Bone Cancer: Be Informed

Bone cancer, simply put, is a malignant or cancerous tumor in the bone that ends up destroying the normal bone tissue. However, not all bone tumors are cancerous. Benign or non-cancerous bone tumours are more common than the cancerous ones.

Bone tumours, be it malignant and benign, compress healthy bone tissue as they grow. But benign tumors do not spread or destroy bone tissue, which is why they are not life-threatening most of the times.

Types of Bone Cancer

Malignant tumours that originate in the bone tissue are called primary bone cancer. . Cancer that spreads/ metastasizes to the bones from other parts of the body like the breast, lung or prostate is called metastatic cancer. Primary bone cancer is not that common compared to metastatic cancers.

Primary Bone Cancers

Our bones are made up of osteoid, cartilaginous and fibrous tissue, as well as bone marrow (the soft, spongy tissue in the centre of most bones). Hence, cancer can originate in any bone tissue. The common types of primary bone cancers include:

Osteosarcoma or cancer that originates in the osteoid tissue in the bone. This tumour mostly occurs in the knee or upper arm.

Chondrosarcoma, or cancer that originates in the cartilaginous tissue, which lines the joints and pads the ends of bones. This type of cancer occurs most often in the shoulder, upper legs or pelvis. If a chondrosarcoma contains cancerous bone cells, the cancer may be classified as osteosarcoma.

The Ewing Sarcoma Family of Tumors (ESFTs), which usually originate in the bone, may also arise in the soft tissue like fat and muscles.

Causes Of Bone Cancerr

Though the actual causes of bone cancer have not been ascertained yet, researchers have identified many factors that may lead to formation of such tumors.Osteosarcoma usually occurs in people, especially children, who have undergone igh-doses of external radiation therapy or had anticancer drugs.A very small number can be linked to congenital defects of the bone and heredity.

Occurrence Of Bone Cancer

Primary bone cancer is quite rare compared to rest of the cancers.

Osteosarcoma occurs mostly between 10 -19 years of age.However, people above 40 with conditions like the Paget disease (a benign condition wherein there is an abnormal development of new bone cells), are at more risk of developing this type of cancer.

Chondrosarcoma in adults over 40 years of age; and the risk increases with age.

ESFTs occur mostly in children and adolescents under the age of 19, especially boys.

Symptoms Of Bone Cancer

The most common and significant symptom of bone cancer is pain. However, not all bone cancers cause.

An unusual pain or swelling in or around the bone can be due to cancer or many other other conditions. Hence you need to seek the help of a doctor to diagnose the cause of the pain.

Bone Cancer: Diagnosis

Radiological/Imaging Investigations:

X-Ray, which helps diagnose the location, size, and shape of a bone tumor.

A bone scan, in which is small amount of radioactive material is injected into a blood vessel and collects in the bones. Any tumour or lesion can be detected by the scanner.

A CT scan, which captures detailed pictures of the area from different angles.

A MRI or magnetic resonance imaging scan, which uses a powerful magnet to generate detailed images of area, without using x-rays.

A PET or positron emission tomography scan, wherein a small amount of radioactive glucose is injected into a vein. The scanner captures detailed, images of the area(s) where the glucose is used. Since cancer cells often use more glucose compared to normal cells, these images help detect malignant cells, if any.

An angiogram or x-ray of blood vessels.

Biopsy or removal of small sample of tissue from the tumor to detect presence of cancerous cells. This can be done through needle biopsy or incisional biopsy.

Needle Biopsy is a procedure wherein the surgeon creates a small hole in the bone and removes a sample of the tissue from the tumor with a needle-like instrument. In an incisional biopsy, the surgeon removes a sample of tissue by cutting into the tumor.

The cells are sent for testing to the lab for the pathologist to examine and detect presence of cancer.

2. Blood Test

A specialised blood test to ascertain the level of an enzyme called alkaline phosphatase may be carried out to check the presence of cancer cells.

Treatment options

Like all cancer treatments, bone cancer too requires a customised treatment plan depending in the type, size, location and stage of the cancer; age of the person and his/her general health.

Treatment plan for bone cancers include surgery, chemotherapy, radiation therapy and cryosurgery.

Surgery is the usual treatment mode for bone cancer, wherein the surgeon removes the tumor from the bone. The field of bone cancer surgery is advancing at a rapid pace and radical procedures like amputation is mostly avoided. However, patients who undergo limb-salvaging surgeries may require reconstructive procedures to enable maximum limb function.

Chemotherapy or use of anticancer drugs kills cancer cells (currently not used to treat chondrosarcoma). Most of the times, patients with bone cancer are given a combination of anticancer drugs so that the cancer cells are eliminated completely and relapse – avoided.

Radiation therapy or radiotherapy uses high-energy x-rays to kill cancer cells. This treatment mode may be combined with surgery in order to ensure the best possible outcomes. Radiotherapy is often used to treat chondrosarcoma and ESFTs. Patients who cannot/ refuse to undergo surgery may also be treated using this procedure.

Cryosurgery is a procedure wherein liquid nitrogen is used to kill cancer cells, by freezing them. At times, this technique is used instead of conventional surgery to destroy the tumour.

Follow Up

What’s probably the most important and not given much importance is the follow-up after the treatment. One should always remember that cancer could recur or even spread to other parts of the body like lungs.

It is very, very crucial to do regular check-ups/ follow-up visits/ investigations to make sure that there’s no problem; and if there’s one, it is addressed early and effectively.

Doctors who are specially trained to treat bone cancers are called Orthopaedic Oncologists. To diagnose the exact reason of pain or swelling in or near the bones, one may need to undergo the following tests:

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