Bone Cancer

Bone cancer is a rare but serious condition that occurs when cancer cells develop in the bones. It can affect people of all ages, although certain types of bone cancer are more common in specific age groups. Understanding the various types of bone cancer, their symptoms, and available treatment options is crucial for early detection and effective management of the disease.

What is Bone Cancer?

Bone cancer refers to the abnormal growth of cells within the bone tissue, leading to the formation of tumours. It is important to distinguish between primary bone cancer, which originates in the bones, and secondary (metastatic) bone cancer, which occurs when cancer from other parts of the body spreads to the bones. Some common symptoms of bone cancer include pain, swelling, and fractures in the affected area. Multiple myeloma, a type of blood cancer that affects the bones, can also cause symptoms such as bone pain, weakness, and frequent infections.

There are several types of bone cancer, each with its own characteristics and treatment options. These include:

• Osteosarcoma: This is the most common type of primary bone cancer, often found in the long bones of the legs and arms, particularly in teenagers and young adults. Osteosarcoma begins in the cells that form bones and is typically treated with chemotherapy and surgery.

• Chondrosarcoma: The second most common form of primary bone cancer, chondrosarcoma forms in cartilage cells and most often develops in the pelvis, legs, and arms. It is more common in middle-aged and older adults and is usually treated with surgery.

• Ewing tumour: Also known as Ewing sarcoma, this rare type of bone cancer primarily affects children and young adults. It can start in the bones or in the soft tissue around the bones, commonly in the legs, pelvis, and ribs. Treatment typically involves chemotherapy and either surgery or radiation therapy.

• Fibrosarcoma and malignant fibrous histiocytomas: These rare types of bone cancer can occur in adults, with fibrosarcoma often appearing in the knees or hips and sometimes arising after radiation therapy for other cancers. Malignant fibrous histiocytomas is a type of sarcoma that can develop in the bone or soft tissue.

• Giant cell tumours of the bone: These tumours can be benign or malignant and are most commonly found in the arm or leg bones of young and middle-aged adults. Although they rarely spread to distant parts of the body, they can recur after surgical removal, with a higher risk of spreading with each recurrence.

• Chordoma: This rare type of bone cancer affects bones in the spine and the base of the skull and is more common in adults aged 30 and older.

• Multiple myeloma: A cancer of the plasma cells in the bone marrow, multiple myeloma causes the accumulation of abnormal plasma cells in the bone marrow, leading to symptoms such as bone pain, frequent infections, and fatigue.

• Leukaemia: While leukaemia is a cancer of the blood cells, it can also affect the bone marrow and cause bone pain and weakening of the bones.

• Non-Hodgkin lymphoma: This type of cancer begins in the lymphatic system but can spread to the bones, causing pain and weakening of the affected bones.

The early signs of bone cancer include:

• Persistent, severe, or worsening bone pain, especially pain that continues into the night

• Noticeable lumps or swelling on or around the affected bone

• Bones that fracture easily after minor injuries

• Unexplained changes in mobility or difficulty using a joint

Bone cancer symptoms can vary depending on the type, location, and stage of the cancer. The most common symptoms include:

• Persistent pain: Persistent or worsening pain in the bone, often described as a deep, aching sensation. The pain may become more intense at night or during physical activity and may not respond to over-the-counter pain relief.

• Swelling: Swelling or a noticeable lump may develop around the affected bone. This swelling can be accompanied by tenderness, making the area sensitive to touch.

• Fractures: Bones weakened by cancer are more susceptible to fractures, even with minimal trauma. These fractures may occur unexpectedly or with normal activities.

• Limited mobility: Difficulty moving the affected limb or joint can occur due to pain or structural changes in the bone. Patients may find it challenging to perform everyday activities, leading to a reduced range of motion.

• Fatigue and weakness: General feelings of fatigue or weakness that are not typical for the individual may arise. This can be due to the body’s response to cancer or anaemia resulting from the disease.

• Unexplained weight loss: Sudden weight loss without changes in diet or exercise can be alarming and may indicate that the body is dealing with a serious issue, such as cancer.

• Fever and night sweats: Some patients may experience low-grade fevers and night sweats. These symptoms may suggest an underlying infection or inflammation associated with cancer.

• Changes in blood counts: Blood tests may reveal low red or white blood cell counts, indicating bone marrow involvement. Symptoms like frequent infections or unusual bruising may arise from these changes.

The staging of bone cancer helps determine how far the cancer has spread and guides treatment planning. The stages include:

• Stage 1: The cancer is localised and contains low-grade cells with no spread beyond the affected bone.

• Stage 2: The cancer is localised and contains high-grade cells but has not spread beyond the affected bone.

• Stage 3: The cancer is localised and contains several high-grade tumours in the same bone, with no spread to other parts of the body.

• Stage 4: The cancer has spread (metastasised) from the original site to other parts of the body, such as the lungs or other bones.

The exact cause of bone cancer is often not known, but certain factors can increase the risk of developing this condition. These include:

• Genetic factors: Some inherited genetic syndromes, such as Li-Fraumeni syndrome and hereditary retinoblastoma, can increase the risk of developing bone cancer.

• Previous radiation therapy: Exposure to high doses of radiation, particularly during childhood, can increase the risk of developing bone cancer later in life.

• Paget's disease: A condition that causes abnormal bone growth and weakening, increasing the risk of developing bone cancer, particularly in older adults.

• Chronic inflammation: Long-term inflammation in the bones, such as that caused by conditions like osteomyelitis, can potentially lead to the development of bone cancer.

• Bone marrow transplantation: In rare cases, individuals who have undergone bone marrow transplantation may have an increased risk of developing bone cancer.

Several factors can increase the risk of developing bone cancer, including:

• Genetic disorders like Li-Fraumeni syndrome, retinoblastoma, and tuberous sclerosis

• Previous radiation therapy, especially at a young age or with high doses

• Benign bone conditions such as Paget's disease, multiple enchondromatosis, and multiple exostoses (osteochondromas)

• Bone marrow transplantation, which has been linked to a higher risk of osteosarcoma in some cases

• Rare conditions like Ollier's disease, which causes non-cancerous bone tumours

Preventing bone cancer can be challenging, as many risk factors, such as genetic predispositions, are not modifiable. However, some general preventive measures include:

• Minimising radiation exposure: Limiting exposure to radiation, particularly in young individuals, may lower the risk of developing bone cancer later in life. This includes both medical radiation exposure and environmental sources.

• Genetic counselling: For those with a family history of genetic disorders that increase bone cancer risk, such as Li-Fraumeni syndrome, genetic counselling and testing can help identify potential risks early on. This allows for closer monitoring and early intervention if necessary.

• Regular monitoring of benign conditions: Benign bone conditions like Paget's disease and multiple enchondromatosis can increase the risk of bone cancer. Regular check-ups and monitoring of these conditions can aid in the early detection of any malignant changes, improving treatment outcomes.

Diagnosing bone cancer involves a combination of physical examinations, imaging tests, and biopsy. The various diagnostic tests include:

• Bone scan: A radioactive tracer is injected into the bloodstream, and images are taken to identify areas of increased bone metabolism, which can indicate the presence of tumours.

• Computed tomography (CT) scan: Detailed cross-sectional images of the bone are obtained to evaluate the extent of the tumour and any potential spread to nearby structures.

• Magnetic resonance imaging (MRI): MRI scans provide detailed images of the soft tissues surrounding the bone, helping to assess the tumour's size, location, and potential invasion into adjacent muscles or organs.

• Positron emission tomography (PET) scan: PET scans can detect areas of increased metabolic activity, which can help identify the primary tumour site and any metastatic spread.

• Biopsy: A biopsy involves removing a small sample of tissue from the affected bone for examination under a microscope. This is the definitive way to diagnose bone cancer and determine its type. Biopsies can be done using a needle (needle biopsy) or through a small incision (open biopsy).

• Blood tests: While blood tests cannot directly diagnose bone cancer, they can provide information about overall health and check for markers associated with specific types of bone cancer, such as alkaline phosphatase levels in osteosarcoma or monoclonal proteins in multiple myeloma.

Treatment for bone cancer depends on several factors, including the type and stage of the cancer, the patient's age and overall health, and the location of the tumour. The main treatment options include:

• Surgery: Surgery is often the primary treatment for bone cancer. The goal is to remove the entire tumour along with a margin of healthy tissue. Depending on the tumour's location and size, this may involve removing a portion of the bone (limb-sparing surgery) or, in some cases, amputation of the affected limb.

• Chemotherapy: Chemotherapy uses medications to kill cancer cells throughout the body. It is often used before surgery to shrink the tumour and make removal easier, or after surgery to kill any remaining cancer cells. Chemotherapy is commonly used for osteosarcoma and Ewing's sarcoma.

• Radiation therapy: Radiation therapy uses high-energy beams to kill cancer cells in a specific area. It may be used before surgery to shrink the tumour or after surgery to kill any remaining cancer cells. Radiation therapy is often used for chondrosarcoma, which is less responsive to chemotherapy.

• Targeted therapy: Targeted therapy medications specifically target cancer cells without harming normal cells. These medications may be used to treat certain types of bone cancer, such as giant cell tumours of the bone.

• Supportive care: Supportive care focusses on relieving symptoms and improving quality of life. This may include pain management, physical therapy, and emotional support.

Living with bone cancer requires ongoing medical care and lifestyle adjustments. Here are a few points to consider:

• Attend regular follow-up appointments with doctors to detect any recurrence or spread of the cancer early, including periodic imaging tests and physical exams.

• Manage side effects from treatments such as chemotherapy, radiation therapy, and targeted therapy, which can include pain, fatigue, and other symptoms. Supportive care and palliative treatments can help improve quality of life.

• Make lifestyle adjustments, such as modifying physical activities to accommodate any limitations caused by the cancer or its treatment.

• Maintaining a healthy diet, getting adequate rest, and managing stress are also important.

• Seek support from family, friends, and doctors, as well as support groups and counselling services, to cope with the emotional and psychological impact of living with bone cancer.

If you experience persistent bone pain, swelling, or tenderness, especially if it worsens at night or with activity, consult your doctor. Other symptoms that warrant medical attention include unexplained weight loss, fatigue, and weakened bones that lead to fractures. Early detection and diagnosis of bone cancer can significantly improve treatment outcomes, so it is essential to seek medical advice if you have any concerns or notice any unusual symptoms.

• Bone cancer is a rare type of cancer that originates in the bones or develops from cancer that has spread to the bones from other parts of the body.

• Common types of bone cancer include osteosarcoma, chondrosarcoma, Ewing sarcoma, and multiple myeloma.

• Symptoms of bone cancer may include persistent bone pain, swelling, tenderness, unexplained weight loss, fatigue, and weakened bones that lead to fractures.

• Treatment for bone cancer typically involves a combination of surgery, chemotherapy, radiation therapy, and targeted therapy, depending on the specific type, stage, and location of the cancer.

• Living with bone cancer requires ongoing medical care, management of treatment side effects, lifestyle adjustments, and support from doctors, family, and friends.