What is Bone Cancer?
Bone cancer is the formation of malignant tumors in the bones of which there are two types. Primary cancer forms from cells in the bones themselves and secondary cancer travels from cancers elsewhere in the body.
Primary cancer in the bones is quite rare and accounts for less than one percent of all cancers in the US. (1)
The exact cause of bone cancer is not completely understood, however there are risks which increase your chances. These include: age, chemotherapy, bone diseases, rare genetic irregularities. (2)
We will detail the three types of primary bone cancer, these include:
Osteosarcoma and Malignant Fibrous Histiocytoma (MFH)
Our bones have cells called osteoblasts. They are responsible for forming new bone tissue and it’s these cells which can become malignant and form cancer cells.
Malignant fibrous histiocytoma is also a bone tumor that’s treated the same way as an osteosarcoma. This type of bone cancer is prevalent in younger people and usually affects bones in the arms and legs. (3)
This cancer forms in the cells of cartilage tissue which pads the end of the bones and joints. This type of bone cancer occurs mostly in the pelvis, shoulder and upper leg joints. (4)
These sarcomas are usually referred to as a family of tumors, (ESFTs). They form in the bone or other soft tissue such as muscle, fat, blood vessels, fibrous tissue or other supporting tissue. (5)
Secondary cancer spreads to the bones from other parts of the body which include the breast, lung, or prostate. This is called metastatic cancer and will be named after originating cancer as the cells don’t change. If they are lung cancer cells they will always be so, even when found in the bones.
Some of the indications of primary bone cancer are:
This is the most common symptom of bone cancer and is caused by either stimulation or actual damage to the nerve cells.
Initially the pain may come and go and may be worse at night or when the bone is in use. You may also notice more pain in your legs or hips when walking or running.
However, as the cancer develops the pain will become constant and more severe with any activity. (6)
Following pain you can notice swelling in the same area and a lump or mass will be felt under the skin. Cancer in the bones around the jaw and neck can actually cause teeth to loosen. (7)
Bones can weaken as a consequence of cancer and this can leave them more susceptible to fracture. A bone can fracture because of the cancer, this causes severe pain in a bone that might previously have felt tender. (8)
Numbness and Tingling
Dependent on where the cancer is located numbness and tingling may be felt as the nerves degenerate. This can also develop weakness in that area. (9)
Unexplained weight loss can be worrying at any time. However, it could be a symptom of cancer and should therefore be treated seriously by seeking medical advice. (10)
There are a number of factors taken into account when staging bone cancer. These include the size of the tumor, whether it has spread to lymph nodes or elsewhere in the body and the grade of the cancer.
In order to understand the stages we will firstly explain grading.
The grading of cancers are from one to three. Grade one (G1) is applied to tissue that still looks like normal cells and will spread slowly. Grade three (G3) is tissue that is abnormal and is likely to spread quickly. Grade two (G2) falls in the middle of these. (12)
The cancer is three inches or smaller. There is no spread to lymph nodes or elsewhere in the body. It is low grade (G1) or the grade cannot be ascertained.
The cancer is larger than three inches across or is in more than one place in the same bone. There is no spread to lymph nodes or elsewhere in the body. It is low grade (G1) or the grade cannot be ascertained.
The cancer is 3 inches across or less. There is no spread to lymph nodes or elsewhere in the body. It is high grade (G2 or G3).
The cancer is larger than 3 inches across.There is no spread to lymph nodes or elsewhere in the body. It is high grade (G2 or G3).
The cancer is found in more than one place on the same bone. There is no spread to lymph nodes or elsewhere in the body. It is high grade (G2 or G3).
The cancer may be in more than one place in the bone and any size. There is no spread to nearby lymph nodes but it has spread to the lungs . The cancer will be any grade.
The cancer may be in more than one place in the bone and any size. It has now spread to nearby lymph nodes. It also could have spread to other organs or other bones. The cancer can be any grade.
The cancer may be in more than one place in the bone and any size. It could have spread to nearby lymph nodes. It has now spread elsewhere in the body like the liver, brain or other bones. The cancer can be any grade. (13)
The treatment options for bone cancers will be determined by your physician after it has been graded and staged. There are five general treatments which are:
Where possible surgery will be done to remove the entire tumor. There are four types of surgery that can be done.
Wide Local Excision
This removes the cancerous tumor and some healthy tissue surrounding it. (14)
Limb Sparing Surgery
This surgery removes the tumor and some healthy tissue around the cancer in the bones of the arm or leg.
In this procedure the surgeon will try and ensure the appearance and use of the limb is preserved. They also use a bone graft or implant to replace the bone and tissue. (15)
If it is not possible to remove a tumor with limb saving surgery then an amputation may be performed on all or part of a limb. If this is the case a prosthesis or artificial limb will usually be fitted after surgery. (16)
This procedure involves removing a section of the leg including the knee cap. The lower leg is then rotated so the foot faces backwards and reattached using the ankle joint in place of the knee.
A prosthesis will be fitted and allows movement of the affected leg using the foot and ankle. (17)
Chemotherapy uses drugs which can halt the growth of cancer cells or kill them completely.
Chemotherapy drugs are taken by mouth or injected into a muscle or vein where they enter the bloodstream. This means they are then able to reach cancer cells throughout the body.
The drugs can also be regionalised to a specific area by placing them directly into spinal fluid, an organ or a body cavity.
How the chemotherapy is administered will also be determined by the type and stage of the cancer being treated. Chemotherapy can be given as one or a combination of anti cancer drugs.
This treatment is often given prior to surgery with an aim to shrink tumors before they are removed. (18)
Radiation therapy uses high energy x-ray radiation or radioactive substances to kill or prevent the growth of cancer cells.
External radiation therapy sends radiation towards the cancer from outside the body via a machine like an x-ray.
However, internal radiation therapy uses sealed needles, wires, or catheters to deliver radioactive substances directly into or near the cancer. (19)
This radioactive drug specifically targets bone cancer cells. It’s often used to treat cancer returning in a different bone and to relieve the symptoms of bone pain associated with cancer. (20)
Stem cell treatment may be considered after administration of this drug. This is where healthy immature blood cells are harvested and frozen prior to treatment from blood or bone marrow.
After treatment is complete they are administered via a transfusion to promote the growth and restoration of blood cells. (21)
Drugs or substances able to target specific cancer cells are used in this therapy. And treatment of this nature is less likely to harm normal cells.
The drugs or substances used have the ability to kill cancer cells, stop their growth or keep them from spreading. Some can stop cancer cells growing or dividing by blocking the signals needed to do this. (22)
All the above treatments can be considered for osteosarcoma, malignant fibrous histiocytoma (MFH) and ewing family sarcomas. Chondrosarcomas are usually treated with radiation therapy and surgery.
What is bone cancer? Bone cancer is the formation of malignant tumors in the bones. There are three types of primary cancer that form in the bones, ligaments or tissues.
What are the signs of bone cancer? The signs of bone cancer include pain in the bones, swelling, tingling or numbness, fatigue and sudden weight loss. Bones can become weak and fracture easily.
How do you develop bone cancer? The exact cause of most bone cancers is not known but it could be hereditary and run in families. Paget disease could also be a factor in older people. This disease causes abnormal tissue generation in the bones and could be a precursor for cancer. Another contributing factor could be exposure to ionizing radiation or radioactive materials like strontium or radium. (23,24)
How are you diagnosed for bone cancer? Following a physical examination and imaging tests combined with analysing symptoms a doctor may suspect bone cancer. If this is the case it will likely be confirmed by examination of cells and tissues obtained during a biopsy. (25)
What is the best treatment for bone cancer? Treatment will depend on the type of bone cancer you have and what stage it is at. Your doctor will discuss your options with you to decide the best course of treatment.
What are the long term complications of bone cancer? Long term complications of this type of cancer include learning to live without all or part of a limb if you have an amputation. There is also the likelihood that the cancer could recur in other bones.
Is bone cancer considered a disability? Some types of bone cancer are classed as a disability. Check with your social security provider to ascertain if this applies. (26)
Is there a cure for bone cancer? There is at present no cure for bone cancer however there are treatments available which do have a good success rate. Your doctor will help you decide which will give you the best prognosis.
Is bone cancer life threatening? This disease is life threatening but the five year survival rates for these type of cancers is between 70 and 80 percent. (27)
Bone cancer is the formation of malignant tumors in the bones and can be a primary or secondary cancer.
The symptoms may not always be obvious but nevertheless need investigating as soon as they come to light.
There is no escaping the fact that this is a life threatening condition however treatments do have a good success rate.