Bone Cancer

Bone cancer is a rare type of cancer that can begin in any bone in your body. The long bones of the arms and legs are most commonly affected. The term,"bone cancer" does not include the tumors that originate from other parts of your body and later spread to involve the bones. Some types of bone cancer primarily occur in children, while others often affect adults.

Not all tumors of the bone are cancerous. Benign or noncancerous bone cancers are common than malignant tumor. The benign tumors are localized masses that do not spread and destroy bone tissues, and are rarely life-threatening. Malignant tumors that originate in the bone tissue itself are termed as primary bone cancers.

Cancer that originates in other parts of the body such as the breast, lung, or prostate and then spreads to the bones is called metastatic cancer. Primary bone cancer is comparatively less common than metastatic cancer.

Persistent, unusual type of pain in the bone is the major symptom of bone cancer. Other signs and symptoms of bone cancer include:

• Swelling or tenderness near the affected bone
• Broken bone
• Fatigue
• Unexpected weight loss

When to see a doctor?

You should see a doctor to determine the cause for your symptoms. Make an appointment with your doctor if you or your child develop signs and symptoms that worry you.

Although the cause of bone cancer is not clearly defined, research has found out several factors that are linked with the development of these tumors. Doctors explain that bone cancer starts due to a mutation in the DNA of a cell. This mutated gene causes the cell to divide uncontrollably. These cells continue to live rather than dying at a set period of time. The mutated cells accumulate to form a mass (tumor) that invade nearby organs or even spread to other areas of the body.

Types of primary bone cancer.

Bone cancers are classified into separate types based on the type of cell in which the cancer began. The most common types of bone cancer include:

• Osteosarcoma: Osteosarcoma arises from osteoid tissue in the bone. Osteosarcoma occurs most often in children and young adults, in the bones of the knee and upper arm.
• Chondrosarcoma: Chondrosarcoma begins in the cartilaginous tissue. It usually occurs in the pelvis, upper legs, and shoulder in middle-aged and elderly adults.
• Ewing's sarcoma: It usually occurs in bone, but may also begin in soft tissues. It is not clear where in bone Ewing's sarcoma begins, but the tumors most commonly arise in the pelvis, legs or arms of children and young adults.

Making a diagnosis of bone cancer is done by several procedures.

You may see your family doctor or a general practitioner if you have any signs and symptoms that worry you. If your doctor suspects a bone cancer, you may be referred to a specialist doctor. Bone cancer is often treated by a multidisciplinary team of specialists that includes:

• Orthopedic surgeons who specialize in surgical treatment of cancers that affect the bones (orthopedic oncologists)
• Doctors specializing in treatment of cancer with chemotherapy or other systemic medications (oncologists)
• Doctors who treat cancer with radiation therapy (radiation oncologists)
• Doctors who examine tissue samples to diagnose the specific type of cancer (pathologists)
• Rehabilitation specialists who can help you recover after surgery

How to prepare?

As your appointments are brief, and there is often a lot of ground to cover, it is a good idea to be well-prepared. Try to:

Be aware of any pre-appointment restrictions. At the time you make the appointment, always ask if there is anything you need to do in advance, such as restrict your diet.

• Write down the symptoms you are having, including those that seem unrelated to the reason of your appointment.
• Write down your key personal information, including major stresses or recent life changes.
• Make a list of all regular medications, vitamins or supplements that you are taking.
• Ask a family member or friend to come along. Sometimes, it might be difficult to remember all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Carry your previous scans or X-rays (both the images and the reports) and any other medical records important to this situation.

Questions to ask your doctor

Preparing a list of questions you want to ask your doctor can help you make the most of your time together. List your questions from most important to least important in case time runs out. For bone cancer, some basic questions to ask your doctor include:

• What type of bone cancer do I have?
• What is the stage and grade of my bone cancer?
• Will I need any additional tests?
• What are the treatment options for my bone cancer?
• What are the chances that treatment will cure my bone cancer?
• What are the side effects and risks of each treatment option?
• Will the treatment make it impossible for me to have children?
• How will cancer treatment affect my other conditions?
• Is there a treatment that you think is best for me?
• Should I see a specialist? What will that cost, and will my insurance cover it?
• If I would like a second opinion, can you recommend a specialist?
• Are there any brochures or other printed material that I can take with me? What websites do you recommend?

What to expect from your doctor?

Your doctor may ask you a number of questions. Being ready to answer these allows more time to cover other points you want to address. Your doctor may ask:

• When did you first begin experiencing your symptoms?
• Have your symptoms been continuous or occasional?
• How severe are your symptoms?
• Is there anything that seems to improve or worsen your symptoms?
• The imaging tests may be advised depending on your situation. Your doctor will recommend one or more imaging tests to evaluate the area of concern, including:
• Bone scan
• Computerized tomography (CT)
• Magnetic resonance imaging scan (MRI)
• Positron emission tomography (PET)
• X-ray

Removing a sample of tissue for laboratory testing.

Your doctor will recommend a procedure that involves removal of a sample of tissue (biopsy) from the tumor for laboratory testing. This test can reveal whether the tissue is cancerous and, if so, what type of cancer you have. Testing will tell your doctor the cancer's grade, which helps understand how aggressive the cancer may be.

Types of biopsy procedures used to diagnose bone cancer include:

• Inserting a needle through your skin and into a tumor: During a needle biopsy, your doctor will insert a thin needle through your skin and then into the tumor. The needle is used to remove small pieces of tissue from the tumor.
• Surgery to remove a tissue sample for testing: During a surgical biopsy, your doctor makes an incision through your skin and removes either the entire tumor (excisional biopsy) or a small portion of the tumor (incisional biopsy).

Tests to determine the extent (stage) of the bone cancer

Once your doctor diagnoses your bone cancer, the extent (stage) of your cancer is determined. The stage of your cancer guides your treatment options.

Stages of bone cancer include:

• Stage I: At this stage, bone cancer is limited to the bone and has not spread to other areas of the body. Stage I cancer is low grade, which means the cancer cells are less aggressive.
• Stage II: This stage of bone cancer is also limited to the bone and hasn't spread to other areas of the body. Stage II cancer is high grade, which means the cancer cells are more aggressive.
• Stage III: At this stage, bone cancer occurs in two or more places on the same bone. Stage III tumors can be either low or high grade.
• Stage IV: This stage of bone cancer indicates that cancer has spread beyond the bone to involve other areas of the body, such as other bones or internal organs.

The treatment option for your bone cancer is based on the type of cancer you have, the stage of the cancer, your age and overall health and your preferences. Different bone cancers respond to different treatments, and your doctors can help guide you regarding which treatment best suits your cancer. For example, some bone cancers are treated with just surgery; some with surgery and chemotherapy; and some with surgery, chemotherapy and radiation therapy.

Surgery.

Surgery is the common treatment for bone cancer. The goal of surgery is to remove the entire bone cancer. In most cases, this involves special surgical techniques to remove the tumor in one single piece, along with a small portion of healthy tissue that surrounds it. Types of surgery used to treat bone cancer include:

Surgery to remove the cancer but spare the limb: If a bone cancer is able to be separated from its nerves and other tissues, the surgeon will remove the bone cancer and spare the limb. Since some amount of the bone is removed along with the cancer, the surgeon replaces the lost bone with bone harvested from another area of your body, with material obtained from a bone bank or with a special metallic prosthesis.

Surgery for cancer that does not affect the limbs: If bone cancer occurs in bones other than those of the arms and legs, surgeons will remove the bone and some surrounding tissue, such as in cancer that affects a rib, or may remove the cancer while preserving as much of the bone as possible, such as in cancer that affects the spine. Bone removed during surgery can be replaced with a piece of bone from another area of the body, with material from a bone bank or with a special metal prosthesis.

Surgery to remove a limb: Large sized bone cancers that are located in a complicated portion of the bone may require surgery to remove the entire or a part of a limb (amputation). As more specialized treatments have been developed, this procedure is done very rarely. You will be provided with an artificial limb after surgery and you will have to go through special training to learn performing everyday tasks using your new artificial limb.

Chemotherapy.

Chemotherapy is the use of anticancer drugs to destroy cancer cells. Chemotherapy is most often given through a vein (intravenously). Patients with bone cancer usually are given a combination of anticancer drugs. The chemotherapy medications travel throughout your body. For this reason, chemotherapy can be used in people with bone cancer that has spread beyond the bone to other areas of the body.

Radiation therapy.

Radiation therapy, also called radiotherapy uses high-energy beams of X-rays, to kill cancer cells. During radiation therapy, you will be made to lie down on a table while a special machine moves around you and aims the energy beams at precise points on your body.

Radiation therapy, typically used in combination with chemotherapy, is often used before an operation. This may decrease the need for amputation.

Radiation therapy may also be used in people with bone cancer that cannot be removed with surgery. After surgery, radiation therapy is used to kill any cancer cells that are left behind. In advanced stage bone cancer, radiation therapy help to control signs and symptoms, such as pain.

Cryosurgery.

Cryosurgery is the use of liquid nitrogen to freeze and destroy cancer cells. This technique is sometimes used instead of conventional surgery to destroy the tumor cells.

Lifestyle modifications are necessary in order to cope with bone cancer.

A diagnosis of cancer is always stressful and overwhelming. It requires some time to find out ways to cope with the distress and uncertainty of cancer. Until then, the following measures may help.

Learn more things about bone cancer as this helps you make proper decisions about your care. Ask your doctor about your bone cancer, including the treatment options and, if you want, your prognosis. As you come to know about bone cancer, you may feel more confident in making your treatment decisions.

Maintain close relationships with your friends and family: Strengthening your relationships with close relatives will help you deal with your bone cancer better. Friends and family often give you the practical support you will need, for instance, preparing meals for you and taking care of your house when you are in the hospital. They can also serve as emotional support when you feel devastated by cancer.

Find someone with whom you can share your feelings: Find a friend or a family member who is a good listener and willing to listen to you talk about your hopes and fears. The concern and understanding of a counselor, medical social worker, clergy member or cancer support group also may be helpful. Ask your doctor about support groups in your neighborhood or else check your phone book, library or a cancer organization, such as the National Cancer Institute or the American Cancer Society.

There are certain factors that have been found to increase the risk of developing bone cancer. These include:

• Inherited genetic disorders: Children with rare genetic syndromes that run in families are at an increased risk of bone cancer. The inherited disorders include Li-Fraumeni syndrome and hereditary retinoblastoma.
• Paget's disease of bone: Paget's disease of bone, which commonly occurs in older adults can increase the risk of bone cancer developing later.
• Radiation therapy as cancer treatment: Being exposed to large doses of radiation, such as those given during radiation treatment for cancer can increase your risk of developing bone cancer in the future.
• Bone marrow transplantation: Patients who have undergone bone marrow (stem cell) transplantation are at an increased risk of developing bone cancer (osteosarcoma).