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Bone cancer

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Related Terms
  • Amputation, biopsy, bone fractures, bone pain, bone scan, bone tumor, chemotherapy, chondrosarcoma, Ewing's sarcoma, metastasized bone cancer, needle biopsy, osteosarcoma, primary bone cancer, radiation, radiation therapy, radiotherapy, sarcoma, secondary bone cancer, surgical biopsy.

Background
  • Bone cancer occurs when bone cells grow uncontrollably. Unlike normal cells, cancer cells do not stop reproducing after they have doubled 50-60 times. These abnormal cells form clumps of tissue, called tumors, inside bones. The first symptom of bone cancer is typically pain in the affected bone(s). Sometimes, a bump either on the bone or in the tissues surrounding the bone may be felt.
  • Primary bone cancer, or cancer that starts in the bone cells, is rare. Fewer than 2,500 Americans are diagnosed with this type of cancer each year. Children are more likely to develop primary bone cancer than adults.
  • Most cases of bone cancer occur when cancer from another part of the body, such as breast, prostate, or lung, has spread to bone cells. This is sometimes called metastatic bone cancer or secondary bone cancer.
  • The most common types of bone cancer are osteosarcoma, chondrosarcoma, and Ewing's sarcoma. These cancers can be primary or secondary cancer.
  • Osteosarcoma: Osteosarcoma, the most common type of bone cancer, primarily develops in growing bones, and it usually affects people between the ages of 10 and 25. This aggressive type of bone cancer often affects the arms and legs, particularly the knees and shoulders of children. In some cases, osteosarcoma spreads to the lungs. About 65% of people with osteosarcoma survive five years after diagnosis.
  • Chondrosarcoma: Chondrosarcoma develops in the cartilage. It often affects the bones in the pelvis and hips. It is most common among people who are 50 years of age or older, and it is slightly more common in males than females. Chondrosarcoma is the second most common bone cancer, accounting for about 25% of all cancerous bone tumors. The five-year survival for the aggressive form of chondrosarcoma is about 30%, and the five-year survival rate for slow-growing tumors is about 90%.
  • Ewing's sarcoma: Ewing's sarcoma develops in the nerve tissue in bone marrow of children who are 4-15 years old. It is very rare in people who are older than 30 years of age. Ewing's sarcoma often develops after a person undergoes treatment, such as radiation or chemotherapy, for another type of cancer. Ewing's sarcoma is the most aggressive bone cancer. It typically affects the middle of the long bones in the arms and legs. The three-year survival rate is about 65%, but this rate is much lower if the cancer has spread to the lungs or other parts of the body.
  • Surgery is often the main treatment for bone cancer. In addition to having bone tumors surgically removed, patients may also undergo chemotherapy, and/or radiation therapy. In some cases, patients may need to undergo a surgical amputation, but this is performed less often today. Specific treatment options depend on the type of bone cancer, as well as its location, size, and stage.
  • In general, the prognosis for patients with bone cancer is based on many factors, including the type of cancer, at what stage the cancer was discovered, and where the tumor is located. For instance, if the tumor is small and limited to a localized area, the patient's prognosis is generally better than if the cancer has spread to other parts of the body.

Diagnosis
  • General: If bone cancer is suspected, a doctor may perform imaging studies and/or a bone scan to determine if there are tumors in the bone. If a tumor is found, a biopsy is needed to determine if it is cancerous.
  • Imaging studies: Imaging studies, such as computerized tomography (CT) scan or magnetic resonance imaging (MRI) scan, provide detailed images of the bones. During these procedures, a small amount of radioactive material is injected into the patient. This substance can be detected by a special camera used to create images of the patient's bones. These tests can detect tumors in the bones.
  • Biopsy: A biopsy is a diagnostic procedure that involves analyzing a small tissue sample from a patient under a microscope. There are two types of biopsies that may be performed to determine if a person has bone cancer: a needle biopsy and surgical biopsy. During a needle biopsy, a thin needle is used to remove a small sample of tissue from the tumor. During a surgical biopsy, a small incision is made through the skin, and either the entire tumor or part of the tumor is removed. Local or general anesthesia may be used, depending on the size and location of the tumor. The tissue sample is then analyzed in a laboratory for the presence of cancerous cells. The type of biopsy performed depends on the size and location of the bone tumor(s).
  • Additional tests: Additional tests may be performed to determine if the cancer has spread to other parts of the body. For example, a bone scan, which identifies areas of rapidly growing or changing bone, may be performed on the whole body to determine if other parts of the body are affected. Blood tests may also be performed. If cancer markers are detected in the bloodstream, this indicates that the cancer has spread to other areas.
  • Staging: Stage 1 bone cancer is considered low-grade cancer. In these cases, the cancer has not spread to any other organ, including the lymph nodes. This type is further subdivided into stage 1A and stage 1B. Stage 1A means that the cancer is still completely inside the bone. Stage 1B means that the bone cancer has grown through the bone wall.
  • Stage 2 bone cancer is considered high-grade cancer, but the cancer has not spread to any other organ, including the lymph nodes. All cases of Ewing sarcomas are high grade, which means all patients with this type of cancer automatically start out with stage 2 bone cancer. Stage 2 is subdivided into stage 2A and stage 2B. Stage 2A means that the cancer is still completely inside the bone. Stage 2B means that the cancer has grown through the bone wall.
  • Stage 3 bone cancer is either low-grade or high-grade cancer that has spread to another body organ, including the lymph nodes. This is the most severe stage.

Complications
  • Bone fractures: Bone cancer generally causes the affected bones to become weak. This is because cancerous cells infiltrate the bone, preventing healthy bone cells from growing and functioning properly. As a result, the patient has an increased risk of experiencing bone fractures after little or no trauma. In addition, healing time after a bone fracture may be increased.
  • Metastasis: Bone cancer may spread to other parts of the body, such as the lungs or lymph nodes. When cancer spreads to another organ, it may lead to organ dysfunction or death.

Treatment
  • General: Specific treatment options depend on the type of bone cancer, as well as its location, size, and stage. Surgery is often the main treatment for bone cancer. In addition to having bone tumors surgically removed, patients may also undergo chemotherapy and/or radiation therapy. In some cases, patients may need to undergo a surgical amputation, but this is performed less often today. There are many treatment centers that specialize in sarcomas (connective tissue cancers), including bone cancer.
  • In general, the prognosis for patients with bone cancer is based on many factors, including the type of cancer, at what stage the cancer was discovered, and where the tumor is located.
  • Surgery: Surgery is often used to treat bone cancer. Tumors and some of the surrounding tissue are surgically removed. Sometimes this may require the removal of portions of muscle, nerves, and/or blood vessels. Depending on the size and location of the affected bone, surgeons may replace the cancerous bone with an artificial device (called a prosthesis) or bone from either the patient's own body or a donor instead of amputating a limb.
  • Before surgery, some patients may undergo chemotherapy to help kill the cancer cells in the body. This helps shrink the size of the cancer so that surgery may be more effective. After surgery, patients often receive chemotherapy and/or radiation therapy to kill any cancer cells that may still be in the body.
  • Amputations were commonly performed in the past in bone cancer patients. However, this procedure is less common today because of the advancements in medical treatment. Surgical amputations are generally only performed when the bone cannot be saved. Limb-preserving procedures are preferred because the patient is able to maintain his/her mobility. However, if the affected bone is not amputated, there is a risk that some cancerous cells were not destroyed and can grow back.
  • Recovery time depends on the size and location of the tumor(s). In general, recovery typically takes several weeks to months. After surgery, a doctor may recommend rehabilitation, physical therapy, and/or occupational therapy. The main risks associated with surgery include infection, recurrence of the cancer, and injury to the surrounding tissues. Other complications may include muscle weakness (if muscle was removed), decreased sensation (if nerves were removed), and an increased risk of fractures.
  • Chemotherapy: Chemotherapy is a drug therapy that kills rapidly dividing cells, including cancer cells. Because these drugs are poisonous (toxic) to cells that multiply quickly, they kill some healthy cells in addition to cancer cells. This includes cells in the bone marrow, gastrointestinal tract, reproductive system, and hair follicles. However, healthy cells usually recover shortly after treatment is completed.
  • Chemotherapy may be used to kill cancer cells that have spread to other parts of the body. Ewing's sarcoma is especially aggressive. Therefore, patients with this type of cancer are likely to undergo chemotherapy. However, in bone cancer patients, chemotherapy is more commonly used in combination with surgery and/or radiation to shrink tumors, which helps make surgery safer and easier on the patient. Chemotherapy may also be used to prolong a person's life by managing the cancer growth. Not all people respond the same way to chemotherapy treatments. The effectiveness of treatment varies significantly based on many factors, such as the type of cancer, size and location of the tumor, as well as the person's age and overall health.
  • Chemotherapy drugs can be given by mouth, injected through a syringe into a vein, artery, or muscle; given intravenously though an IV drip device; placed into a catheter (tube) that goes into the bladder, chest cavity, brain, spinal cord, liver, or abdomen; or they can be applied to the skin. The decision on which way to deliver these drugs depends on several factors, mainly the type of cancer and the type of drug being used. At the same time, people may be given other medications, including steroids, allergy medications (anti-histamines), anti-nausea medications, sedatives, and antibiotics, to reduce side effects of chemotherapy.
  • Because healthy cells are also killed during chemotherapy, there are many potential side effects of treatment. Side effects of chemotherapy depend on the type of drugs, the amounts taken, and the length of treatment. The most common side effects include hair loss, nausea, vomiting, weakened immune system (which may lead to an increase in infections), fatigue, and loss of appetite. These side effects start to go away once treatment is completed. Because adequate nutrition is essential during chemotherapy, a doctor may recommend a nutritionist, especially if the patient experiences nausea and loss of appetite.
  • Radiation therapy: Radiation therapy uses high-energy rays to kill cancer cells. It is considered a local therapy, meaning that it is used to target specific areas of the body that have tumors. A radiation oncologist plans and supervises therapy. As with chemotherapy, healthy cells are also killed during radiation therapy. However, there is less damage with radiation therapy than chemotherapy. This is because only a localized area receives radiation therapy.
  • Bone cancer patients may undergo radiation therapy before surgery to shrink cancerous tumors or after surgery to help kill any cancer cells that may still be in the body. It may also be used in combination with chemotherapy or to help shrink tumors in order to decrease symptoms of pain and pressure.
  • Radiation therapy is usually given on an outpatient basis, with the patient visiting the hospital up to five times per week. Before each treatment, the patient is carefully positioned, usually lying on a treatment table. Parts of the body that are not being treated may be covered. It is important to remain completely still during the treatment. Each treatment usually lasts only a few minutes and causes no immediate discomfort. Although the patient is left alone during the actual treatment, the radiotherapy technician watches from an observation room, and the patient is able to talk to the technician with a microphone. A course of radiotherapy typically lasts between two and six weeks, depending on the patient's individual circumstances. The length of radiation treatment varies depending on the stage of the disease. Radiation therapy may be used alone, but is commonly used in combination with chemotherapy.
  • Common side effects include fatigue, loss of appetite, the suppression of the blood counts, and damage to the surrounding skin and soft tissues. Undergoing radiation before surgery may increase the risk of postoperative wound or healing problems.

Author information
  • This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
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Causes
  • Primary bone cancer: There is no known cause of primary bone cancer. Some inherited disorders have been shown to increase a person's risk of developing bone cancer. For instance, Li-Fraumeni syndrome is a rare disorder that predisposes people to certain cancers, including bone cancer. People with Rothmund-Thomson syndrome, an inherited skin disorder, also have an increase risk of developing bone cancer. An inherited eye cancer, called hereditary retinoblastoma, and an inherited cartilage disorder, called multiple exostoses, have also been associated with an increased risk of bone cancer.
  • Metastatic bone cancer: Most cases of bone cancer occur when cancer from another part of the body, such as the breast, prostate, or lung, has spread to bone cells.
  • People who undergo radiation therapy or chemotherapy for other types of cancer have an increased risk of developing bone cancer. Research has shown that the risk is greatest if high doses are used, if therapy is performed for prolonged periods of time, or if therapy is performed at a young age. This is because these therapies may change the genetic makeup of cells.

Copyright © 2011 Natural Standard (www.naturalstandard.com)

The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.