Bone Cancer
What are bones for?
The 206 bones in the body serve several purposes. They support and protect internal organs (for example, the skull protects the brain and the ribs protect the lungs). Muscles pull against bones to make the body move. Bone marrow, the soft, spongy tissue in the center of many bones, makes and stores blood cells.
What is cancer?
Cancer is a group of diseases. More than 100 different types of cancer are known. They all have one thing in common: cells become abnormal. These abnormal cells grow and destroy body tissue and can spread to other parts of the body.
Healthy cells that make up the body's tissues grow, divide, and replace themselves in an orderly way. This process keeps the body in good repair. If cells lose the ability to control their growth, they grow too rapidly and without any order. They form too much tissue. The mass of extra tissue is called a tumor. Tumors can be benign or malignant.
Benign tumors are not cancer. They do not spread to other parts of the body and are seldom a threat to life. Benign tumors can usually be removed. Although benign bone tumors sometimes return, they usually can be removed with additional surgery.
Malignant tumors are cancer. They can invade and destroy nearby healthy tissues and organs. Cancer cells also can break away from the tumor and enter the bloodstream. That is how bone cancer can spread to other parts of the body. This spread is called metastasis.
Cancer that begins in the bone is called primary bone cancer. Each year, more than 2000 people in the United States learn that they have bone cancer. It is found most often in the arms and legs, but it can occur in any bone in the body. Children and young people are more likely than adults to have bone cancers.
Primary bone cancers are called sarcomas. There are several types of sarcoma. Each type begins in a different kind of bone tissue. The most common are osteosarcoma, Ewing's sarcoma, and chondrosarcoma.
Osteosarcoma is the most common type of bone cancer in young people. It usually occurs between ages 10 and 25. Males are affected more often than females. Osteosarcoma often starts in the ends of bones, where new bone tissue forms as a young person grows. It usually affects the long bones of the arms or legs.
Ewing's sarcoma usually is found in people between 10 and 25 years old; teenagers are most often affected. This cancer forms in the middle part (shaft) of large bones. It most often affects the hip bones and the long bones in the thigh and upper arm. It also occurs in the ribs.
Chondrosarcoma is found mainly in adults. This type of tumor forms in cartilage, the rubbery tissue around joints.
Other types of bone cancer include fibrosarcoma, malignant giant cell tumor, and chordoma. These rare cancers most often affect people over 30.
Cancers that begin in the bone are quite rare. On the other hand, it is not unusual for cancer to spread to the bone from other parts of the body. When this happens, the disease is not called bone cancer. Each type of cancer is named for the organ or the tissue in which it begins. Cancer that spreads is the same disease and has the same name as the original, or primary, cancer. Treatment for cancer that has spread to the bones depends on where the cancer started and the extent of the spread.
Cancers that begin in the muscles, fat, nerves, blood vessels, and other types of connective or supporting tissues in the body are called soft tissue sarcomas. They can affect both children and adults. They are not discussed in this article.
Leukemia , multiple myeloma , and lymphoma are cancers that arise in cells produced in the bone marrow. These are different diseases and are not types of bone cancer.
What are symptoms of bone cancer?
Symptoms of bone cancer tend to develop slowly. They depend on the type, location, and size of the tumor.
Pain is the most frequent symptom of bone cancer. Sometimes a firm, slightly tender lump on the bone can be felt through the skin. In some cases, bone cancer interferes with normal movements. Bone cancer can also cause bones to break.
These symptoms are not sure signs of cancer. They may also be caused by other, less serious problems. Individuals who are experiencing symptoms should consult a doctor.
How is bone cancer diagnosed?
To diagnose bone cancer, the doctor asks about the patient's personal and family medical history and does a complete physical exam. In addition to checking the general signs of health, the doctor usually orders blood tests and x-rays. X-rays can show the location, size, and shape of a bone tumor. On x-rays, benign tumors usually look round and smooth, with distinct edges. Bone cancers generally have odd shapes and irregular edges.
If x-rays show that the tumor is possible cancer, some of the following special tests may be done. These tests can also show whether the cancer has begun to spread.
Bone scans outline the size, shape, and location of abnormal areas in the bone. A small amount of radioactive material is injected into the bloodstream. This material collects in the bones and is detected by a special instrument called a scanner.
CT or CAT scan is an x-ray procedure that gives detailed pictures of cross-sections of the body. The pictures are created by a computer.
MRI ( magnetic resonance imaging ) also creates detailed pictures of cross-sections of the body. MRI uses a very strong magnet linked to a computer.
Angiograms are special x-rays of the blood vessels. A dye that shows up on x-rays is injected into the bloodstream so that the vessels can be seen in detail. This test is also done to help plan surgery.
A biopsy is the only sure way to tell whether cancer is present. Biopsies are best done at a hospital where doctors are experienced in the diagnosis of bone cancers. The doctor removes a sample of tissue from the bone tumor. A pathologist looks at the tissue under a microscope. If cancer is found, the pathologist can tell the type of sarcoma and whether it is likely to grow slowly or quickly.
If a diagnosis of bone cancer is made, it is important for the doctor to know exactly where the cancer is located and whether it has spread from its original location. This information is very important for planning treatment. The results of exams, tests, x-rays, scans, and the biopsy are all used in staging the cancer. The stage indicates whether the disease has spread and how much tissue is affected.
How is bone cancer treated?
A number of factors are considered to decide on the best treatment for bone cancer. Among these are the type, location, size, and extent of the tumor as well as the patient's age and general health. A treatment plan is tailored to fit each patient's needs.
Treatment Methods
Bone cancer is treated with surgery, radiation therapy , and/or chemotherapy . The doctor often uses a combination of treatment methods, depending on the patient's needs. Patients may be referred to doctors who specialize in different kinds of cancer treatment. Often, the specialists work together as a team. The team may include a surgeon, a pediatric oncologist, and a radiation oncologist.
Surgery is part of the treatment for most bone cancers. Because the disease may recur near the original site, the surgeon removes the tumor and some healthy bone and other tissue around the tumor.
When bone cancer occurs in an arm or leg, the surgeon tries, whenever possible, to remove just the tumor and an area of healthy tissue around it. Sometimes, the surgeon can use a metal device to replace the bone that is removed. In some children, the surgeon may replace the bone with a metal device that can be lengthened as the child grows. This limb-sparing procedure will require additional operations to keep expanding the artificial bone.
Sometimes, however, when the tumor is large, amputation may be necessary. If the limb is removed, a prosthesis (artificial part) can be made. The artificial part takes the place of a leg, arm, hand, or foot.
Chemotherapy uses drugs to kill cancer cells. Often, a combination of three or more drugs is used. Chemotherapy can be given by mouth or by injection into a muscle or blood vessel. The drugs travel through the body in the bloodstream. Chemotherapy is given in cycles: a treatment period followed by a recovery period, then another treatment and recovery period, and so on.
Some patients have chemotherapy as an outpatient at the hospital, clinic, or doctor's office or at home. Depending on which drugs are given, however, the patient may need to stay in the hospital for a short while.
Chemotherapy is almost always used in combination with surgery for cancers of the bone. Sometimes, chemotherapy is used to shrink a tumor before surgery. It is also used as an adjuvant therapy after surgery to kill cancer cells that may remain in the body and to prevent the disease from recurring. In some cases, a patient may have chemotherapy both before and after surgery. For some bone cancer, chemotherapy is combined with radiation therapy. Chemotherapy can also be used to control bone cancer that has spread.
Radiation therapy (also called radiotherapy) uses high-energy rays to damage cancer cells and stop them from growing. In some cases, radiation therapy is used instead of surgery to destroy the tumor. This form of treatment can also be used to destroy cancer cells that remain in the area after surgery.
The patient goes to the hospital or clinic each day for radiation treatments. Usually, treatments are given 5 days a week for 5 to 8 weeks.
What are the side effects of treatment for bone cancer?
The methods used to treat bone cancer are very powerful. It is hard to limit the effects of treatment so that only cancer cells are destroyed; healthy tissue may also be damaged. That is why treatment often causes side effects. Side effects depend on the type of treatment and on the part of the body being treated.
Surgery for cancer of the bone is a major operation. The area must be carefully watched for infection. Rehabilitation is an important part of post-surgery treatment.
The side effects of chemotherapy depend on the drugs that are given. In addition, each person reacts differently. Chemotherapy affects rapidly growing cells, such as blood-forming cells and those that line the digestive tract. As a result, patients may have side effects, such as a lowered resistance to infection, loss of appetite, nausea, vomiting, or mouth sores. They may also have less energy and may lose their hair. These are short-term side effects which usually end after treatment stops.
During radiation therapy, patients can become very tired as treatment continues. Resting as much as possible is important. Skin reactions such as redness or dryness in the area being treated are common, and the skin should be protected from the sun. Good skin care is important at this time, but the patient should not use any lotion or cream on the skin without checking with the doctor.
For some patients, it may be important to have a complete dental exam before treatment begins. Because cancer treatment can make the mouth sensitive and easily infected, doctors often advise patients to see a dentist so that their mouths are as healthy as possible.
Loss of appetite can be a problem for patients during their treatment for cancer. Patients who eat well may be better able to withstand the side effects of their treatment, so good nutrition is important. Eating well means getting enough calories to prevent weight loss and having enough protein to regain strength and rebuild normal tissues. Many patients find that eating several small meals and snacks during the day works better than trying to have three large meals.
The side effects that patients have during cancer treatment vary for each person. They may even be different from one treatment to the next. Attempts are made to plan treatment to keep problems to a minimum. Fortunately, most side effects are temporary. Doctors, nurses, and dietitians can explain the side effects of cancer treatment and can suggest ways to deal with them.
Researchers are concerned about the possibility of long-term effects in young people who are treated with chemotherapy and radiation therapy. These depend on the location of the tumor and the way it is treated. Some types of chemotherapy can affect a patient's fertility. When this side effect is permanent, it is not possible for the person to have children. This can be true for both men and women. Radiation therapy can increase the possibility that a second tumor will later develop in the area that was treated. The doctor can tell patients and their families more about these possible effects.
What happens after treatment for bone cancer?
Regular follow-up is very important after treatment for bone cancer. The doctor will want to continue to check the patient closely for several years. This is important to be sure that cancer has not come back or to find and treat it promptly if it does. Checkups may include a physical exam, x-rays, scans, blood tests, and other laboratory tests.
Cancer treatment can cause side effects many years later. For this reason, patients should continue to have check-ups and should report any problem as soon as it appears.
Patients who have had part or all of a limb removed will need physical therapy. Physical therapists and doctors who specialize in rehabilitation help patients learn to do their regular activities in new ways. Physical therapists also help patients learn to use their prostheses.
The diagnosis of cancer can change the lives of patients and the people close to them. These changes can be difficult to handle. It is natural for patients and their families and friends to have many different and sometimes confusing emotions.
At times, patients and their loved ones may feel frightened, angry, or depressed. These are normal reactions when people face a serious health problem. Patients, including children and teenagers, usually are better able to cope with their emotions if they can talk openly about their illness and their feelings with family members and friends. Sharing feelings with others can help everyone feel more at ease, opening the way for others to show their concern and offer their support.
Concern about what the future holds, as well as worries about tests, treatments, hospital stays, and medical bills, are common. Talking with doctors, nurses, or other members of the health care team may help calm fears and ease confusion. Patients can take an active part in decisions about their medical care by asking questions about bone cancer and their treatment choices. Patients, family, or friends often find it helpful to write down questions to ask the doctor as they think of them. Taking notes during visits to the doctor can help them remember what was said. Patients should ask the doctor to explain anything that is not clear. Patients and families have many important questions, and the doctor is the best person to answer them.
Sometimes, patients use statistics to try to figure out their chance of being cured. It is important to remember, however, that statistics are averages. They are based on the experience of large numbers of people, and no two cancer patients are alike. Only the doctor who takes care of a patient knows enough about his or her case to discuss the chance of recovery (prognosis). Doctors often talk about "surviving" bone cancer, or they may use the term "remission" rather than "cure." Even though many bone cancer patients recover completely, doctors use these terms because the disease can recur.
People who have had bone cancer may worry that removal of a limb or other surgery will affect not only how they look but how other people feel about them. Parents may worry about whether their children will be able to take part in normal school and social activities. Adults who have had extensive surgery can be concerned about working, taking part in social activities, and caring for their families.
The doctor can give advice about treatment, working, going to school, or other activities. Patients may also want to discuss concerns about the future, family relationships, and finances. If it is hard to talk with the doctor about feelings or other personal matters, it may be helpful to speak with a nurse, social worker, counselor, or a member of the clergy.
A physical or vocational therapist can help patients get used to new ways of doing things. This is especially important for those who have lost all or part of a limb and are learning to use a prosthesis. Therapists also understand and can help patients deal with the feelings that come with these changes.
Learning to live with the changes that are brought about by bone cancer is easier for patients and those who care about them when they have helpful information and support services. Many patients feel that it helps to talk with others who are facing problems like theirs. They can meet other cancer patients through self-help and support groups. Some hospitals have special support groups for youngsters with cancer and their families. Often, a social worker at the hospital or clinic can suggest local and national groups that will help with rehabilitation, emotional support, financial aid, transportation, or home care.
The American Cancer Society (ACS), for example, is a nonprofit organization that has many services for patients and their families. Local ACS offices are listed in the telephone book.
Information about other programs and services is available through the Cancer Information Service. The toll-free number is 1-800-4-CANCER.
What does the future hold for patients with bone cancer?
At this time, little is know about the causes of bone cancer. Doctors can seldom explain why one person gets this rare type of cancer and another doesn't. We do know, however, that bone cancer is not contagious; no one can "catch" cancer from another person.
Scientists at hospitals and medical centers all across the country are studying bone cancer. They are trying to learn more about what causes this disease and how to prevent it. They are also looking for better ways to diagnose and treat it.
The National Cancer Institute (NCI) is supporting many studies of new treatments for bone cancer. When laboratory research shows that a new treatment method has promise, it is used to treat cancer patients in clinical trials. These trials are designed to answer scientific questions and to find out whether a new treatment is safe and effective. Patients who take part in clinical trials make an important contribution to medical science and may have the first chance to benefit from improved treatment methods. Researchers are exploring new drugs and drug combinations and new ways of giving radiation therapy and chemotherapy. They are also looking for ways to use surgery more effectively in combination with other forms of treatment.
One way to learn about clinical trials is through PDQ, a computerized resource of cancer treatment information. Developed by NCI, PDQ contains an up-to-date list of trials all over the country. The Cancer Information Service, at 1-800-4-CANCER, can provide PDQ information to doctors, patients, and the public.
What resources are available to patients with cancers of the bone?
Information about cancer is available from many sources, including the ones listed below. You may wish to check for additional information at your local library or bookstore and from support groups in your community.
Cancer Information Service(CIS)
1-800-4-CANCER
The Cancer Information Service, a program of the National Cancer Institute, is a nationwide telephone service for cancer patients, their families and friends, the public, and health care professionals. The staff can answer questions in English and Spanish and can send booklets about cancer. They also know about local resources and services. One toll-free number, 1-800-4- CANCER (1-800-422-6237), connects callers all over the country with the office that serves their area.
American Cancer Society(ACS)
1599 Clifton Road, N.E.
Atlanta, GA 30329
1-800-ACS-2345
The American Cancer Society is a voluntary organization with a national office (at the above address) and local units all over the country. It supports research, conducts educational programs, provides free booklets, and offers many services to patients and their families. To obtain booklets or to learn about services and activities in local areas, call the Society's toll-free number, 1-800-ACS-2345 (1-800-227-2345), or the number listed under "American Cancer Society" in the white pages of the telephone book.
Candlelighters Childhood Cancer Foundation (CCCF)
7910 Woodmont Avenue, Suite 460
Bethesda, MD 20814
1-800-366-CCCF
Candlelighters is a national organization of parents whose children have or have had cancer. It operates a patient information service and publishes newsletters for parents and young people. Local chapters sponsor family support groups. - Cancers that begin in bone are rare.
- It is not unusual for cancers to spread to bone from other parts of the body. This is not called bone cancer, but is named for the organ or tissue in which the cancer begins.
- Pain is the most frequent symptom of cancer of the bone.
- Diagnosis of cancer of the bone is supported by findings of the medical history and examination, blood and x-ray tests and confirmed with a biopsy.
- Treatment of cancer of the bone depends on the type, location, size, and extent of the tumor as well as the age and health of the patient.
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