radiotherapy: High-dose radiation may be used cautiously for tumors that cannot be surgically removed due to location or to improve tumor control after surgery. However, it carries a risk of transforming the benign bone tumor into a cancerous tumor years later.
Embolization: This procedure blocks blood vessels supplying the tumor, causing it to shrink. It can be used for tumors that cannot be surgically removed or before surgery to reduce bleeding.
Treatment choice depends on factors such as tumor location, size, aggressiveness, presence of fracture, and the patient’s overall health and preferences.
Rehabilitation
Following GCTB treatment, many patients benefit from rehabilitation services to regain strength, restore movement, and return to daily activities. The rehabilitation team includes:
- Physiotherapists: Help restore strength, movement, and function
- Occupational Therapists: Assist with improving daily task performance
- Dieticians: Provide nutrition advice vital for recovery
- Prosthetists: Design prosthetic limbs if amputation is necessary (rare)
- Orthotists: Provide aids like splints or special footwear to support bone alignment
Rehabilitation is crucial for addressing physical challenges from the tumor or treatment and achieving the best possible long-term functional outcomes.
Complications
Despite being a benign bone tumor, GCTB can lead to several complications:
Local Recurrence: The most common complication, where the tumor grows back in the same area after treatment. Recurrence rates range from 20% to 50%, particularly after curettage alone.
Metastasis: Though rare (1% to 9% of cases), GCTB can spread to other body parts, most commonly the lungs (Pulmonary Metastasis). This is associated with increased morbidity and mortality.
Malignant Transformation: In very rare instances, the benign bone tumor can become cancerous. This can occur spontaneously or after treatments like radiotherapy, sometimes many years after initial treatment.
Other potential complications include:
- Joint arthritis
- Limited movement or joint problems
- Pathological fractures
- Surgical site infections
- Hardware failure if implants are used
- Side effects from Denosumab, such as jaw bone damage or low calcium levels
Prevention
Since the exact cause of Giant Cell Tumour of Bone is unknown, there are no specific preventive measures. Unlike some conditions, GCTB is not linked to lifestyle choices or environmental factors.
However, early detection plays a crucial role in improving outcomes. Being aware of potential symptoms like persistent bone pain, swelling, or lump development around joints and seeking prompt medical attention can lead to earlier diagnosis and treatment.
Living With Giant Cell Tumour of Bone
Living with Giant Cell Tumour of Bone involves ongoing monitoring and support, even after successful treatment. While the outlook is generally favorable with adequate tumor control, the risk of local recurrence and rare metastasis means long-term follow-up care is essential.
Regular hospital visits may continue for years, sometimes for life. Visit frequency typically starts every 3 months for the first two years, then every 6 months for years 3-5, and annually thereafter. If recurrence occurs, follow-up care may extend to 10 years.
During appointments, healthcare professionals will:
- Monitor general health
- Discuss new symptoms or concerns
- Perform tests including X-rays and chest imaging to check for recurrence or Pulmonary Metastasis
- Check for treatment-related late effects
Key Takeaways
- Giant Cell Tumour of Bone is a rare, non-cancerous tumor that can cause significant local damage despite being benign
- Common symptoms include bone pain, swelling, and risk of pathological fracture
- Diagnosis requires imaging studies and definitive biopsy for confirmation
- Surgical removal through curettage or wide excision is the standard treatment
- Denosumab represents a major treatment advance, shrinking tumors and strengthening bone
- Local recurrence is the most common complication, requiring long-term monitoring
- Rehabilitation services are crucial for optimal recovery and function
- Regular follow-up care is essential for detecting any recurrence or complications early
At Sancheti Hospital, we understand the complexity and challenges associated with Giant Cell Tumour of Bone. Our multidisciplinary team of orthopedic oncologists, radiologists, pathologists, and rehabilitation specialists work collaboratively to provide comprehensive care for patients with GCTB.
We offer advanced diagnostic capabilities including high-resolution imaging and expert pathological services for accurate diagnosis. Our treatment approach combines the latest surgical techniques with modern therapies like Denosumab, ensuring each patient receives personalized care tailored to their specific needs. Our dedicated rehabilitation team helps patients regain function and return to their daily activities with confidence.
We also provide ongoing support through our comprehensive follow-up care programs, ensuring long-term monitoring and early detection of any complications. At Sancheti Hospital, we are committed to delivering world-class care while supporting patients and their families throughout their treatment journey.
Meet Our Ortho Onco Specialist
Patient Stories & Experiences
The pain in my left knee left me feeling helpless for years. After my treatment here, I can finally say I'm pain-free.
Vinita Singh
The nerves were swollen, and the body went numb. But thanks to Sancheti Hospital, I got a second life!
Parvati
I finally could walk again, a relief I've only felt after the hip pain surgery. I thank the doctors at Sancheti Hospital for their help.
Balaji Kharat
I'm a police officer, and I'm extremely thankful to Sancheti Hospital for treating my fracture without surgery.
Shantilal
My life has completely changed after the knee replacement surgery at Sancheti Hospital. It's like I can finally live again!
Kalpana Lepcha
The knee pain I've carried for years finally went away with the help of Sancheti Hospital.
Karuna
I can't believe that I get to finally live a normal and happy life, all thanks to the knee surgery I had at Sancheti Hospital.
Kishore Bhosle
Frequently Asked Questions
How long does GCTB treatment take and when can I return to normal activities?
Treatment duration varies based on the approach. Surgery typically requires 2-4 hours, with hospital stays of 3-7 days. Denosumab treatment may last 6-12 months before surgery. Full recovery and return to normal activities usually takes 3-6 months, depending on tumor location and treatment type.
Will I need a joint replacement if GCTB is near my knee or other joints?
Not necessarily. Many patients keep their natural joints, especially with modern treatments like Denosumab that shrink tumors before surgery. Joint replacement is only considered if the tumor has severely damaged the joint or if wide excision is needed. Your surgeon will discuss joint-preserving options first.
Are there any dietary restrictions or lifestyle changes needed during treatment?
Patients on Denosumab need adequate calcium and vitamin D intake to prevent low calcium levels. Maintain good dental hygiene to reduce jaw problems. No specific dietary restrictions otherwise, but a balanced diet supports healing. Avoid high-impact activities until cleared by your doctor.
What happens if I get pregnant while having GCTB or during treatment?
Denosumab is not recommended during pregnancy and breastfeeding. If you’re planning pregnancy, discuss timing with your doctor. Pregnancy may need to be delayed until treatment completion. Surgery can be performed during pregnancy if urgently needed, but timing depends on the pregnancy stage.
