Giant Cell Tumor of Bone
What is a giant cell tumor?
Giant cell tumors are benign bone tumors that can grow aggressively and destroy bone close to a joint. Typically they occur close to the knee, wrist, ankle or hip. While benign (noncancerous), giant cell tumors of bone can grow quickly.
Typically occurring after a child has reached skeletal maturity, giant cell tumors are more frequently diagnosed in girls. They are rarely seen in young children.
Causes of giant cell tumor
It is not known what causes giant cell tumors.
Signs and symptoms of giant cell tumor
The symptoms of a giant cell tumor can include:
- Pain, stiffness or tenderness at the site of the tumor
- Pain that’s severe enough to wake from sound sleep
- Weakness of the involved bone, which may lead to a fracture
Testing and diagnosis of giant cell tumor
Giant cell tumors can grow rapidly, so quick diagnosis and treatment is essential to produce the best outcome.
At Children’s Hospital of Philadelphia (CHOP), our clinical experts perform a careful and complete medical workup and examination of your child. We use a variety of diagnostic tests to diagnose giant cell tumors of bone, including:
- X-rays, which produce images of bones.
- Magnetic resonance imaging (MRI), which uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of organs, soft tissues, muscles, ligaments and other structures within the body. Your child is exposed to no radiation during an MRI.
- Computed tomography (CT) scan, which uses a combination of X-rays and computer technology to examine bones and produces cross-sectional images ("slices") of the body.
- Needle biopsy, a procedure where a doctor places a small needle through the skin and into the lesion to withdraw a sample of the abnormal tissue. The tissue is analyzed to confirm any findings.
Treatments for giant cell tumor
There are many treatment options available for bone and soft tissue tumors, and some children will need a combination of these therapies. At CHOP, experts at the Bone and Soft Tissue Tumor Program take a team approach to treatment. Orthopaedic and other specialists collaborate to provide your child with individualized care and the best possible outcomes.
Our program is led by Kristy L. Weber, MD, and Alexandre Arkader, MD, nationally renowned surgeons who specialize in treating bone and soft tissues tumors, limb-sparing surgery and reconstructive surgery.
Treatment for giant cell tumors may include:
- Intralesional curettage, which involves thoroughly scraping out the bone to completely remove the tumor and all cyst lining.
- Intraoperative adjuvants — such as cryotherapy (liquid nitrogen), phenol (a chemical) or cauterization (burning the tumor bed) – which are used to remove microscopic tumor cells.
- Bone grafting or cement to fill the cavity, a procedure to replace missing area of bone with cadaver bone or medical cement. If cadaver bone is used, crutches and protected weight-bearing will be needed for 6-12 weeks. If cement is used, the patient can walk on or use the extremity immediately.
- Chemotherapy, XGEVA® (denosumab), an FDA-approved medication for adults and some teens who have recurrent or difficult-to-remove giant cell tumors of bone.
Your child’s clinical team will recommend the best treatment for your child’s individual situation.
Giant cell tumors that appear in the head or neck and require specialized surgery will be treated by a surgeon from the Head and Neck Disorders Program at CHOP.
Depending on the size and location of the tumor removed, your child may be able to return home that day or may spend one night in the hospital.
Though surgery for tumors is highly effective, we understand that any surgery can be a stressful experience for children and families. At CHOP, we offer a wealth of resources about how to prepare your child for surgery and what to expect during surgery.
Additionally, we employ numerous best practices before, during and after surgery to decrease the risk of infection and increase positive outcomes. For more details about safety protocols at Children's Hospital of Philadelphia, see safety in surgery.
At Children's Hospital of Philadelphia, we offer ongoing support and services for patients and families at our Main Campus and throughout our CHOP Care Network. Our team is committed to partnering with parents and referring physicians to provide the most current, comprehensive and specialized care possible for your child.
Giant cell tumors of bone can recur in 10-15 percent of patients, so it is important for your child to continue to see your child’s surgeon after treatment.
Your child will see the orthopaedic surgeon about one to two weeks after surgery, then again every three to four months for up to five years to monitor for possible recurrence of the giant cell tumor.
During follow-up visits, X-rays are recommended to check the reconstruction and make sure there is no recurrence.
If the giant cell tumor of bone returns, your child’s doctor may treat it:
- By surgically re-removing the tumor and filling the area with cadaver bone or cement
- By removing the entire area of bone and replacing it with a metal joint replacement.
- With XGEVA® (denosumab), an FDA-approved medication for adults and some teens who have recurrent or difficult-to-remove giant cell tumors of bone
In rare cases (less than 2 percent), a giant cell tumor can spread to the lungs. A chest X-ray is often done at the time of initial diagnosis to check this. If the tumor does spread to the lungs, the tumor is usually treated by surgical removal.
Your child can continue to be monitored into adulthood by some of the same doctors who treated him at Children’s Hospital of Philadelphia. CHOP’s Bone and Soft Tissue Tumor Program works closely with Penn Medicine. For families who live farther away, our clinical professionals will help your child transition to adult care near home.
Reviewed by Kristy L. Weber, MD, FACS, Alexandre Arkader, MD