by What is Bone Cancer?
‘Bone cancer’ mainly means a malignant tumor of the bone that destroys the bone tissue. Not all bone tumors are cancerous. In fact, noncancerous tumors are the more common type than cancerous tumors.
Bone cancer is mainly divided into two categories: primary and secondary bone cancers.
Primary bone cancer begins in the bone cells, and secondary bone cancer can start anywhere and then spread to the bones throughout the body.
Primary bone tumors begin in the bone itself.
Primary bone cancers are called ‘sarcomas’. Sarcomas are cancers that begin in bone, muscle, fibrous tissue, blood vessels, adipose tissue, as well as some other tissues. It can develop anywhere in the body. Most bone cancers are called ‘sarcomas’
Mainly when a person has cancer, they are told that they have cancer in their bones, but when doctors talk about cancer that starts elsewhere and spreads to the bones, it is called secondary cancer or ‘metastatic’ and this can be seen and identified in many different types of advanced cancer, such as breast cancer, prostate cancer, and lung cancer.
When these bone cancers are viewed under a microscope, they look like the tissue from the organ they came from. For example, if a person has lung cancer that has spread to the bone, the cancer cells in the bone look and act like lung cancer cells. These types of cancer cells neither look nor function like bone cancer cells even when they are in the bones. Such cancer cells act like lung cancer cells. Therefore, only lung cancer medicines are suggested in its treatment.
Also Read :
Types of Bone Cancer
There are several different types of bone cancer or bone tumors. They are named after the bone or tissue surrounding the bone, which infection is affected as well as the cells that form the tumor.
Some are primary bone tumors (non-cancerous) and others are malignant bone tumors (cancerous).
Here we are talking about some types of malignant bone tumor or bone cancer which are as follows :-
- Osteosarcoma: Osteosarcoma (also called osteogenic sarcoma) is the most common and primary bone cancer. This cancer begins in bone cells and most often occurs in young people between the ages of 10 and 30. It is less common in middle-aged people and is more common in men than in women. Tumors affected by osteogenic sarcoma often develop in the bones of the hands, feet, and pelvis.
- Chondrosarcoma: Chondrosarcoma is a cancer that occurs in the cartilage cells. It is the second most common primary type of bone cancer. This cancer is rare in people under the age of 20. The risk of developing ‘chondrosarcoma’ increases after the age of 20 and up to the age of 75. The chances of getting this cancer are as much in women as it is in men. Chondrosarcomas can make their appearance anywhere in cartilage cells. Chondrosarcomas mostly develop in bones such as the pelvis, leg bone, or arm bone.
- Ewing Sarcoma: Ewing tumors are the third most common and primary type of bone cancer and the second most common cancer affecting most children, adolescents, and young adults. Most of the Ewing tumors develop in bones, but the chance is that they can also start in other tissues and organs. This cancer can develop in the most common parts of the body such as the pelvis, around the chest (such as the ribs or shoulders), and in the long bones of the legs and arms. This cancer is most common in children and adolescents and is rare in people over the age of 30.
- Malignant Fibrous Histiocytoma: Malignant fibrous histiocytoma often begins in softer tissue (connective tissues such as ligaments, tendons, fat, and muscle) than bones. When bones are affected by malignant fibrous histiocytoma, it usually affects the legs (often around the knees) or the arms. This type of cancer most often occurs in elderly and middle-aged adults and is rare in children. Malignant fibrous histiocytoma mostly develops in its surrounding areas, but it can spread to any distant part of the body, such as the lungs.
- Fibrosarcoma: This is another type of cancer that develops more in soft tissues than in bones. Usually elderly and middle-aged adults are affected by ‘fibrosarcoma’. ‘Fibrosarcoma’ most commonly affects the bones of the feet, hands and jaw.
- Chordoma: This primary bone tumor usually occurs in the bones of the skull and spine. It is most common in adults over the age of 30, and the tumor is much more common in men than in women. Chordoma tumors grow slowly and often do not spread to other parts of the body, but they often regress if they are not completely removed.
Also Read :
Stages of Bone Cancer
From a patient’s perspective, malignant bone cancer mainly depends on whether the cancer has spread to other parts of the body. If the cancer has not spread, it is usually easy to diagnose.
According to the University of Rochester Medical Center, about 70 percent of people who get bone cancer have a lifestyle that lasts about 5 years. However, the survival rate can vary depending on the disease status.
Bone cancer depends on how advanced it is:
Stage 1 – the cancer has not spread beyond the bone and the cancer is not aggressive
Stage 2 – Similar to stage 1, but it is an aggressive cancer category.
Stage 3 – Cancerous tumors are present in at least two places in the same bone.
Stage 4 – Cancerous tumors have spread to other parts of the body.
Symptoms of Bone Cancer
Symptoms of bone cancer are often triggered by conditions other than cancer, such as an injury or arthritis.
The symptoms of bone cancer are as follows:-
- Pain: Complaints of pain in the affected bone are common in bone cancer patients. Primarily the pain caused by this is not under control. The pain condition gets worse at night or when the bone is used (for example, foot pain when walking). As the cancer progresses, the pain persists all the time. The pain increases with movement and if a person’s leg is involved, he may even become paralyzed.
- Swelling: Swelling in the area of pain may not occur after a week but it is possible that you may feel a lump or mass in the area where you are having pain, which could be a tumor.
- Fractures (fractures): Bone cancer can weaken the bone in which it develops, but it is often found that fractures do not occur in the bones. People affected by bone cancer usually have sudden severe pain in one of their limbs which can be painful for a few months.
- Numbness: Cancerous tumors can press on the nerves in the bones of the affected spine, causing numbness and tingling or weakness.
- Other symptoms: Cancer can cause weight loss and fatigue. Along with this, if the cancer spreads to the internal organs of the body, then it can also cause other symptoms.
Causes of Bone Cancer
The exact cause of bone cancer is not known till today. However, scientists have found that bone cancer is associated with a number of other conditions, which include risk factors. Research is still going on, to learn more about the causes of these cancers.
Scientists have made great achievements in understanding how any change in a person’s DNA can cause cancer in their normal cells. They have found out that the biggest cause of Cancer is through DNA mutations (defects) that activate ‘oncogenes’ or deactivate tumor suppressor genes.
Some people with cancer have mutations in their DNA, which they inherit from their parents. These mutations further increase the risk of this disease.
In many cases, genetic testing is done to see if a person has such a mutation, which is genetically caused by a DNA mutation.
Most bone cancers are not caused by changes in genetic DNA. They are the result of mutations acquired throughout the life of the individual.
These changes are the result of radiation or chemicals, which can increase the risk of causing cancer, but often there is no obvious reason for their occurrence. These changes are only present in cancer cells, so they are not likely to be passed on to the patient’s children.
Scientists have made great progress in understanding the process of bone cancer, but there is still some information related to it, which has not been fully confirmed.
Bone cancer prevention
At the present time, there is no information about the prevention of bone cancer.
Bone Cancer Test
The patient’s symptoms, the results of physical and imaging tests, and blood tests show that bone cancer is present in a person.
But in most cases, doctors confirm this suspicion by examining a sample of the tissue or cell with the help of a microscope to confirm this suspicion. This confirmatory procedure is known as a ‘biopsy’.
Bone cancer symptoms due to other diseases, such as bone infection, as well as imaging test results in these cases can confuse you with symptoms of bone cancer.
The correct diagnosis of a bone tumor depends on complete information about its affected location (this includes information such as the affected bone and which part of the bone is affected) and microscope examination.
- X-rays
Most bone cancers are visible on a bone X-ray. Due to the cancer present in the bones, the bones that are solid can appear ‘rough’ instead of solid and this can appear as a hole in the bone. Sometimes doctors can see a tumor in the affected bone, which may have spread to surrounding tissue (such as muscle or fat).
- Computed tomography (CT scan)
CT scans are very helpful in staging cancer. A CT scan lets you know whether your bone cancer has spread to your lungs, liver, or other organs. A CT scan helps to visualize lymph nodes and distant organs of the body where metastatic cancer may be present.
- Magnetic resonance imaging (MRI scan)
An MRI scan is the best test for locating bone tumors. These tests are also particularly useful in visualizing the brain and spinal cord.
- Radionuclide bone scan
This process helps to see if the cancer has spread from one bone in the body to other bones. It can spot ‘metastases’ even before regular X-rays. Along with this, radionuclide bone scans can show how much bone loss has been caused by the primary cancer.
- Positron Emission Tomography (PET Scan)
A PET Scan is useful in looking for cancers throughout the body. Sometimes PET scans are also successful in telling whether a tumor is cancerous or not. A PET scan is combined with a CT scan to better understand certain types of cancer.
- Biopsy
A ‘biopsy’ is a sample of a cell (tissue) taken from a tumor so that it can be examined with the help of a microscope. Biopsy is the only way to know whether the tumor concerned is cancerous or other bone disease. If cancer is present anywhere in the body, a ‘biopsy’ can help the doctor find out whether it is a primary bone cancer or has started elsewhere and spread to the bones. Several types of tissue and cell samples are useful for the diagnosis of bone cancer. It is very important that the surgeon who performs the ‘biopsy’ procedure to diagnose and treat the tumor must be experienced.
- Needle biopsy
Needle biopsy is of two types : fine needle biopsy and core needle biopsy.
In a fine needle biopsy (FNA), the doctor removes some fluid and some cells from the tumor by attaching a very thin needle to a syringe.
Whereas in core needle biopsy, the doctor uses a larger needle to remove a small group of tissues.
Many experts believe that core needle biopsy is better than FNA (fine needle biopsy) for diagnosing primary bone cancer.
- Surgical bone biopsy
In this procedure, a surgeon needs to cut through the skin to access the tumor so that he can remove a small piece of tissue. It is also called an incisional biopsy.
Under this, if all the tumor is removed (not just a small piece) it is called an ‘excisional biopsy’.
If this type of biopsy is needed, it is important that the surgeon performing the biopsy is also the one who will later remove the cancer.
Bone Cancer Treatment
The treatment of bone cancer depends on a variety of factors, including: The type of bone cancer where it is located, its aggressiveness, whether it has spread or has spread.
- Surgery
Surgery therapy aims to remove the cancerous tumor and some of the bone tissue around it. Because if some cancer cells are left, they can grow and then spread.
Limb-sparing surgery, also known as limb salvage surgery, which means surgery in which the surgeon can take some bone from another part of the body to replace the affected bone without removing the bone Or artificial bone can also be used. However, in some cases complete removal of the organ may be necessary.
- Radiation therapy
Radiotherapy is commonly used to treat bone cancer and other types of cancer. Along with this, radiotherapy is also commonly used in the treatment of many cancer types.
In this, high energy ‘X-ray’ particles (radiation) are used to destroy cancer cells. Radiography damages the DNA inside tumor cells, preventing them from spreading.
Radiotherapy may be used in the following cases:
Treating the patient by completely destroying the tumor, relieving pain in more advanced cancers, shrinking the tumor so that it can be easily surgically removed, and removing cancer cells that remain after surgery .
Combined therapy (radiotherapy with other forms of therapy) : In some cases, radiotherapy combined with chemotherapy may be used.
- Chemotherapy
Chemotherapy uses chemicals to treat disease. Specifically, it helps to destroy cancer cells. There are mainly five goals of using chemotherapy:
- To be completely free from disease – It is used in some cases to cure the patient, you can get rid of cancer completely with chemotherapy alone.
- Co-therapy – Chemotherapy can be helped by some other treatments, such as radiotherapy or surgery.
- To prevent disease recurrence – Chemotherapy, used to prevent the return of cancer, is most commonly used when the tumor is removed after surgery.
- To slow the progression of cancer cells – Chemotherapy can slow the growth of cancer.
Chemotherapy is very helpful in relieving the symptoms of cancer, it is used more often for upper stage cancer patients.
Risks and Complications of Bone Cancer
A risk factor can be anything that increases the chances of a disease like cancer.
Different types of cancer can have different risk factors. For instance, exposing the skin to intense sunlight is a risk factor for skin cancer.
Smoking is a risk factor for cancer of the lung, mouth, throat, bladder, kidney and many other organs. But the presence of one or more risk factors does not mean that you will get the disease. Most people with bone cancer have no obvious risk factors.
Whereas, even in the case of people who have been ill for a long time, doctors give uncertain or exact reasons.
Patients with inflammatory diseases, such as those with Paget’s disease, are at higher risk for developing bone cancer. However, despite all this, no one has been able to understand why one person gets bone cancer while others do not. It is not contagious – you cannot get this disease from someone else who is infected.
The following groups of people may have high risk factors for developing bone cancer –
- Child or young adult – Most cases of bone cancer occur in children or young adults over the age of 20.
- Patients who have been given radiation therapy.
- People who already have Paget’s disease.
- People whose close relatives (parents or siblings) have had bone cancer.
- Individuals with hereditary retinoblastoma – this is a type of cancer that most commonly affects young children.
- Li-Fraumeni syndrome – people having this rare genetic condition.
(Disclaimer: The information in this part of the article is for educational purposes only. All results must be clinically correlated with patient data in order to make an accurate diagnosis.)
References :
- American Cancer Society. What Causes Bone Cancer?. New York;
- Anant Ramaswamy et al. Indian data on bone and soft tissue sarcomas: A summary of published study results. South Asian J Cancer. 2016 Jul-Sep; 5(3): 138–145. PMID: 27606300
- Better health channel. Department of Health and Human Services. State government of Victoria; Bone cancer
- Department of Health and Services. CANCER FACTS. National Cancer institute; Institutes of Health .
- Ferguson JL et al. Bone Cancer: Diagnosis and Treatment Principles.. Am Fam Physician. 2018 Aug 15;98(4):205-213. PMID: 30215968
