Bone cancer

Bone cancer can begin in any bone in the body, but it most commonly affects the pelvis or the long bones in the arms and legs. Bone cancer is rare, making up less than 1 percent of all cancers. In fact, noncancerous bone tumors are much more common than cancerous ones.

The term "bone cancer" doesn't include cancers that begin elsewhere in the body and spread (metastasize) to the bone. Instead, those cancers are named for where they began, such as breast cancer that has metastasized to the bone.

Some types of bone cancer occur primarily in children, while others affect mostly adults. Surgical removal is the most common treatment, but chemotherapy and radiation therapy also may be utilized. The decision to use surgery, chemotherapy or radiation therapy is based on the type of bone cancer being treated.

Symptoms

Signs and symptoms of bone cancer include:

• Bone pain
• Swelling and tenderness near the affected area
• Weakened bone, leading to fracture
• Fatigue
• Unintended weight loss

When to see a doctor

Make an appointment with your doctor if you or your child develops bone pain that:

• Comes and goes
• Becomes worse at night
• Isn't helped by over-the-counter pain relievers

Causes

The cause of most bone cancers is unknown. A small number of bone cancers have been linked to hereditary factors, while others are related to previous radiation exposure.

Types of bone cancer

Bone cancers are broken down into separate types based on the type of cell where the cancer began. The most common types of bone cancer include:

• Osteosarcoma. Osteosarcoma is the most common form of bone cancer. In this tumor, the cancerous cells produce bone. This variety of bone cancer occurs most often in children and young adults, in the bones of the leg or arm. In rare circumstances, osteosarcomas can arise outside of bones (extraskeletal osteosarcomas).
• Chondrosarcoma. Chondrosarcoma is the second most common form of bone cancer. In this tumor, the cancerous cells produce cartilage. Chondrosarcoma usually occurs in the pelvis, legs or arms in middle-aged and older adults.
• Ewing sarcoma. Ewing sarcoma tumors most commonly arise in the pelvis, legs or arms of children and young adults.

Risk factors

It's not clear what causes bone cancer, but doctors have found certain factors are associated with an increased risk, including:

• Inherited genetic syndromes. Certain rare genetic syndromes passed through families increase the risk of bone cancer, including Li-Fraumeni syndrome and hereditary retinoblastoma.
• Paget's disease of bone. Most commonly occurring in older adults, Paget's disease of bone can increase the risk of bone cancer developing later.
• Radiation therapy for cancer. Exposure to large doses of radiation, such as those given during radiation therapy for cancer, increases the risk of bone cancer in the future.

Diagnosis

Imaging tests can help determine the location and size of bone tumors, and whether the tumors have spread to other parts of the body. The types of imaging tests recommended depend on your individual signs and symptoms. Tests may include:

• Bone scan
• Computerized tomography (CT)
• Magnetic resonance imaging (MRI)
• Positron emission tomography (PET)
• X-ray

Needle or surgical biopsies

Your doctor may recommend a procedure to remove a sample of tissue (biopsy) from the tumor for laboratory testing. Testing can tell your doctor whether the tissue is cancerous and, if so, what type of cancer you have. It can also reveal whether the tumor cells are growing quickly or slowly.

Types of biopsy procedures used to diagnose bone cancer include:

• Inserting a needle through your skin and into a tumor. During a needle biopsy, your doctor inserts a thin needle through your skin and guides it into the tumor. Your doctor uses the needle to remove small pieces of tissue from the tumor.
• Surgery to remove a tissue sample for testing. During a surgical biopsy, your doctor makes an incision through your skin and removes either the entire tumor or a portion of it.

Determining the type of biopsy you need and the particulars of how it should be performed requires careful planning by your medical team. Doctors need to perform the biopsy in a way that won't interfere with future surgery to remove bone cancer. For this reason, ask your doctor for a referral to a team of doctors with extensive experience in treating bone tumors before your biopsy.

Stages of bone cancer

If your doctor confirms a diagnosis of bone cancer, he or she tries to determine the extent (stage) of the cancer because that will guide your treatment options. Factors to be considered include:

• The size of the tumor
• How fast the cancer is growing
• The number of bones affected, such as adjacent vertebrae in the spine
• Whether the cancer has spread to other parts of the body

The stages of bone cancer are indicated by Roman numerals, ranging from 0 to IV. The lowest stages indicate that the tumor is smaller and less aggressive. By stage IV, the cancer has spread to other parts of the body.

Treatment

The treatment options for your bone cancer are based on the type of cancer you have, the stage of the cancer, your overall health and your preferences. Different bone cancers respond to different treatments, and your doctors can help guide you in what is best for your cancer. For example, some bone cancers are treated with just surgery; some with surgery and chemotherapy; and some with surgery, chemotherapy and radiation therapy.

Surgery

The goal of surgery is to remove the entire cancerous tumor. In most cases, this involves special techniques to remove the tumor in one single piece, along with a small portion of healthy tissue that surrounds it. The surgeon replaces the lost bone with some bone from another area of your body, with material from a bone bank or with a replacement made of metal and hard plastic.

Bone cancers that are very large or located in a complicated point on the bone may require surgery to remove all or part of a limb (amputation). As other treatments have been developed, amputation is becoming less common. If amputation is needed, you'll likely be fitted with an artificial limb and go through training to learn to do everyday tasks using your new limb.

Chemotherapy

Chemotherapy uses strong anti-cancer drugs, usually delivered through a vein (intravenously), to kill cancer cells. However, this type of treatment works better for some forms of bone cancer than for others. For example, chemotherapy is generally not very effective for chondrosarcoma, but it's an important part of treatment for osteosarcoma and Ewing sarcoma.

Radiation therapy

Radiation therapy uses high-powered beams of energy, such as X-rays, to kill cancer cells. During radiation therapy, you lie on a table while a special machine moves around you and aims the energy beams at precise points on your body.

Radiation therapy is often used before an operation because it can shrink the tumor and make it easier to remove. This, in turn, can help reduce the likelihood that amputation will be necessary.

Radiation therapy may also be used in people with bone cancer that can't be removed with surgery. After surgery, radiation therapy may be used to kill any cancer cells that may be left behind. For people with advanced bone cancer, radiation therapy may help control signs and symptoms, such as pain.

Coping and support

A cancer diagnosis can be overwhelming. With time you'll find ways to cope with the distress and uncertainty of cancer. Until then, you may find it helps to:

• Learn enough about bone cancer to make decisions about your care. Ask your doctor about your bone cancer, including your treatment options and, if you like, your prognosis. As you learn more about bone cancer, you may become more confident in making treatment decisions.
• Keep friends and family close. Keeping your close relationships strong will help you deal with your bone cancer. Friends and family can provide the practical support you'll need, such as helping take care of your house if you're in the hospital. And they can serve as emotional support when you feel overwhelmed by cancer.
• Find someone to talk with. Find a good listener who is willing to listen to you talk about your hopes and fears. This may be a friend or family member. The concern and understanding of a counselor, medical social worker, clergy member or cancer support group also may be helpful. Ask your doctor about support groups in your area. Or check your phone book, library or a cancer organization, such as the National Cancer Institute or the American Cancer Society.

Preparing for an appointment

If you have any signs and symptoms that worry you, start by making an appointment with your family doctor. If your doctor suspects you may have bone cancer, you may be referred to a specialist. Bone cancer is often treated by a team of specialists that may include:

• Orthopedic surgeons who specialize in operating on cancers that affect the bones (orthopedic oncologists)
• Doctors who specialize in treating cancer with chemotherapy or other systemic medications (oncologists)
• Doctors who use radiation to treat cancer (radiation oncologists)
• Doctors who analyze tissue to diagnose the specific type of cancer (pathologists)
• Rehabilitation specialists who can help you recover after surgery

How to prepare

Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well-prepared. Try to:

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medications, vitamins or supplements that you're taking.
• Consider taking a family member or friend along. Sometimes it can be difficult to remember all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Bring your previous scans or X-rays (both the images and the reports) and any other medical records important to this situation to the appointment.

Questions to ask

Preparing a list of questions for your doctor can help you make the most of your time together. List your questions from most important to least important in case time runs out. For bone cancer, some basic questions to ask your doctor include:

• What type of bone cancer do I have?
• What is the stage of my bone cancer?
• What is the grade of my bone cancer?
• Will I need any additional tests?
• What are the treatment options for my bone cancer?
• What are the chances that treatment will cure my bone cancer?
• What are the side effects and risks of each treatment option?
• Will treatment make it impossible for me to have children?
• I have other health conditions. How will cancer treatments affect my other conditions?
• Is there one treatment that you think is best for me?
• What would you recommend to a friend or family member in my situation?
• Should I see a specialist? What will that cost, and will my insurance cover it?
• If I would like a second opinion, can you recommend a specialist?
• Are there any brochures or other printed material that I can take with me? What websites do you recommend?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may allow more time to cover other points you want to address. Your doctor may ask:

• When did you first begin experiencing symptoms?
• Have your symptoms been continuous or occasional?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?

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