Bone Cancer & Treatment

What Is Bone Cancer?
Bone cancer can be primary bone cancer or secondary bone cancer. Primary bone cancer started in the bone; the cancer initially formed in the cells of the bone, while secondary cancer started elsewhere in the body and spread to the bone. Examples of primary bone cancer include steosarcoma, Ewing sarcoma, malignant fibrous histiocytoma, and chondrosarcoma.

According to the National Cancer Institute, USA, it is estimated that by the end of 2010 there will have been 2,650 new cases and 1,450 deaths from cancer of the bones and joints. The National Health Service (NHS), UK, informs that primary bone cancer accounts for 1 in every 500 cancers in the United Kingdom. There are approximately 500 cases of bone cancer each year in the UK, making this kind of cancer a fairly rare one. 

Primary bone cancer (tumor) - these can be divided into benign tumors - which can have a neoplastic (abnormal tissue growth), developmental, traumatic, infectious, or inflammatory cause - and cancers. 

Examples of benign bone tumors include - osteoma, osteoid osteoma, osteochondroma, osteoblastoma, enchondroma, giant cell tumor of bone, aneurysmal bone cyst, and fibrous dysplasia of bone. 

Examples of malignant primary bone tumors include: osteosarcoma, chondrosarcoma, Ewing's sarcoma, malignant fibrous histiocytoma, fibrosarcoma, and other sarcomas. Multiple myeloma is a blood cancer which may include one or more bone tumors. Teratomas and germ cell tumors are frequently located in the tailbone. 

Osteosarcoma is the most common type of bone cancer. It usually develops in children and young adults. After leukemia and brian tumors, osteosarcoma is the third most common cancer among for children in the UK and the USA. 

Ewing sarcoma usually develops in the pelvis, shin bone or thigh bone. 90% of patients develop this type of cancer when they are less than 20 years of age. 

The outlook for a patient with malignant bone cancer depends mainly on whether it has metastasized (spread to other parts of the body). If the cancer is localized (has not spread), prognosis is usually good.

Symptoms of Bone Cancer

A symptom is something the patient feels and reports, while a sign is something other people, such as the doctor notice. For example, pain may be a symptom while a rash may be a sign. 

The patient initially experiences pain in the affected area. Over time the pain gets worse and continuous. In some cases the pain is subtle and the patient may not see a doctor for several months. The progression of pain with Ewing sarcoma tends to be faster than in most other bone cancers. Typically, bone cancer pain is deep, nagging and has a permanent character.

There may also be swelling in the affected area. 

• Often the bone will weaken, resulting in a significantly higher risk of fracture. 
• The patient may find he/she loses weight unintentionally. 
• A mass (lump) may be felt in the affected area. 
• Although much less common, the patient may also experience fever, chills and/or night sweats.

Causes of Bone Cancer

Nobody knows in general what the causes of bone cancer are. Patients with chronic (long-term) inflammatory diseases, such as Paget's disease are at a significantly higher risk of developing bone cancer later on in life. However, nobody can explain why one person gets bone cancer while another one doesn't. It is not contagious - you cannot catch it from someone else. 

The following groups of people may be at a higher risk of developing bone cancer:

• Being a child or very young adult - most cases of bone cancer occur in children or young adults aged up to 20.
• Patients who have received radiation therapy (radiotherapy).
• People with a history of Paget's disease.
• People with a close relative (parent or sibling) who has/had bone cancer.
• Individuals with hereditary renoblastoma - a type of eye cancer that most commonly affects very young children.
• People with Li-Fraumeni syndrome - a rare genetic condition.
• Babies born with an umbilical hernia.

Treatment for Bone Cancer

The type of treatment for bone cancer depends on several factors, including what type of bone cancer it is, where it is located, how aggressive it is, and whether it is localized or has spread. There are three approaches to bone cancer:

• Surgery
• Chemotherapy
• Radiotherapy (radiation therapy)

Surgery 

The aim is to remove the tumor, all of it if possible, and some of the bone tissue that surrounds it. If some of the cancer is left behind after surgically removing the tumor it may continue to grow and eventually spread. Limb sparing surgery, also known as limb salvage surgery means that surgical intervention occurs without having to amputate the limb. The surgeon may take some bone from another part of the body to replace lost bone (bone graft), or an artificial bone may be put in. In some cases, however, amputation of a limb may be necessary. 

Radiation therapy 

Also known as radiotherapy, radiation oncology and XRT. Approximately 40% of patients of all types of cancer undergo some kind of radiotherapy. It involves the use of beams of high-energy X-rays or particles (radiation) to destroy cancer cells. Radiotherapy works by damaging the DNA inside the tumor cells, destroying their ability to reproduce. Radiotherapy can be used for different reasons:

• Total Cure - to cure the patient by completely destroying the tumor.
• To alleviate symptoms - radiotherapy is often used to relieve pain in more advanced cancers.
• Neo-adjuvant radiotherapy (before surgery) - if a tumor is large, radiotherapy can shrink it, making it easier and less harmful to then surgically remove it.
• Adjuvant radiotherapy - given after surgery. The aim is to eliminate the cancer cells that remained behind.
• Combination therapy (radiotherapy combined with another type of therapy) - in some cases, chemoradiation - radiotherapy combined with chemotherapy - is more effective.

Chemotherapy

The use of chemicals (medication) to treat disease - more specifically, it usually refers to the destruction of cancer cells. Cytotoxic medication prevents cancer cells from dividing and growing. In general, chemotherapy has 5 possible goals:

• Total remission - to cure the patient completely. In some cases chemotherapy alone can get rid of the cancer completely.
• Combination therapy - chemotherapy can help other therapies, such as radiotherapy or surgery have more effective results.
• Delay/Prevent recurrence - chemotherapy, when used to prevent the return of a cancer, is most often used after a tumor is removed surgically.
• Slow down cancer progression - used mainly when the cancer is in its advanced stages and a cure is unlikely. Chemotherapy can slow down the advancement of the cancer.
• To relieve symptoms - also more frequently used for patients with advanced cancer.

Lifestyle after Bone Cancer

After your operation

After bone or joint surgery, you will need a lot of physiotherapy to get you going again. This is very hard work at the time. But it will pay off as you find you can move around more and more easily.

You may have to have further operations in the future if you have limb sparing surgery. You may have complications. Or if you are young and had not finished growing when you had your false bone or joint put in, you may need to have it replaced as you get bigger. Some false bones are made to expand. If you have one of these, you will still need to go into hospital from time to time to have it extended, but will not need major surgery to replace the whole thing.

Wear and tear

False bones and joints very rarely break. But after several years, there may be signs of wear and tear in your false bone or joint. It isn’t possible to generalise about this, as there are so many different types and makes of prostheses. But after some time, the plastic surfaces of the joint or bone can become worn and need replacing. If you have had a metal rod inserted into your bone this can sometimes become loose and so may need replacing or strengthening.

If you have had a false knee fitted due to bone cancer, you are likely to need further surgery at some point in the future. Around 3 people out of every 100 each year (3%) need a replacement knee joint.

Complications

Eventually, most people who have a false joint or bone will develop some sort of complication that needs surgery to put it right. The most likely complications are

• Infection
• The prosthesis working loose
• Mechanical failure

If you think there is something wrong with your false bone or joint, get in touch with your surgeon. The earlier you recognise a likely problem, the easier it is likely to be to deal with. The signs you should look out for are

• Pain
• Swelling
• Temperature (fever)
• An open wound over the operation site
• A cracking sound in the joint as you move

Difficulty moving your limb

You will have trouble moving the affected limb to start with. But your physiotherapists will give you lots of exercises that will gradually make things easier for you. Your physiotherapist should be able to give you some idea of how things will turn out if you keep up with your exercises. For many people, there is no reason why you shouldn't be using your affected limb normally in time.

Changes in how you look

How you look is an important part of your self esteem. It can be very hard to accept sudden changes in your looks that you are not happy with. It is not unusual for people who have had limb sparing surgery to feel confused and upset for some time after their operation. You may feel worried about how your friends and family see you. You may feel that you are no longer as physically attractive. Going back to work, meeting new people and going for job interviews can all be more of a struggle if you are coping with changes in your appearance.

If you are very young, you may be very worried about how your friends will see you. If you have children, you may worry how this will affect them and how they will answer their own friends' questions. It is quite normal to worry about such things. The important thing to remember is that the people closest to you will not see you any differently as a person. They will want to support you as much as they can, so let them in on how you are feeling. They can help to support you when they know how you feel.

Swelling in your arm or leg (lymphoedema)

Swelling is very uncommon after limb sparing surgery, unless you have also had radiotherapy to the lymph nodes that normally drain fluid from your limb.

The lymphatic system is a system of thin tubes that runs throughout the body. These tubes are called lymph vessels. Lymph is a clear fluid that circulates around the body tissues. Along the lymph vessels are small bean shaped lymph glands or nodes. You have lymph nodes all over your body, but those most affected by this type of treatment would be those

• Under your arms, in your armpits
• In each groin, at the top of your legs

If you have surgery and radiotherapy to these places, it can affect the drainage of lymph through these nodes. This makes it more difficult for the tissue fluid to circulate and drain out of the limb, as it normally would. It can cause a condition called lymphoedema. This is when the limb becomes swollen and heavy.