Primary bone cancer is a rare type of cancer that originates in the bones. It differs from secondary bone cancer, which occurs when cancer from another part of the body spreads to the bones. This content focuses solely on primary bone cancer.
Signs and Symptoms of Bone Cancer
Bone cancer can develop in any bone, but it most commonly affects the long bones of the legs and upper arms. Key symptoms include:
- Persistent bone pain that worsens over time and often continues at night.
- Swelling and redness (inflammation) over a bone, potentially restricting movement if located near a joint.
- A noticeable lump over a bone.
- Weak bones prone to fractures.
If you or your child experience severe or persistent bone pain, it is essential to consult a GP. While bone cancer is rare, further investigation is necessary to rule out serious conditions.
Types of Bone Cancer
The primary types of bone cancer include:
- Osteosarcoma: The most common type, often affecting children and young adults under 20.
- Ewing Sarcoma: Most commonly found in individuals aged 10 to 20.
- Chondrosarcoma: Primarily affects adults over 40.
Young people are more susceptible due to the rapid bone growth during puberty, which may contribute to the development of bone tumors. Each type affects different cells, influencing the treatment approach and prognosis.
Causes of Bone Cancer
In most cases, the exact cause of bone cancer is unknown. However, certain factors may increase the risk:
- Exposure to radiation during previous radiotherapy.
- Paget’s disease of the bone, although only a small percentage of individuals with this condition develop bone cancer.
- Genetic conditions such as Li-Fraumeni syndrome, where a faulty gene reduces the body’s ability to suppress cancerous cell growth.
How Bone Cancer is Treated
Treatment for bone cancer varies based on the type and extent of cancer spread. Common treatment methods include:
- Surgery: Removal of the cancerous bone section. Reconstruction or replacement is often possible, but in some cases, amputation may be necessary.
- Chemotherapy: Utilizes powerful cancer-killing drugs.
- Radiotherapy: Uses radiation to target and destroy cancerous cells.
- Mifamurtide: This medication may be recommended for some cases of osteosarcoma.
Outlook and Prognosis
The prognosis for bone cancer depends on factors such as:
- Age of the patient.
- Type and stage of the cancer.
- Likelihood of further cancer spread (grade).
Healthy individuals with non-spreading bone cancer typically have a better chance of a successful cure.
Symptoms of Bone Cancer: What to Watch For
Bone pain is the most common symptom associated with bone cancer, but other symptoms can also occur. It’s important to recognize these signs early for prompt diagnosis and treatment.
Bone Pain
Pain from bone cancer often starts as a feeling of tenderness in the affected bone and gradually worsens. It may become a persistent ache or an intermittent ache that continues even during rest and at night.
- Commonly Affected Areas: Bone cancer frequently develops in the long bones of the legs or upper arms.
- Misdiagnosis Risk: In adults, this pain may be mistaken for arthritis, while in children and teenagers, it can be confused with growing pains.
Other Symptoms
In addition to bone pain, some people may experience:
- Swelling and Redness (Inflammation): This may occur around the affected bone, and if the cancer is near a joint, it can lead to difficulty in using the joint.
- Noticeable Lump: A lump may develop over or near the affected bone.
- Bone Weakening and Fractures: Cancer can weaken the bone, making it more susceptible to breaks or fractures even from minor injuries or falls.
Less Common Symptoms
Some individuals may also experience:
- High Temperature (Fever): 38°C (100.4°F) or higher.
- Unexplained Weight Loss.
- Night Sweats.
When to Seek Medical Advice
If you or your child experiences persistent, severe, or worsening bone pain, or if you are concerned about any symptoms, it is crucial to consult your GP. While these symptoms are often not caused by cancer, early diagnosis and appropriate treatment are important for the best outcomes.
Causes of Bone Cancer: Risk Factors and Genetic Links
Bone cancer develops when cells within the bones multiply uncontrollably, forming a tumor. While the exact cause is often unknown, certain factors can increase the likelihood of developing bone cancer.
Key Risk Factors for Bone Cancer
1. Previous Radiotherapy Treatment
Exposure to high doses of radiation during radiotherapy may increase the risk of cancerous changes in bone cells later in life. However, the overall risk remains small.
2. Bone Conditions
Certain non-cancerous (benign) bone conditions may raise the risk of bone cancer, though the overall likelihood remains low:
- Paget’s Disease of the Bone: This condition, which affects how bones break down and rebuild, increases the risk for individuals over 50 to 60 years of age.
- Rarer Bone Disorders: Conditions like Ollier’s disease, which causes tumors to develop in bones, can also raise the risk of bone cancer.
3. Genetic Conditions
Genetic predispositions can play a significant role:
- Li-Fraumeni Syndrome: This rare genetic disorder causes a faulty version of a gene responsible for tumor suppression. It increases the risk of bone cancer and other types of cancer.
4. Other Medical Conditions
Certain conditions may also contribute to a higher risk of developing bone cancer:
- Retinoblastoma: This rare childhood eye cancer is linked to the same faulty gene that can cause bone cancer.
- Umbilical Hernia: Research has found that babies born with an umbilical hernia have a higher risk of developing Ewing sarcoma, though the risk remains very small.
How Bone Cancer Develops
Cancer occurs when cells divide and multiply uncontrollably, forming a tumor. In bone cancer, this abnormal cell growth occurs within the bone, leading to the development of a tumor.
Diagnosing Bone Cancer: Tests and Procedures
If you or your child is experiencing bone pain, it is important to see your GP. Your doctor will discuss your symptoms, examine the affected area for swelling or lumps, and assess whether you have difficulty moving that area. Questions about the nature of the pain, such as whether it is constant, intermittent, or worsened by certain activities, will also help guide further evaluation.
Referral for an X-Ray
If bone cancer is suspected, you may be referred for an X-ray. This imaging test uses radiation to produce internal images of your body and is highly effective for examining bones. X-rays can detect bone damage or new bone growth caused by cancer and can help rule out other causes, such as fractures. If the X-ray results suggest bone cancer, you will be referred to a specialist centre or an orthopaedic surgeon for further assessment.
Biopsy: Definitive Diagnosis
A biopsy is the most definitive way to diagnose bone cancer. During this procedure, a small sample of bone tissue is taken and examined in a laboratory. There are two main types of biopsy:
- Core Needle Biopsy: Performed under local or general anaesthetic, a thin needle is used to extract a sample.
- Open Biopsy: Conducted under general anaesthetic, the surgeon makes an incision to remove a tissue sample. This may be necessary if the results of a core needle biopsy are inconclusive.
The biopsy will help determine the type and grade of bone cancer you have.
Further Tests to Assess Cancer Spread
If a biopsy confirms or suggests bone cancer, additional tests will be conducted to understand how far the cancer has spread. These may include:
MRI Scan
An MRI scan uses magnetic fields and radio waves to create detailed images of bones and surrounding soft tissues. This test is effective for determining the size and spread of the tumor.
CT Scan
A CT scan produces detailed 3D images of your body using a series of X-rays. It is often used to check if cancer has spread to the lungs.
Bone Scans
A bone scan offers more detailed information about the inside of your bones compared to X-rays. During this test, a small amount of radioactive material is injected into your veins. Abnormal bone areas absorb this material faster and appear as “hot spots” on the scan.
Bone Marrow Biopsy
For individuals with Ewing sarcoma, a bone marrow biopsy may be necessary to check if the cancer has spread to the bone marrow. This involves inserting a needle into the bone to extract a marrow sample.
Staging and Grading Bone Cancer
Once all tests are completed, your healthcare team will determine the stage and grade of the cancer:
- Stage 1: Low-grade cancer confined to the bone.
- Stage 2: High-grade cancer still confined to the bone.
- Stage 3: Cancer has spread to other body parts, such as the lungs.
Stage 1 and some stage 2 cancers have a good chance of being cured. Stage 3 cancer is more challenging to treat, but treatment can help relieve symptoms and slow its progression.
Coping with a Diagnosis
Receiving a bone cancer diagnosis can be distressing and overwhelming. Feelings of anxiety, stress, and depression are common, especially for young people or parents of children with the diagnosis. Support is available:
- Speak with your GP about managing depression or anxiety.
- Contact the Bone Cancer Research Trust for more information and support.
- Teenagers may find assistance through the Teenage Cancer Trust, a charity dedicated to young people with cancer.
Treating Bone Cancer: Options and What to Expect
The treatment for bone cancer depends on the type of cancer, its stage, and the patient’s overall health. The main treatment options include surgery, chemotherapy, and radiotherapy. Treatment is typically managed by a multi-disciplinary team (MDT) that includes specialists like orthopaedic surgeons, clinical oncologists, and specialist cancer nurses.
Treatment Plan Overview
Your MDT will recommend a tailored treatment plan that may include:
- Surgery to remove the cancerous bone section. Reconstruction or replacement of the bone may be possible, though amputation may be necessary in certain cases.
- Chemotherapy to destroy cancer cells.
- Radiotherapy to target and eliminate cancerous tissue.
- In some instances, mifamurtide may be used to boost the immune system against cancer cells.
Surgery for Bone Cancer
Surgery is a key component of treatment and is often combined with other therapies.
Limb-Sparing Surgery
When possible, limb-sparing surgery is performed to remove only the cancerous part of the bone, sparing the rest of the limb. The affected bone and surrounding tissue are removed, and the missing section may be replaced with a metal implant (prosthesis) or a bone graft from another part of the body.
Amputation
Amputation may be necessary if:
- Cancer has spread to major blood vessels or nerves.
- Infection develops after limb-sparing surgery.
- The cancer is in an area where limb-sparing surgery isn’t feasible.
Following amputation, patients often use advanced prosthetic limbs, enabling many to regain mobility, walk, run, and even participate in sports.
Recovery and Rehabilitation
After surgery, rehabilitation is essential to regain function and adapt to daily life. This may involve:
- Physiotherapy: Exercises to restore movement and strength.
- Occupational Therapy: Techniques to assist with daily tasks.
- Referral to local limb centres for continued support if an amputation was performed.
Chemotherapy
Chemotherapy uses cancer-killing drugs to target bone cancer cells and can be used in several ways:
- Before surgery to shrink tumors.
- In combination with radiotherapy before surgery (chemoradiation), especially for Ewing sarcoma.
- After surgery to prevent recurrence.
- Palliative chemotherapy to manage symptoms in cases where a cure isn’t possible.
Chemotherapy is often delivered via a drip into a vein, and treatment cycles involve medication administration followed by rest periods to allow recovery.
Common Side Effects of Chemotherapy
- Nausea and vomiting
- Diarrhoea
- Mouth ulcers
- Fatigue
- Increased infection risk
- Temporary hair loss
- Potential infertility
[Read more about chemotherapy side effects.]
Radiotherapy
Radiotherapy uses high-energy beams to target cancer cells. It may be used:
- Before or after surgery.
- To control symptoms and slow cancer spread if a cure isn’t possible.
Treatment is typically delivered in daily sessions (5 days per week) over several weeks.
Side Effects of Radiotherapy
- Skin redness and irritation (similar to sunburn)
- Joint pain
- Nausea
- Localized hair loss
- Fatigue
[Read more about radiotherapy side effects.]
Mifamurtide
For patients with osteosarcoma, mifamurtide may be recommended. It works by stimulating the immune system to attack cancer cells. Treatment typically involves infusions over several weeks.
Potential Side Effects of Mifamurtide
- Nausea and vomiting
- Diarrhoea or constipation
- Headaches and dizziness
- Loss of appetite
- Fatigue and weakness
Women taking mifamurtide should avoid pregnancy and breastfeeding during treatment.
Follow-Up Care
Regular follow-up appointments will be necessary after treatment to monitor for recurrence. Appointments are typically more frequent in the first two years, gradually becoming less frequent over time. Contact your specialist if you experience symptoms of recurrence.
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