Bone cancer can strike at both adults and children. It is a form of malignancy that develops in any bone, though the long bones of the legs and arms are the most common. Bone cancer is rare, making up less than one percent of all cancers. In fact, noncancerous tumors are more prevalent than cancerous ones.
Cancer that spreads from a different location to the bone is not considered bone cancer. Instead, those cancers are named after the part where they originated, such as breast cancer that has metastasized to the bone. Treatment depends on the type of bone cancer being treated. Surgical removal is the most common, although doctors also use chemotherapy and radiation therapy.
Primary bone cancer, which means cancer that started in the bone, comes in several forms. Chondrosarcoma, osteosarcoma, and Ewing’s sarcoma accounts for most cases of the disease.
- Chondrosarcoma develops in cartilage and mainly targets the arms, legs, and pelvis.
- Osteosarcoma begins in the bone cells and affects the same parts as chondrosarcoma. It is characterized by an increase in osteoblast activity. These are cells that aid in bone design and formation.
- Ewing’s sarcoma is often seen in the pelvis, legs, arms, and chest wall.
- Chordoma is usually cancer in the spine and base of the skull.
- Fibrosarcoma chordoma starts in soft tissue but can occur in the jaw, legs, or arms.
- Malignant fibrous histiocytoma also grows in soft tissue but can also develop in bones, particularly the legs and arms.
- Giant cell bone tumors are typically benign, but the cancerous form can start at the legs, especially near the knees.
Most cases of “bone cancer” are secondary bone cancer or tumors that came from a different area and invaded the bone. For example, if it was breast cancer that spread to the bone, the disease would be called “breast cancer metastatic to the bones.” Still, this stage is extremely serious. It’s classified as stage 4 as it already involves multiple organs, making it harder to treat.
Scientists have not uncovered the exact causes of bone cancer, but changes in the DNA of the malignant cells seem to play an important role. While these do not directly cause bone cancer, here are risk factors that may influence a person’s tendency to develop the disease.
Families with a history of sarcoma, as is seen with Li-Fraumeni syndrome, have more chance of developing osteosarcomas. Children with familial retinoblastoma, which is a type of eye cancer, are also susceptible to osteosarcoma.
Another inherited condition, the Rothmund-Thomson syndrome, can increase the risk of osteosarcoma. This disorder is characterized by sparse hair, skin rash, and malformed bones. Multiple exostoses, a genetic condition that causes bumps on the bones can increase the risk of developing chondrosarcoma.
Chemotherapy for another cancer
Some medication used for cancer treatment, such as anthracyclines and alkylating agents, may increase the risk of developing secondary cancer, usually osteosarcoma.
Previous radiation therapy
The site of radiation therapy becomes susceptible to bone cancer, particularly if the treatment was given during childhood. A typical X-ray should be safe, but higher doses (often over 60 Gy) can also increase your risk. This usually occurs in a child being treated for another type of cancer who receives a course of radiation therapy.
Benign tumors or other conditions
Some noncancerous bone diseases like fibrous dysplasia may increase the risk of osteosarcoma. Paget’s disease of the bone, a disorder common in older adults, can break down the bone gradually and lead to bone cancer.
Pain in the bone is the most common sign of bone cancer, but other symptoms vary from person to person. Here are some of them:
- Fractures due to bone weakness
- Unintentional weight loss
- Swelling or tenderness around the affected area
If the results of your physical exam, as well as your symptoms, suggest the presence of bone cancer, your physician will order additional tests. Imaging tests like magnetic resonance imaging (MRI), X-rays, and computerized tomography (CT scans), can help determine abnormalities in your bone. There’s also a bone scan that helps your doctor see the metabolic activity of the bone. It will show any growth or bone matter that may have broken down.
The most accurate diagnosis will have to come from a bone biopsy. Your doctor will remove a tiny sample of bone tissue to be examined under a microscope. The procedure takes less than an hour, but it can be tricky and has the risk of spreading the disease from the site of origin. It’s crucial to choose a skilled surgeon experienced in treating patients with bone cancer to perform the biopsy. If cancer is detected, it is then staged and graded by a pathologist.
The main treatment is surgery for a low-grade primary bone cancer. This procedure aims to take away the tumor and a margin of healthy tissue or bone around it to make sure all of the cancer cells are gone. Doctors often use a combination of treatment for high-grade primary bone tumor.
Surgery alone is generally not enough to treat people with certain types of bone cancers, especially osteosarcoma. These diseases sometimes recur and affect other organs. Chemotherapy can help destroy the remaining cancer cells and help patients live longer. It is especially useful for treating cancer that has visibly spread at the time of diagnosis.
Radiation therapy is often used if the tumor cannot be removed with surgery. Meanwhile, immunotherapy, a treatment designed to boost the body’s natural defenses against cancer, still needs further testing to be approved for bone cancer treatment.
Dealing with cancer is often described as a “battle” you must win. If you are diagnosed with bone cancer, one strategy that can help is to learn as much as you can about the disease and its treatment. From that fateful day at the doctor’s office to making sense of life with your “new normal,” it’s crucial to hold onto hope and find support from your loved ones and your medical team.