Orthopedics - Oleksa A.P. 2006

Tumor-like conditions and bone tumors
Laboratory examination

Unlike benign tumors, malignant ones cause hematological alterations, which are particularly pronounced in advanced cases. Typically, there is an elevation in ESR, leukocytosis, and a relative increase in the number of lymphocytes and monocytes. Total protein and albumin levels decrease, accompanied by a relative increase in globulins. During tumor necrosis, all protein fractions decline. In multiple myeloma, findings include leukopenia, anemia, thrombocytopenia, and an elevated ESR. Determining the ERYTHROCYTE SEDIMENTATION RATE can also hold prognostic significance for most Bone Marrow-derived tumors (Ewing's Sarcoma, histiocytosis, leukemia) as well as metastatic malignancies. An elevated erythrocyte sedimentation rate serves as an unfavorable prognostic indicator in Ewing's sarcoma or lymphoma.

Since malignant tumors destroy Connective Tissue structures containing complex protein-carbohydrate complexes, biochemical assays measuring the serum levels of muco- and Glycoproteins, as well as sialic acids, warrant close attention, as these parameters increase sharply.

There is also an elevation in alkaline phosphatase levels, observed in approximately half of patients with osteosarcoma and occasionally in those with other PRIMARY Bone tumors. If an elevated alkaline phosphatase level is detected at THE START OF Treatment in a patient with a tumor, It is important to monitor this level subsequently, as it serves as an indicator of treatment efficacy and disease prognosis.

During intensive bone destruction, serum calcium levels increase, while non-Hemoglobin iron content decreases.

A crucial assay is the determination of hexokinase, an enzyme indicative of the maximum rate of Glycolysis in malignant tumors. Hexokinase is absent in the Blood serum of healthy individuals, yet in patients with malignant tumors, even in early stages, it is detected in 78 % of cases.

It should be noted that serological, biochemical, and immunological blood tests have limited value for diagnosing musculoskeletal tumors. However, this does not apply to certain specific diagnostic tests of paramount importance, such as detecting IMMUNOGLOBULINS in multiple myeloma or specific Antigens in prostate Cancer metastases.