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Bone Cancer

By on March 5, 2012 in Diseases, Prevention with 0 Comments

Important Key Points: 

  • Cancer that originates in the bone is rare.
  • Pain is the most common symptom of bone cancer.
  • Surgery is the usual treatment for bone cancer.
  • Modern surgical techniques have reduced the chances of amputation for 9 out of 10 patients diagnosed with bone cancer.
  • Because bone cancer can recur after treatment, it is important to make regular follow-ups.
  • It is recommended that people with bone cancer register to participate in clinical trials (research studies) that evaluate new treatments.

 

What is bone cancer?

 

Bone cancer is a malignant (cancerous) bone tumor that destroys the tissue of normal bone. Not all bone tumors are malignant. In fact, benign bone tumors (noncancerous) are more common than malignant tumors. Both tumors, benign as well as malignant, grow and compress the healthy bone tissue, but benign tumors do not spread, do not destroy the bone tissue and are rarely life threatening.

Malignant tumors that begin in bone tissue are called primary bone cancer. Cancer that has metasized (spread) to bones from other parts of the body, such as breast, lung and prostate cancer is called metastasis and is named for the organ or tissue in which it originated. Primary bone cancer is much less common than the cancer that spreads to the bones.

 

Are there different types of primary bone cancer?

 

Yes, cancer can originate in any bone. The bones are formed by three types of fabrics: osteoid (hard or compact), cartilage (hard and flexible) and fibrous (filamentary), as well as elements of bone marrow (soft tissue , spongy center of most bones).

Common types of primary bone cancer include:

Osteosarcoma , which originates from osteoid tissue in the bone. This tumor occurs most frequently in the knee and the humerus (upper arm).

Chondrosarcoma , which originates in the cartilage tissue. The cartilage cushions the ends of bones and joints coated. Chondrosarcoma occurs most frequently in the pelvis (located between the hip bones) in the upper leg and shoulder. Sometimes a chondrosarcoma contains cancerous bone cells. In that case, doctors classify the tumor and osteosarcoma.

The tumors of the Ewing sarcoma family (Ewing Sarcoma Family of Tumors, ESFT ), which usually originate in the bone but may also arise in soft tissue (muscles, adipose tissue (fat), fibrous tissue, blood vessels and other supporting tissues). Scientists believe that ESFT arise from immature nervous tissue elements in the bone or soft tissue. The ESFT occur more frequently along the spine and pelvis, and legs and arms.

Other cancers that originate in the soft tissue are called sarcomas of soft tissue. These are not bone cancer and therefore not described in this application.

 

What are the possible causes of bone cancer?

 

Although bone cancer does not have a clearly defined cause, researchers have identified several factors that increase the chance of developing these tumors. Osteosarcoma most often occurs in people who have received high doses of radiotherapy or treatment with certain anticancer drugs, children appear to be particularly prone to osteosarcoma. A small number of bone cancers are hereditary. For example, children who have had retinoblastoma hereditary (a rare cancer of the eyes) have a higher risk of osteosarcoma, particularly if treated with radiation . Also, people who have hereditary defects of bones and people with metal implants, which are sometimes used by doctors to repair fractures, are more prone to osteosarcoma. Ewing’s sarcoma is not closely related to any syndrome of hereditary cancer with congenital childhood diseases or with previous exposure to radiation.

 

How often  does bone cancer occur?

 

Primary bone cancer is rare. This is much less than one percent of all cancers. Each year, approximately 2,300 new cases of primary bone cancer are diagnozed in the United States. Certain populations are more likely to have different types of bone cancer:

Osteosarcoma occurs most often between 10 and 19 years of age. However, people over 40 years of age who have other conditions such as Paget’s disease (a condition characterized by benign abnormal formation of new bone cells), have an increased risk of breast cancer.

Chondrosarcoma occurs mainly in older adults (over 40 years of age). The risk increases as people age. This disease rarely occurs in children and adolescents.

The ESFT occur more frequently in children and adolescents under 19 years of age. The disease occurs more often in boys than girls. These tumors are extremely rare in black children.

 

What are the symptoms of bone cancer?

 

 

Pain is the most common symptom of bone cancer, but not all bone cancers cause pain. Persistent or unusual pain or swelling at or near the bone may be producidospor cancer or may be due to other problems. It is important to consult a doctor to determine the cause.

 

How is bone cancer diagnosed?

 

To make the diagnosis of bone cancer, the doctor asks about the personal medical history and patient’s family. The doctor also does a physical examination and may ask for lab tests and other diagnostic tests. Such evidence may include:

  • X-rays can show the location, size and shape of a bone tumor. If X-rays suggest that there is an abnormal area that may be cancerous, the doctor may recommend special imaging tests. Although X-rays suggest that an abnormal area is benign, it is possible that the doctor wants more testing, especially if the patient is experiencing persistent or unusual pain.
  • The bone scan is a test which is injected into a blood vessel in a small amount of radioactive , which travels through the bloodstream, the substance then accumulates in the bones and is detected by a scanner .
  • The computed tomography (CT), which consists of a series of detailed pictures of areas inside the body, taken from different angles, which are made ​​by a computer linked to an x-ray machine
  • Magnetic resonance imaging, or MRI, which uses a powerful magnet linked to a computer to create detailed pictures of areas inside the body without using x-rays
  • The positron emission tomography (PET ), in which a small amount of  radioactive glucose is injected into the vein and a scanner is used to create detailed computerized pictures of areas inside the body where it has used glucose. Because cancer cells often use more glucose than normal cells, images can be used to find cancer cells in the body.
  • The angiogram is X-ray blood vessels.
  • Biopsy (removing a tissue sample from the bone tumor) to determine whether cancer is present. The surgeon may perform a needle biopsy or incisional biopsy . In a needle biopsy, the surgeon makes a small hole in the bone and removes a sample of tumor tissue with an instrument like a needle. In an incisional biopsy, the surgeon cuts into the tumor and removes a tissue sample. Orthopedic oncologists (doctors experienced in treating bone cancer) are best trained to perform biopsies. A pathologist (a doctor who identifies diseases by studying cells and tissues to the microscope ) examines the tissue to determine if it is cancerous or not.
  • Analysis of blood to determine the concentration of an enzyme called alkaline phosphatase. There is a lot of this enzyme in the blood when cells that form bone tissue are very active, either when children are growing, or when a broken bone is healing, or when disease or tumor caused by abnormal production of bone tissue. Since it is normal to find high levels of alkaline phosphatase in children and adolescents who are growing, this test is not a reliable indicator of bone cancer.

 

What are the treatment options for bone cancer?

 

Treatment options depend on the type, size, location and stage of cancer and the age and general health of the patient. Treatment options for bone cancer include surgery, chemotherapy , radiotherapy and cryosurgery.

  • Surgery is the usual treatment for bone cancer. The surgeon removes the entire tumor with negative margins (no cancer cells are found in the margins or edges of the tissue that is removed during surgery). The surgeon may also use special surgical techniques to minimize the amount of healthy tissues removed with the tumor.
  • Major advances in surgical techniques and pre-operative treatment of tumors have ensured that a majority of patients with bone cancer in an arm or a leg need not go through radical surgical procedures (such as total amputation of a limb). However, most patients who undergo conservative surgery of limb may need to undergo reconstructive surgery to maximize the function of the affected limb.
  • Chemotherapy is the use of anticancer drugs to kill cancer cells. Patients with bone cancer usually receive a combination of anticancer drugs. However, chemotherapy is not currently used to treat chondrosarcoma.
  • Radiation therapy uses high energy X-rays to kill cancer cells. This treatment may be used in combination with surgery. This is commonly used to treat chondrosarcoma, which can not be treated with chemotherapy and the ESFT. Can also be used for patients who do not want surgery.
  • Cryosurgery is the use of liquid nitrogen to freeze and destroy cancer cells. This technique can be used sometimes instead of conventional surgery to destroy tumors.

 

Are follow-up treatments necessary?

 

Yes, sometimes bone cancer metastasizes, especially to the lungs or may recur (come back), either in place or in other bones of the body. People who have had bone cancer should see the doctor regularly and report immediately about any unusual symptoms. Monitoring varies across different types and stages of bone cancer. Generally, patients are checked frequently by their physicians and performed blood tests and X rays regularly. People who have had bone cancer, especially children and adolescents, are more prone to other cancers such as leukemia. Regular monitoring ensures early detection and treatment can start early.

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