Giant cell tumour of bone

1 / Understanding GCT

Locally aggressive does not mean harmless.

Giant cell tumour of bone, or GCT, often arises close to a joint. It can erode bone, cause pain or swelling and sometimes lead to a fracture. Although usually non-cancerous, it can rarely spread to the lungs; malignant GCT is also rare. These possibilities require a precise diagnosis rather than reassurance from the name alone.

Further reading: [1]

2 / Assessment

Assess the bone, joint and diagnosis.

X-rays and MRI help show how much bone is affected and whether the tumour extends into surrounding tissues. A biopsy usually confirms the diagnosis. Chest imaging may also form part of the assessment.

Bring previous imaging, pathology and details of earlier treatment. If a biopsy is still needed, ask how its route fits the proposed operation.

Further reading: [1]

3 / Surgical choices

Balance joint preservation and tumour control.

Curettage removes tumour from inside the bone while retaining the surrounding structure. Resection removes the involved segment. Joint-preserving surgery is favoured where feasible, but extensive destruction or soft tissue involvement can change the choice.

A wider operation may reduce recurrence risk but require more reconstruction and affect function. A fracture does not automatically rule out curettage. The fracture pattern, tumour extent and ability to restore stable bone matter.

Further reading: [2] [3] [6]

4 / Selected treatment

Denosumab needs a specific purpose.

Denosumab may be considered when surgery is not feasible or would cause substantial harm. Its use before an operation needs careful multidisciplinary discussion; it is not a routine step for every GCT.

If recommended, discuss dental assessment, calcium monitoring, side effects and the plan for continuing or stopping treatment. Calcium disturbances and jaw complications are recognised risks. Monitoring remains important after treatment ends.

Regular multidisciplinary tumour board review at Aster MIMS Kannur supports these decisions, with sarcoma pathology review and medical oncology input when needed.

Further reading: [3] [4] [5]

5 / Follow-up

Plan for recovery and possible recurrence.

GCT can return after treatment. Follow-up checks the operated area and, where indicated, the lungs. The schedule depends on the tumour and treatment rather than a single timetable for everyone.

Discuss when weight bearing, joint movement and work can resume. If the tumour returns, the next decision requires reassessment of the bone and previous treatment; recurrence does not automatically mean the same operation should be repeated.

Further reading: [1] [2]