Bone Cancer

Bone Cancer

Overview

Bone cancer is rare and may arise from cells within or around the bone. These cancer cells arise de novo (start from the beginning) and multiple aggressively to destroy the bone. The cancer cell may spread through blood circulation to multiple organs like the lung and may spread to other bones and tissues. These tumours grow to a large size and impair the function and may lead to death.

Types of Bone Cancers

Bone cancer is of different types based on the cell of origin. Common bone cancers may include:

  • Osteosarcoma: In this type, the cancerous cells produce bone. It is also called as ‘Osteogenic Carcinoma’ because of the type of cells involved.
  • Ewing’s Sarcoma: These tumours arise, most commonly, in the arms, legs or pelvis

Both Osteosarcoma and Ewing’s sarcoma is more common in children between the ages of 5 to 20 years.

Cancers like Multiple Myeloma, Chondrosarcoma are more common in late adult and old age. Cancer arising from any part of the body like breast, thyroid, lung etc. may secondarily spread to the bone and these are called as Secondary (or Metastatic) Bone Cancers.

Symptoms

Patients with bone cancer show the following symptoms:

  • Persistent bone pain that is not relieved by rest or pain medication
  • Progressive swelling and tenderness near the affected part
  • The weakened bone that may lead to fracture
  • Unintended weight loss
  • Fatigue
  • Tumours which arise from the spine may present with weakness in the hand, foot or even paralysis.

Diagnosis

Bone cancers are not easily detected and hence the diagnosis is delayed. As these cancers are rare, the awareness in public is poor. As early detection is the most essential aspect of bone cancer management, it is important for people to consult the concerned doctors at the earliest. A thorough examination and appropriate investigations are essential for making the correct diagnosis. Investigations like X-ray, CT scan, MRI scan, Bone scan, PET scan may be needed. A biopsy is a very important investigation which should be performed by the treating surgeon to confirm the diagnosis.

Treatment

In the past, bone cancers were considered to be incurable and procedures, such as amputation surgery were performed to relieve patients from pain. Various advances were made in the management of these cancers. High-end investigation modalities like MRI scan, PET scan, etc. have made diagnosis easier now. Various limb salvage procedures are now available for upper limb, lower limb and pelvic cancers. Many reconstruction techniques are also available which includes Megaprosthetic Replacement, Allo Bone Graft, Vascularized Fibula, Rotationplasty, etc. For children with bone cancer, special implants like expandable megaprosthesis are also available.

In patients with metastatic bone cancer, palliative surgeries are performed to relieve them of cancer pain and improve quality of life and function.

A multimodality approach is now recommended which may include chemotherapy, Surgery and Radiotherapy. Chemotherapy helps prevent cancer spread and save lives. Radiotherapy may be used as an adjuvant to surgery.

Conclusion

With the advent of newer technology and skills, primary bone cancers can be detected early and cured. The cure rates have improved from 25 % to 70 %. For patients who present late with extensive local disease and metastasis (spread) where cure is not possible, care is directed towards relieving pain and improving function. Quality of life may thus be improved.

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