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My wife and I are both nurses planning to go to China with a volunteer medical aid group. We've been studying up on the types of problems that occur in that country. My special area of expertise is orthopedics. I see that the Chinese are more likely than Caucasians of developing a problem called giant cell tumor. What can you tell me about this?

Giant cell tumors of the sacrum are uncommon. They are usually benign but they can grow very large putting pressure on the nearby nerves and other soft tissues. Sometimes they do become malignant and metastasize to the lungs. Giant cell tumors occur more often in Chinese people (up to 20% of the population are affected) compared to Caucasians in Western countries. The reason for this is unknown. The tumor most frequently involves the ends of long tubular bones in skeletally mature adults between the ages of 20 and 55 years of age. Sixty percent occur around the knee; 10% to 12% involve the distal radius (bone in the forearm). The bones of the hand and wrist and spine (vertebrae) are rarely affected. Giant cell tumors are the second most frequent primary bone-involved tumor in the sacrum. Symptoms depend on the location but include pain on weight bearing with pathologic fracture may be the presenting clinical feature when tumors occur in the weight-bearing bones. Sacral tumors may present with low back pain radiating to one or both of the legs. Abdominal discomfort and bowel and bladder symptoms may be present. Optimal treatment is a matter of considerable discussion and debate. Decisions about treatment may vary in a country like China depending on availability of medical services. Radiation, surgery, or both are effective but they are not without significant side effects and complications. Recurrence (tumor grows back) is common and has been reported in one-third to almost one-half of patients surgically treated.

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