Bone Cancer is in fact a very uncommon type of cancer which begins in the bone. Although, this cancer can begin within any bone in the body, but is found to most commonly affect the longer bones which make up for the arms & legs. There are many types of bone cancers which exist. Some of these types of bone cancer primarily occur among children, while most others affect only adults. However, the term ‘Bone Cancer’ does not include cancers which originate elsewhere in the body & metastasize to the bone. Instead, such cancers are named for where they begin, like breast cancer which has spread to the bone.
Signs & Symptoms of Bone Cancer
Signs & symptoms of bone cancer include the following.
- Broken bone
- Bone pain
- Tenderness & swelling near affected area
- Fatigue
- Unintended loss of weight
People should make an appointment with the doctor in case they or their children develop worrying signs & symptoms.
Causes of Bone Cancer
It is still not clear as to what really causes most bone cancers. However, as doctors presently know, bone cancer begins with an error in the DNA of the cell. This error prompts the cell to grow in an uncontrolled manner. These cells are subsequently found to go on living instead of dying within a set time frame. Accumulated mutated cells then form a tumor (mass) which can invade nearby structures and/or spread to various other areas of the body.
Various Types of Bone Cancer
Difference between primary cancer & secondary cancer is very important when people are looking for information on cancer. People having secondary cancer will need to look in for the original type of cancer, since behavior of cancer including treatment that it will respond to will anyway depend upon where this cancer has started in the body. Breast cancer basically will remain breast cancer, no matter where it spreads inside the body.
- Primary Bone Cancer – Primary bone cancers are those which start in the bones. These cancer cells are bone cells which have eventually turned cancerous.
- Secondary Bone Cancer – These are cancerous cells which have originated somewhere else in the body & subsequently spread to the bones. Also called metastatic cancer, these cells are like cells of the original tumor. Therefore, patients having breast cancer which has spread to the bones will have cancer cells in bones which actually be like breast cancer cells.
Bone cancers are generally broken down into separate types which are based upon the type of cell where the cancer originated. Most common types of bone cancers include the following.
- Osteosarcoma – This type of cancer begins within the bone cells. Osteosarcoma generally is found to occur among children & young adults, mostly within the bones of arms & legs. This is one of the most common type of primary bone cancer which can also occur at any age & grow anywhere within the skeleton. Most common sites of Osteosarcoma include the following.
- Femur – lower thighs
- Tibia – shin bone
- Humerus – upper arm
- Ewing’s Sarcoma – This bone cancer is named after the surgeon who had first described this. However, it is yet not clear as to where Ewing’s sarcoma begins, but these tumors most commonly arise in pelvis (hips), thighs (femur) or shins (tibia) bones. Although common among arms or legs of children & teenagers, Ewing’s tumors are also found in soft tissues of the body. These soft connective tissue tumors are called Soft Tissue Tumors. Patients having soft tissue Ewing’s tumor will have the same treatment as Ewing’s tumor since they effectively respond to the same type of treatment.
- Chondrosarcoma – This is a primary bone cancer type which is commonly found in adults over 40 years of age. Chondrosarcoma is relatively rare & usually begins in cells of the cartilage & occurs in arms, legs & pelvis. Cartilage is a smooth & shiny substance which normally covers ends of bones inside joints & provides support for the joint while allowing bones to smoothly slide over one another. This cancer of the cartilage cell can grow inside a bone or on the surface of bone. Chondrosarcoma patients may have islands of cartilage inside bone or on bone surface in areas where cartilage wouldn’t normally grow. However, this bone tumor is very slow in growing. Most common sites of this cancer of the cartilage include the following.
- Pelvis – hips
- Femur – thigh bones
- Humerus – upper arms
- Scapulae – shoulder blades
- Ribs
- Spindle Cell Sarcoma – Quite similar to osteosarcomas, spindle cell sarcomas however do not produce bony substances called osteoid like osteosarcomas do. Nevertheless, they behave in a similar fashion like osteosarcomas & doctors also treat them in the same way. Spindle cell sarcomas are usually found in adults over 40 years of age. There are many types of spindle cell sarcomas including the following.
- Leiomyosarcoma
- Fibrosarcoma
- Malignant Fibrous Histiocytoma
- Undifferentiated Sarcoma of Bone
- Undifferentiated Sarcoma of Bone – This type of cancer means that cancerous cells are not specialized in nature. These cancer cells are immature & quite underdeveloped & therefore it is not possible to say as to which type of bone cells they have started from. Patients who are having spindle cell sarcoma with specialized cancerous cells will either fall under the category of fibrosarcoma or leiomyosarcoma, depending upon the appearance of cancer cells under microscope.
- Malignant Fibrous Histiocytoma (MFH) – This is no more a commonly used diagnosis of bone cancer. Most tumors which earlier used to be called as MFH are now accurately diagnosed as several other types of sarcoma. However, a small number of bone cancers which would still be called as MFH are known as Undifferentiated High Grade Pleomorphic Sarcoma. When such tumors are found in bone, doctors most often refer them as spindle cell sarcoma of bone.
- Fibrosarcoma – This is also a very rare type of bone cancer which is most often found among middle aged adults. Most common site where fibrosarcomas are found is the femur or the thigh bone.
- Leiomyosarcoma of Bone – This is an extremely rare type of bone cancer & still very little is known about them.
- Chordoma – This is a very rare & slow growing type of bone cancer which is most commonly found among people aged between 40 – 60 years. Moreover, these are found more often among women than in men. Chordomas are found to develop from notochord. Notochord is formed from early spinal tissue in babies while developing in the womb. This tissue is subsequently replaced by bone after about 6 months of time. However, at times small areas of notochord still remain undeveloped. About 2 of the 5 chordomas, which account for about 35 – 40 percent of all cases, grow in skull or bones in middle of the face. Rest of these type of cancers, grow within bones (vertebrae) of the spine. Moreover, about half of these cancers are found in lower region of the spine. Chordomas usually do not spread; but when they do, most common areas they metastasize to are the nearby lymph nodes, lungs, liver, the bones & skin.
Risk Factors Associated With Bone Cancer
It is still not clear as to what exactly causes bone cancer. However, certain factors including the following are found to be closely associated with increased risk for bone cancer.
- Inherited Genetic Syndromes – There are certain rare genetic syndromes like Li-Fraumeni syndrome & hereditary retinoblastoma which are passed through families & are found to increase risk of bone cancer.
- Paget’s Disease of Bone – This most commonly occurs in older adults. Paget’s disease of bone can however increase risk of developing bone cancer in future.
- Radiation Therapy for Cancer – Exposure to large dosage of radiation like those provided during radiation therapy treatment for cancer is also found to increase risk of developing bone cancer in future.
Diagnosing Bone Cancer
Type of imaging tests which a bone cancer patient will have to undergo depends upon the individual’s condition. Doctors may recommend one or more of the following imaging tests so as to evaluate areas of concern.
- CT Scan – Computerized Tomography
- Bone Scan
- MRI – Magnetic Resonance Imaging
- X-Rays
- PET – Positron Emission Tomography
Sample Tissue for Laboratory Testing
Doctors often recommend biopsy procedure so as to remove sample of tissue from tumor for testing in a laboratory. This testing can tell doctors if the tumor is cancerous & if so which is the type of cancer the patient is having. This laboratory testing will also reveal the grade of cancer & which will enable doctors understand the aggressiveness of cancer.
Types of Biopsy Procedures Used for Diagnosing Bone Cancer
- Inserting Needle through Skin into Tumor – Commonly known as a needle biopsy, doctors will insert a thin needle through skin & guide it inside the tumor in this procedure. This needle is subsequently used to remove small pieces of tissue from the tumor.
- Surgery to Remove Tissue as Sample for Testing – During this surgical intervention, doctors will make an incision through skin so as to either perform an excisional biopsy (removing the entire tumor) or incisional biopsy (portion of tumor).
Determination of the type of biopsy & particulars of how biopsy should be performed for a patient requires careful planning by the medical team. Surgeons will need to perform biopsy in a way which will not interfere with future surgery which is to be employed for removal of bone cancer. Therefore, bone cancer patients should ask their doctors for referral to a team of surgeons with extensive experience in treating bone tumors prior to undergoing biopsy.
Tests to Determine Stages of Bone Cancer
Once doctors have diagnosed bone cancer, they will work to determine the extent of cancer. The stage of cancer will eventually guide the ideal treatment option. Stages of bone cancer include the following.
- Stage I – Bone cancer at this stage is limited to the bone & has not yet spread to any other areas of the body. Bone cancer is low grade at Stage I, which means that cancerous cells are less aggressive at this point of time.
- Stage II – Bone cancer at this stage is also limited to the bone & has still not spread to other regions of the body. However, Stage II bone cancer is high grade, meaning that cancerous cells are more aggressive now.
- Stage III – Bone cancer at this stage is found to occur within two or more places on the same bone. Stage III bone cancers can either be low grade or high grade.
- Stage IV – This bone cancer stage indicates that cancer has spread beyond the bone to other parts of the body. Common Stage IV bone cancer areas of spread can include internal organs or other bones.
Treatment Options for Bone Cancer
Treatment options for bone cancer are normally based upon the type of cancer patients have including preferences, overall health & the stage of cancer. Moreover, different bone cancers respond differently to treatments. Doctors can however guide bone cancer patients as to which treatment is best suited to their cancer type. Like for example, some bone cancers are best treated with surgery alone; some with a combination of surgery & chemotherapy, while others with surgery, chemotherapy & radiation therapy.
Surgery for Bone Cancer
Goal of bone cancer surgery is to remove the entire cancerous tissue of the bone. This involves special techniques in most cases so as to remove tumor as a single piece along with small portions of healthy tissue surrounding it. Some types of surgeries which are used as treatment for bone cancers are listed below.
- Surgery to Remove Bone Cancer while Sparing the Limb – Surgeons are able to remove bone cancer & spare the limb when it can be effectively separated from nerves & other tissue. Since some bone is also removed with cancer, surgeons will often replace lost bone with some bone from other areas of the body or with material from bone banks or with special metal prosthesis.
- Surgery for Bone Cancer Which Does not Affect Limbs – Surgeons may remove bone & some surrounding tissue when bone cancer is found to occur in bones other than those of legs & arms. This is normally possible in cancer cases like the one affecting ribs or when surgeons remove cancer while preserving much of bone as possible like in cancers which affect the spine. Parts of bone which are removed during surgery can effectively be replaced with piece of bone from another part of the body, with material from bone banks or with special metal prosthesis.
- Surgery to Remove Limb in Bone Cancer – Bone cancers located in complicated points on bone or the ones which are very large may require surgery for removing part or the complete limb (amputation) at times. However, this procedure is becoming less common with development of other forms of treatment. Patients undergoing amputation are fitted with artificial limbs following surgery & have to go through training programs so as to learn to perform everyday tasks with the help of the new limb.
Chemotherapy for Bone Cancer
Chemotherapy is basically a drug treatment which uses chemicals in order to kill cancerous cells. Most often administered intravenously, chemotherapy medications quickly travel throughout the body. Chemotherapy is commonly used in people having bone cancer which has eventually spread beyond the bone to other areas of the patient’s body.
Radiation Therapy for Bone Cancer
Radiation therapy utilizes high-powered beams of energy like X-rays in order to kill cancerous cells. Patients will normally lie on a table during radiation therapy while special machines hover around them & aim beams of energy precisely at tissues containing cancerous cells within the body. Typically given along with chemotherapy, radiation therapy is often used before bone cancer surgery so as to shrink the size of tumors. Quite often, this may increase the possibility that amputation may no longer be necessary. Moreover, radiation therapy is also being used in bone cancer patients where tumors cannot be removed through surgery. Sometimes, radiation therapy may also be used after surgery in order to kill any cancerous cells which may have remained even after surgical intervention. Radiation therapy also helps control signs & symptoms like pain for people living in advanced stages of bone cancer.
Coping with Diagnosis of Bone Cancer
Both practically & emotionally, it can be very difficult coping with diagnosis of bone cancer in the beginning. Patients are most likely to feel frightened, upset & confused to start with as things get out of control. However, it is very important for them to get the right information about the type of bone cancer they are having & the best possible treatment option. Bone cancer patients who are well informed about their ailment & treatment are better equipped to make the right decisions & cope with their illness. Most bone cancer patients undergoing surgery also undergo limb salvage procedures as well. However, some of these may require amputation. Loss of limb for a patient can be extremely difficult to cope with. Many such patients have to face emotions of bereavement & grief. It is therefore very important to remember to come to terms with feelings about undergoing amputation & these patients at this point of time may need much attention so as to cope with these practical changes.
Practically Coping with Changing Circumstances
Coping along with fear & anxiety which diagnosis of bone cancer brings, patients will also have to work out as to how best to practically manage function after amputation. There may also be money matters which need to be sorted out. How does a patient relate his having bone cancer & the type of words they would choose to convey is a daunting task which they need to fulfill?
Recovery Following Bone Cancer Surgery
Following bone or joint surgery for cancer, patients will require a lot of physiotherapy so as to get them going once again. This invariably is very hard work at this point of time. However, it will pay them as they find that moving around can be much easier than they imagined. Some bone cancer patients may also have to undergo further operations in future if they have limb sparing surgery. Bone cancer patients may also at times develop some complications or if they were young & not finished growing at the time of having artificial bone or joint put in, may also need to have them replaced as they grow older. Although some false bones are made so as to expand, patients having one of them will still need to go to hospital from time to time in order to have them extended. However, they will not be required to undergo another major surgery so as to replace the whole false bone. Once bone cancer patients have recovered from surgery, they should be able to do almost everything they used to do earlier. Nevertheless, some doctors advise them against indulging in contact sports like hockey, rugby or soccer. This is not because artificial bone is weaker in any way but simply because there are chances that it may become damaged. Whenever prosthesis becomes damaged, bone cancer patients would invariably require another major surgery so as to try & put them right.
Prosthesis Wear & Tear Following Bone Cancer Surgery
Artificial bones & joints which are fitted following bone cancer surgery rarely break. However, after several years of service they may show signs of wear & tear. Although, this cannot be generalized as there are several different types & makes of prosthesis, the plastic surfaces of bones & joints become worn & at times need to be replaced. Patients having metal rods inserted into bones can sometimes become loose & may also need strengthening or replacing. Patients having false knee fitted due to bone cancer are likely to need further surgery in future. Almost 3 out of every 100 such cases need revision knee joint replacement surgery. Patients who are still growing at the time of getting their false bone or joint will require a growing prosthesis to be inserted. This growing prosthesis can be regularly lengthened. Older varieties of growing prosthesis require only a minor operation so as to manually increase length, while newer varieties of prosthesis can be lengthened by using electromagnets as an internal device can be turned on so as to start the process of lengthening. Since this is a non-invasive procedure, patients will not be required to undergo any surgery. However, these patients will also not be able to have any MRI scan imaging tests.
Risks & Complications
Eventually, most people having artificial bones or joints are likely to develop some sort of complication which will require surgery to put it right. Most likely complications associated with bone cancer surgery include the following.
- Infection
- Mechanical failure
- Loose working of prosthesis
Patients should get in touch with the surgeon when they feel there is something wrong with the false bone or joint. The earlier they recognize a likely problem, the easier it is to deal with. Signs patients should look out for include the following.
- Swelling
- Pain
- Fever (high temperature)
- Cracking sound in joint on movement
- Open wound over operation site
Fever & pain often indicate that patients are having an infection in bone which requires urgent treatment. Bone cancer surgery patients should ask surgeons to take a look whenever a false joint feels odd or seems unstable, or is making noise which it did not earlier. Since surgeons understand your predicament, they will not consider anything as nuisance. Moreover, it is always better to be on a safer side.
Scarring Following Limb Sparing Surgical Intervention
Limb sparing surgery can be an extremely large surgical intervention involving cutting into a lot of tissue, muscle & bone as well. This may also leave patients with long scars which can cause a few problems like the following.
- Lymphoedema – swelling in arms or legs
- Changes in patient’s appearance
- Difficulty in moving limbs
Although, not everyone undergoing limb sparing surgery will have these problems, but it will depend upon how deep the scars & wounds are & whether they are undergoing other treatments like radiotherapy. Patients should also worry about pain following surgery. They should speak to the doctor or clinical specialist nurse in case they are having pain. However, pain is rarely a long term problem. Patients may also feel some discomfort & tightness in case they are applying radiotherapy to the area because it can make healthy tissues less stretchy over a period of time.
- Lymphoedema – Swelling in Arms or Legs
Swelling in arms & legs after limb sparing surgery is very uncommon unless patients have also undergone radiotherapy to lymph nodes which normally drain fluid from limbs. Lymphatic system is composed of thin tubes called lymph vessels & which run throughout the body. Lymph is a clear fluid which circulates around body tissues. Alongside lymph vessels there are small bean shaped nodes or lymph glands located all over the body. Lymph nodes which are most affected by this kind of treatment include the following.
- Lymph nodes in each groin at the top of legs
- Lymph nodes under arms, in armpits
Drainage of lymph through these lymph nodes can be affected in patients who have undergone surgery & radiotherapy to these areas. This will create difficulty for tissue fluid to circulate & drain out of limbs, as it normally would have. Condition caused as a result of this situation is called lymphoedema. Limbs become heavy & swollen as a result of this condition. As a result of this, patient’s shoes, watch straps, bracelets & rings can become tighter. However, treatment for lymphoedema can be successful if started early. Patients should therefore talk to the doctor in case they have swelling in arms or legs which have been treated. Such cases of lymphoedema may be referred to physiotherapists or specialist nurses who are experts in treating this ailment.
- Changes in Patient’s Appearance
How patients appear following limb sparing surgery is an important part of self esteem. It can sometimes be very hard to accept sudden changes in appearance, especially with the ones that are not pleasing. Therefore, it is not unusual for people having undergone limb sparing surgery to feel upset & confused for some time following operation. They may feel worried about how family & friends see them as they feel that they are no more physically attractive. Moreover, getting back to work, acquainting new people & attending job interviews can be more of a struggle while they are coping with changes in appearance. Younger patients may be worried about how their friends would respond to their changing appearance. Patients who are parents may worry as to how this will affect their children & how would they be able to answer their friend’s questions. Nevertheless, these types of worries are quite normal. Most important is to remember that people close to them will not see them any differently as a person & would like to support them as much as they can. It would be sensible to let them in on feelings as they deserve to know how patients feel. These changes in appearance will also make patients feel less confident about sex. They will need more time to come to terms with whatever has happened to them. Coping with sex after bone cancer surgery can initially be distressing.
- Difficulty in Moving Limbs
To start with, limb sparing surgery patients will have trouble moving the affected limb. Physiotherapists will however give them plenty of exercises which will gradually ease things for them. This will also give patients some idea of how things will turn out in case they keep it up with exercises. For most patients, there is no reason why they should not be using affected limbs normally as best as they can.
Affordable Bone Cancer Treatment in India
While many cases of bone tumors are reported, most are deemed as noncancerous & will therefore not have any impact on bone tissue. Reason for bone cancer however is still a mystery but genetic causes & breakdown of bone are found to increase risk of developing bone cancer. When cost of healthcare among developed nations is increasing by leaps & bounds, India has effectively proved to be an oasis & emerged as a leading global medical tourism destination providing high quality of treatments at reasonable costs. HealthYatra.com is a reputed healthcare tourism company based in South Asia offering a wide spectrum of affordable medical solutions including cancer treatments like for bone cancer to people from all around the world. Associated with top surgeons in cancer treatment & the best hospital facilities specializing in this field, experts at HealthYatra.com will also be happy to combine an exotic recuperative vacation to go along with your medical procedure so as to make your health travel a memorable experience.
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