HEALTH - BONE CANCER (CANCER OF THE BONES) SYMPTOMS & TREATMENT
What is Bone Cancer?
Bone cancer is caused by a problem with the cells that make bone. More
than 2,000 people are diagnosed in the United States each year with a
bone tumor. Bone tumors occur most commonly in children and adolescents
and are less common in older adults. Cancer involving the bone in older
adults is most commonly the result of metastatic spread from another
tumor. Although bone cancer can arise in any of your bones, it most frequently occurs in the long bones of your arms and legs.
Your body has 206 bones. These bones serve multiple different
functions. First, your bones provide structure to your body and help
provide its shape. Muscles attach to the bones and allow you to move.
Without the bones, your body would become a pile of soft tissues
without structure, and you would be unable to stand, walk, or move.
Second, the bones help to protect the more fragile organs of the body.
For example, the bones of the skull protect the brain, the vertebrae of
the spine protect the spinal cord, and the ribs protect the heart and
lungs. Third, the bones contain bone marrow, which makes and stores new
blood cells. Finally, the bones help control your body's collection of
various proteins and nutrients including calcium and phosphorus.
A tumor can be benign (not cancerous) or malignant (cancerous). Benign
tumors are usually less dangerous and are not able to spread to other
parts of the body. Malignant tumors are usually more serious and can
spread to other areas in the body. The ability of cancer cells to leave
their initial location and move to another location in the body is
called metastasis. Metastasis can occur by the cancer cells entering
the body's bloodstream or lymphatic system to travel to other sites in
the body.
When cancer cells metastasize to other parts of the body,
they are still named by the original type of abnormal cell. For
example, if a group of breast cells becomes cancerous and metastasizes
to the bones, it is called metastatic breast cancer. Many different
types of cancer are able to metastasize to the bones. The most common
types of cancer that spread to the bones are lung, breast, prostate,
thyroid, and kidney. Most of the time, when people have cancer in their
bone, it is caused by cancer that has spread from elsewhere in the body
to the bones.
It is much less common to have a true bone cancer, a cancer that arises from cells that make up the bone. It is important to determine whether the cancer in the bone is from another site or is from a cancer of the bone cells. The treatments for cancers that have metastasized to the bone are based on the initial type of cancer.
There are many different types of bone cancer. The most common bone tumors include osteosarcoma, Ewing's sarcoma, chondrosarcoma, malignant fibrous histiocytoma, fibrosarcoma, and chordoma.
- Osteosarcoma is the most common primary malignant bone cancer. It most commonly affects males between 10 and 25 years old, but can less commonly affect older adults. It often occurs in the long bones of the arms and legs at areas of rapid growth around the knees and shoulders of children. This type of cancer is often very aggressive with a health risk of spreading to the lungs. The five-year survival rate is about 65%.
- Ewing's sarcoma is the most aggressive bone tumor and affects younger people between 4-15 years of age. It is more common in males and is very rare in people over 30 years old. It most commonly occurs in the middle of the long bones of the arms and legs. The three-year survival health rate is about 65%, but this rate is much lower if there has been spread to the lungs or other tissues of the body.
- Chondrosarcoma is the second most common bone tumor and accounts for about 25% of all malignant bone tumors. These tumors arise from the cartilage cells and can either be very aggressive or relatively slow-growing. Unlike many other bone tumors, chondrosarcoma is most common in people over 40 years old. It is slightly more common in males and can potentially spread to the lungs and lymph nodes. Chondrosracoma most commonly affects the bones of the pelvis and hips. The five-year survival for the aggressive form is about 30%, but the survival health rate for slow-growing tumors is 90%.
- Malignant fibrous histiocytoma (MFH) affects the soft tissues including muscle, ligaments, tendons, and fat. It is the most common soft-tissue malignancy in later adult life, usually occurring in people 50-60 years of age. It most commonly affects the extremities and is about twice as common in males as females. MFH also has a wide range of severity. The overall five-year survival health rate is about 35%-60%.
- Fibrosarcoma is much more rare than the other bone tumors. It is most common in people 35-55 years of age. It most commonly affects the soft tissues of the leg behind the knee. It is slightly more common in males than females.
- Chordoma is a very rare tumor with an average survival of about six years after diagnosis. It occurs in adults over 30 years of age and is about twice as common in males as females. It most commonly affects either the lower or upper end of the spinal column.
In addition to bone cancer, there are various types of benign bone tumors. These include osteoid osteoma, osteoblastoma, osteochondroma, enchondroma, chondromyxoid fibroma, and giant cell tumor (which has the potential to become malignant). As with other types of benign tumors, these are not cancerous.
There are two other relatively common types of cancer than develop in the bones: lymphoma and multiple myeloma. Lymphoma, a cancer arising from the cells of the immune system, usually begins in the lymph nodes but can begin in the bone. Multiple myeloma begins in the bones, but it is not usually considered a bone tumor because it is a tumor of the bone marrow cells and not of the bone cells.
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Health: Symptoms of Bone Cancer (Bones, Cancer)
The most common symptom of bone tumors is pain. In most cases, the symptoms become gradually more severe with time. Initially, the pain may only be present either at night or with activity. Depending on the growth of the tumor, those affected may have symptoms for weeks, months, or years before seeking medical advice. In some cases, a mass or lump may be felt either on the bone or in the tissues surrounding the bone. This is most common with MFH or fibrosarcoma but can occur with other bone tumors. The bones can become weakened by the tumor and lead to a fracture after little or no trauma or just from standing on the affected bone. Fever, chills, night sweats, and weight loss can occur but are less common. These symptoms are more common after spread of the tumor to other tissues in the body.
Possible symptoms of bone cancer include:
- Weakened bones, sometimes leading to fractures
- Joint swelling and tenderness (for tumors in or near joints)
- Fatigue
- Fever
- Unintended weight loss
- Anemia
Health: Risk Factors of Bone Cancer (Bones, Cancer)
Primary bone cancer is different from secondary or metastatic bone cancer. In secondary or metastatic bone cancer, the cancer originates in a different place but spreads (metastasizes) to the bones. For example, someone with prostate cancer may develop bone lesions from the prostate cancer. But, even though the cancer has spread to the bone, it's still prostate cancer.
Metastatic bone cancer is much more common than is primary bone cancer. Additionally, primary bone cancer doesn't refer to cancer that begins in the bone marrow — the soft inner core of your bones that makes your blood cells. Bone marrow cancers include diseases such as multiple myeloma and acute and chronic leukemias.
In general, no one knows for certain what causes most primary bone cancers. Adults with Paget's disease of bone, which involves abnormal development of new bone cells, may be at increased risk of osteosarcoma.
In a few cases, bone cancers may have a hereditary component, such as in:
- Li-Fraumeni syndrome. This condition is characterized by an increased health risk of many different cancers, including osteosarcoma, breast cancer, brain cancer and others.
- Rothmund-Thomson syndrome. This condition causes short stature, skeletal health problems and rashes, and increases risk of bone cancer.
- Hereditary retinoblastoma. Children with this rare cancer of the eye have an increased risk of osteosarcoma.
- Multiple exostoses. Children with this inherited health condition that causes cartilage bumps to form on your bones have an increased risk of chondrosarcoma.
The association with radiation
Radiation is occasionally associated with bone cancer. Exposure to
radiation from a diagnostic X-ray won't harm you. But heavy doses of
radiation, such as radiation therapy given for other cancers, can
increase your health risk of developing bone cancer, especially if you receive
the therapy at a young age.
Still, radiation therapy is becoming more and more sophisticated, which may lead to fewer of such side effects. For example, doctors today are better able to regulate doses of radiation and more precisely target the tumor being treated.
Chemotherapy. Some drugs, including alkylating agents and anthracyclines, used to treat cancer may increase the health risk of developing a secondary cancer, usually osteosarcoma.
Talk to your doctor or health care provider if you develop symptoms that may indicate bone cancer, such as unexplained bone pain. Having bone pain doesn't necessarily mean you have bone cancer. Bone pain is more likely due to injuries or arthritis. And bone tumors are often noncancerous (benign). However, the only way to determine whether a tumor is cancerous is for a doctor to examine a sample of the tissue.
Health: Diagnosis of Bone Cancer (Bones, Cancer)
The first thing your doctor will do is to take a complete medical history. This will give your doctor clues as to your diagnosis. Some types of cancer are more common in people if they have close family members that have had that type of cancer. A description of your symptoms can help your doctor identify the possibility of bone cancer from other possible causes. Next, a complete physical examination can help find the cause of your symptoms. This may include testing your muscle strength, sensation to touch, and reflexes. Certain blood tests can be ordered that can help to identify a possible cancer.
The following tests may be used to diagnose bone cancer:
Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. The sample removed from the biopsy is analyzed by a pathologist (a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease). The type of biopsy (needle or incisional) performed will depend on the location of the cancer. However, there are some cases where a biopsy may not be able to be performed.
For a needle biopsy, a small hole is made in the bone, and a tissue sample is removed from the tumor with a needle-like instrument. In an incisional biopsy, the tissue sample is removed after a small cut is made in the tumor.
Blood tests. Some laboratory tests may help detect bone cancer. Alkaline phosphatase and lactate dehydrogenase levels may be higher in patients with osteosarcoma or Ewing’s sarcoma. However, it is important to note that alkaline phosphatase is normally high when cells that form bone tissue are very active (for example, when children are growing or a broken bone is mending), so high levels do not always mean cancer. Patients with chondrosarcoma may have abnormal glucose tolerance tests.
X-ray. An x-ray is a picture of the inside of the body. Typically, if an x-ray suggests cancer, the doctor would order other imaging tests.
Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, a contrast medium (a special dye) is injected into a vein to provide better detail.
Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. A contrast medium may be injected into a patient’s vein to create a clearer picture. MRI scans are useful to check for tumors in nearby soft tissues.
Bone scan. A bone scan uses a radioactive tracer to look at the inside of the bones. The tracer is injected into a patient’s vein. It collects in areas of the bone and is detected by a special camera. Healthy bone appears gray to the camera, and areas of injury, such as those caused by cancerous cells, appear dark.
Positron emission tomography (PET) scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of radioactive substance is injected into a patient’s body and absorbed by the organs or tissues being studied. This substance gives off energy that is detected by a scanner, which produces the images.
Integrated PET-CT scan. This scanning method collects images from both CT and PET scans at the same time, and then combines the images. This technique has the advantage of looking at both the structure and metabolism of the tumor and normal tissue. This information can be helpful to plan treatment and determine the health benefits of different treatments.
If a tumor is identified, your doctor will use all of the information from the history and physical examination along with the laboratory and imaging studies to put together a list of possible causes (differential diagnosis).
Besides determining whether the tissue is cancerous, examining tissue can determine how aggressive the cancer is (its grade). Further testing, such as scans and blood tests, will determine if the cancer has spread and how far (its stage).
Childhood bone cancers, such as osteosarcoma or Ewing's sarcoma, are generally grouped into two stages, depending on whether the cancer is contained in one part of the body (localized) or has spread to other parts (metastasized).
Survival is based on a number of factors, including the type of cancer, at what stage the cancer was discovered and where the tumor is located. If the tumor is very small and localized, the prognosis is generally more promising than if the cancer has begun to spread.
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Natural Alternative Treatment: CANCER FREE
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Health: Conventional Treatment for Bone Cancer (Bones, Cancer)
There are many different methods available for your doctor to treat bone cancer. The best treatment is based on the type of bone cancer, the location of the cancer, how aggressive the cancer is, and whether or not the cancer has invaded surrounding or distant tissues (metastasized), and the patient’s overall health.For a low-grade tumor, the primary treatment is surgery. The goal of surgery is to remove the tumor and a margin of healthy bone or tissue around the tumor to make sure all the cancer cells are gone.
For a high-grade tumor, oncologists (a doctor who specializes in the health care and treatment of people with cancer) often use a combination of treatments, including surgery, chemotherapy, and radiation therapy.
Surgery
Surgery for bone cancer often involves a wide excision of the tumor. A wide excision removes the tumor along with a margin of normal tissue in all directions. Limb-sparing techniques are used whenever possible. However, amputation (removal) of the affected arm or leg may be necessary depending on the tumor’s size or location.
Wide excision surgical techniques have reduced the number of amputations performed for patients with bone cancer. About 75% to 80% of patients can be treated with conservative surgery compared with amputation. These surgeries often require prostheses, such as metal plates or bone from other parts of the body, to replace the missing bone and provide strength to the remaining bone.
For some patients, amputation may offer the best option. These include patients whose cancer is located where it cannot be completely removed by surgery, patients who cannot undergo reconstruction, or when the surgical area cannot be adequately covered with soft tissue. Surgeons use soft tissue, such as muscle, to cover the reconstruction area. The tissue helps in healing and reduces the health risk of infection.
Children with bone cancer may require amputation more often than adults since their bones grow more. To avoid amputation, some children can be fitted for expandable joint prostheses that adjust as the skeleton grows. These prostheses require multiple operations to adjust bone length as the child grows.
Chemotherapy
Chemotherapy is the use of drugs to kill cancer cells. Systemic chemotherapy is delivered through the bloodstream, targeting cancer cells throughout the body. Chemotherapy for bone cancer can usually be given as an outpatient treatment, which is treatment that can be given at a clinic or doctor’s office instead of being admitted to a hospital.
Chemotherapy is often useful for treating cancer that has metastasized. Fast-growing bone cancer may be treated first with chemotherapy before surgery. This often reduces the size of the primary tumor and may destroy tiny areas of metastasis if some of the cancer cells have spread to other areas.
Surgery alone is not usually sufficient treatment for patients with some bone cancers, particularly osteosarcoma. These cancers sometimes recur as distant metastases (most often in the lungs) that were most likely present in a microscopic form when the person was diagnosed. The use of chemotherapy has increased survival rates for some types of bone cancer.
For most high-grade tumors, the oncologist gives chemotherapy for three to four cycles before surgery to shrink the primary tumor, so the tumor is easier to remove. Chemotherapy before surgery may also improve survival, since it may kill cells that have spread from the original tumor. The tumor’s response to chemotherapy, evaluated with a microscope after the primary tumor has been removed, can be used to better determine the prognosis. Chemotherapy that is given before surgery is called preoperative chemotherapy, neoadjuvant chemotherapy, or induction chemotherapy.
After the patient has recovered from surgery, the patient may receive additional chemotherapy to kill any remaining tumor cells. This is called postoperative or adjuvant chemotherapy. The use of chemotherapy to shrink the tumor before surgery combined with chemotherapy after surgery has saved many lives and many patients’ limbs.
Some common chemotherapy drugs given to patients with bone cancer are ifosfamide (Ifex), methotrexate (multiple brand names), cyclophosphamide (Cytoxan, Neosar), etoposide (VePesid, Etopophos, Lastet), cisplatin (Platinol), doxorubicin (Adriamycin), and dactinomycin (Actinomycin-D, Cosmegen, Lyovac Cosmegen).
In particular, Ewing’s sarcoma responds well to chemotherapy. Some drugs used to treat Ewing’s sarcoma are vincristine (Oncovin), dactinomycin, cyclophosphamide, doxorubicin, ifosfamide, and etoposide.
The side effects of chemotherapy depend on the individual and the dose used, but can include fatigue, risk of infection, nausea and vomiting, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished.
The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications.
Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy.
For bone cancer, radiation therapy is most often used for patients with a tumor that cannot be removed by surgery or that may have cancer cells remaining after surgery. Radiation therapy may be done before surgery to shrink the tumor, or it may be done after surgery to eliminate any cancer cells remaining after surgery. Radiation therapy makes it possible to do less extensive surgery, often preserving the arm or leg. Radiation therapy may also be used to alleviate pain in advanced bone cancer.
For patients with Ewing’s sarcoma, radiation therapy may be used with chemotherapy and surgery. However, oncologists have had good results in recent years using surgery for Ewing’s sarcoma, with or without radiation therapy. Ewing’s sarcoma that starts in bones that cannot be surgically removed is treated with chemotherapy and radiation therapy.
Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Most side effects go away soon after treatment is finished.
Health: Side Effects of Treatment of Bone Cancer (Bones, Cancer)
Unfortunately, there are health risks and side effects with each of the
treatments for bone cancer. The main risks associated with surgery
include infection, recurrence of the cancer, and injury to the
surrounding tissues. In order to remove the entire cancer and reduce
the risk of recurrence, some surrounding normal tissue must also be
removed. Depending on the location of the cancer, this may require the
removal of portions of bone, muscle, nerves, or blood vessels. This
could cause weakness, loss of sensation, and the risk of fracture or
fracture of the remaining bone. You could be referred to a
rehabilitation specialist for physical and occupational therapy after
surgery to try to improve your strength and function health wise.
Chemotherapy uses very powerful medication to try to kill cancer cells. Unfortunately, some normal cells are also killed in the process. The medications are designed to kill rapidly dividing or growing cells. The normal cells that are affected often include hair, blood-forming cells, and cells lining the digestive system. Side effects include nausea and vomiting, loss of hair, infection, and fatigue. Fortunately, these side effects usually resolve after the chemotherapy is over. Good nutrition is important for your body to fight the cancer. You may be referred to nutrition specialist to help with this, especially if you experience nausea and loss of appetite.
The main health risks and side effects from radiation therapy include fatigue, loss of appetite, and damage to the surrounding skin and soft tissues. Prior radiation therapy can also increase the risk of wound problems from surgery in the same area.
Health: Coping with Bone Cancer (Bones, Cancer)
A diagnosis of cancer, whether yours or your child's, presents big challenges. Remember that no matter what your concerns or the prognosis, there are resources and strategies that may make dealing with cancer easier. Here are some suggestions for coping:
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Learn all you can. Find out everything you can about your or your child's cancer — the type, stage and risks involved and your treatment options and their side effects. The more you know, the more you can participate in treatment decisions. In addition to talking with your doctor, look for information in your local library and from reliable Internet sources.
The National Cancer Institute answers questions from the public over the phone at 800-4-CANCER, or 800-422-6237. Or contact the American Cancer Society at 800-ACS-2345, or 800-227-2345.
- Be proactive. Although you may feel tired and discouraged, don't let others — including your family and your doctor — make important decisions for you. It's vital that you take an active role in your own or your child's treatment.
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Maintain a strong support system. Having a support system and a positive attitude can help you cope with the challenges cancer brings. Although friends and family can be your best allies, they sometimes may have trouble dealing with the illness of a loved one. If so, the concern and understanding of a formal support group or of others coping with their own cancer or that of their child can be especially helpful.
Although support groups aren't for everyone, they can be a good source for practical information for you and your family, too. You may also develop deep and lasting bonds with people who are going through the same things you are.
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Maintain hope. Although your hopes may change as you go through a cancer diagnosis and treatment, it's important to have hope. For example, when you first hear the diagnosis, you may hope that there's been a mistake. Once you accept the diagnosis, you'll hope for a good result from treatment.
One way to maintain hope is to set goals. Having goals helps you feel in control and can give you a sense of purpose. But don't choose goals you can't possibly reach. You may not be able work a 40-hour week, for example, but you may be able to work part time. In fact, many people find that continuing to work and engage in everyday activities can be helpful.
- Take time for yourself. Eating well, relaxing and getting enough rest can help combat the stress and fatigue of cancer. Also, plan ahead for the times when you may need to rest more or limit what you do. If your child has cancer, one of the most important things you can do is take care of yourself. As a caregiver, you need to have the strength and emotional reserves to meet your child's needs.
- Stay active. Having cancer doesn't mean you have to stop doing the things you enjoy or normally do. For the most part, if you feel well enough to do something, go ahead and do it. It's important to stay involved as much as you can. If your child has cancer, try to keep his or her life as normal as possible.
- Look for a connection to something beyond yourself. Having a strong faith or a sense of something greater than yourself may help you successfully cope with cancer.
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Disclaimer: This information is not presented by a medical practitioner. Therefore any content of this site is strictly intended for educational and informational purpose only. Any access to this site is strictly on a voluntary basis and at the sole discretion of the user. No content of this site is intended as a substitute for medical advice, diagnosis or treatment, nor constitute the practice of any medical profession or health care provider. The information provided on this site is here to educate visitors on health issues that may affect their lives. Otherwise, always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition. And never disregard professional medical advice or delay in seeking it because of something you have read.
Sources: NIH News In Health/National Institutes of Health/National Library of Medicine/Dept of Health and Human Services_______________________________________________________________________________________________________
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