Bone cancer is considered as a rare cancer that develops in a bone. This cancer can start in any bone in the body and mostly long bones are affected that make up the legs and arms. Many bone tumors are benign that means they are non-cancerous and does not spread to any part of the body. Normal bone tissue is destroyed by this cancer and can spread to different body parts (known as metastasis).
Types of Bone Cancer
Primary Bone Sarcoma: This tumor first develops in the bone. There is no exact cause of bone sarcoma but heredity can be considered as one of the causes. Bone cancer can be categorized into different types that include –
- Chondrosarcoma: This type is most commonly seen in those people who are in between the age of 40-70. This cancer starts in cartilage cells and its common sites include leg, shoulder, hip, arm and pelvis.
- Ewing’s Sarcoma: This type is most commonly seen in young people who are in between the age of 5-20. The most common sites of this cancer include the upper arm, ribs, leg and pelvis.
- Osteosarcoma: This type is most common in the upper arm and knee and it starts from the bone cells. Osteosarcoma is usually seen in young adults and teens.
Benign Bone Tumors
The most common types of benign tumors include –
- Enchondroma: This type appears in the bones of the feet and hand. This usually involves no symptoms and is also considered as the most common type of hand tumor.
- Giant Cell Tumor: This tumor is a benign tumor that affects the leg.
- Osteoblastoma: This is a single tumor that takes place in the feet and the hand. This is usually seen in young adults.
- Osteochondroma: This is considered as the most benign bone tumor and is mostly people who are under 20 years of age are afflicted with it.
- Osteoid Osteoma: This usually occurs in the long bones that is seen commonly in those people who are in their early 20s.
Metastatic cancer is the cancer that spreads to the bones from elsewhere in the body. Metastatic cancer spreads to a bone but it is still not known as bone cancer as the tumor cells are from the primary cancer.
The cancers that spread to the bone are –
- Lung Cancer
- Prostate Cancer
- Breast Cancer
The causes of bone cancer are unknown. The patients, who are suffering from chronic inflammatory diseases such as Paget’s disease, have more chances of developing a bone cancer. The bone cancer starts due to an error in the DNA of a cell. This error tells a cell to divide and grow in an abnormal way. The cells then go on multiplying instead of dying at a given time. The build-up of these mutated cells creates a tumor that can affect surrounding structures or can also spread to different body areas.
- Unintended weight loss
- Bone pain
- Broken bone
- Tenderness and swelling close to the affected area
DIAGNOSTIC AND STAGING WORK UP
- OPD Consultations
- Computerized tomography (CT)
- Bone scan
- Magnetic resonance imaging (MRI)
- Positron Emission Tomography (PET)
A sample of tissue (Biopsy) from the tumor is removed for laboratory testing. Testing is done to know whether the tissue is cancerous and, if so, what is the type of cancer. Testing may also reveal the cancer's grade, which helps oncologists to understand how aggressive the cancer is.
Types of biopsy procedures used to diagnose bone cancer include:
- Inserting a needle through skin and into a tumor. During a needle biopsy, surgical oncologist inserts a thin needle through the skin and guides it 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, surgical oncologist makes an incision through the skin and removes either the entire tumor (excisional biopsy) or a portion of the tumor (incisional biopsy).
Determining the type of biopsy patients need and the particulars of how it should be performed requires careful planning by the oncology team. Surgical Oncologists perform the biopsy in a way that will not interfere with future surgery to remove bone cancer.
Tests to determine the extent (stage) of the bone cancer
Once diagnose, oncologists determine the extent of spread (stage) of the cancer. Treatment options are guided by the cancer's stage.
Stages of bone cancer include:
- Stage I. Bone cancer is limited to the bone and hasn't spread to other areas of the body. After biopsy testing, cancer at this stage is considered low grade and is not considered aggressive.
- Stage II. Bone cancer is limited to the bone and hasn't spread to other areas of the body. Biopsy testing usually reveals that the bone cancer is high grade and is considered aggressive.
- Stage III. Bone cancer occurs in two or more places on the same bone.
- Stage IV. Bone cancer indicates that cancer has spread beyond the bone to other areas of the body, such as the brain, liver or lungs.
The treatment options for bone cancer are based on the type of cancer, the stage of the cancer, overall health of the patient and their preferences. Bone cancer treatment typically involves surgery, chemotherapy, radiation or a combination of treatments.
The goal of surgery is to remove the entire bone cancer. To accomplish this, surgical oncologists remove the tumor along with a margin of surrounding healthy tissues 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 can be separated from nerves and other tissue, the surgical oncologist is able to remove the bone cancer and spare the limb. Since some of the bone is removed with the cancer, the surgeon replaces the lost bone with some bone from another part of the body or with a special metal prosthesis. Intense rehabilitative therapy may be necessary after limb-sparing surgery to make the affected arm or leg to become fully functional.
- Surgery to remove a limb. Bone cancers that are large or located in a complicated point on the bone require surgery to remove all or part of a limb (amputation). As other treatments have been developed, this procedure is becoming less common. After surgery an artificial limb is fitted and training is given to do everyday tasks using new limb.
- Surgery for cancer that doesn't affect the limbs. If bone cancer occurs in bones other than those of the arms and legs, surgeons may 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 or with a special metal prosthesis.
Radiation therapy uses high-powered beams of energy, to kill cancer cells. During radiation therapy, patients lie on a table while a linear accelerator moves around you and aims the energy beams at precise points on the body.
Preoperative radiation therapy may be used to shrink a bone cancer to increase the likelihood that the surgical oncologist can remove the entire cancer with surgery. In this situation, radiation therapy may be combined with chemotherapy.
Radiation therapy may also be used in people with bone cancer that can't be removed with surgery. It may also be used after surgery to kill any cancer cells that may be left behind. For people with advanced bone cancer, radiation therapy may help control signs and symptoms, such as pain.
Chemotherapy is a drug treatment that uses chemicals to kill cancer cells. Chemotherapy is most often given through a vein (intravenously). The chemotherapy medications travel throughout the body.
Chemotherapy is often used before surgery, usually in combination with radiation therapy, to shrink a bone cancer to a more manageable size that allows the surgical oncologist to use a limb-sparing surgery. Chemotherapy may also be used in people with bone cancer that has spread beyond the bone to other parts of the body.