Bone Cancer symptomes risks tests treatment sign and types

What is bone cancer? What is metastatic bone cancer?

Bone cancer is a malignant tumor that arises from the cells that make up the bones of the body. This is also known as primary bone cancer. When cancer is detected in bones, it either originated in the bones (as in primary bone cancer) or has spread to the bone after originating elsewhere (cancer that has metastasized to bone). In fact, when cancer is detected in bone, it most often has started in another organ or somewhere else and then spread to the bones. This cancer that has metastasized to the bone is named for the site where the original cancer began (for example, metastatic prostate cancer that has spread to the bone). Breast, prostate, and lung cancers are among the types of cancers that commonly spread to the bone in their advanced stages. Less commonly, cancer can begin within the bone as primary bone cancer, and this is true bone cancer. Primary and metastatic bone cancers are often treated differently and have a different prognosis. It is also important to note that benign (non-cancerous) tumors can also arise in the bones, and these benign tumors are more common than bone cancers.

There are other cancers that may begin in the bone even though they are not considered to be true bone cancers. Lymphoma is a cancer of the cells that are responsible for the immune response of the body. Lymphoma usually begins in the lymph nodes, but it sometimes begins in the bone marrow. Multiple myeloma is another cancer of the immune cells that typically begins in the bone marrow. These tumors are not considered primary bone cancers because they do not arise from the actual bone cells.

This article focuses on primary bone cancer, which is cancer of the bone cells themselves.

What are risk factors for bone cancer?

About 2,300 cases of bone cancer are diagnosed in the U.S. each year. Primary bone cancers are not common and account for far less than 1% of all cancers. Bone cancers are more common in children and younger adults than in older people. Cancer found in the bones of an older adult usually has spread to the bone after originating from another location in the body.

Risk factors for bone cancers include the following:

  • Previous treatment with radiation therapy
  • Previous chemotherapy with drugs known as alkylating agents
  • Mutation in a gene known as the retinoblastoma (Rb) gene or other genes
  • Associated conditions, such as hereditary retinoblastoma, Paget’s disease of bone, Li-Fraumeni syndrome, Rothmund-Thomson syndrome, tuberous sclerosis, and Diamond-Blackfan anemia
  • Implantation of metal to repair previous fractures
Understanding Cancer: Metastasis, Stages of Cancer, and More

Early Bone Cancer Symptoms

Whether the cancer in bone is primary or metastatic, the early symptoms vary from no symptoms at all to severe bone pain. It is very common for cancer in bone to not cause any symptoms. This form of cancer can only be detected using imaging tests, such as X-ray tests, computerized tomography (CT scan), or magnetic resonance imaging (MRI).

What causes bone cancer?

As with other cancers, there is no one cause of bone cancer. In general, cancers arise when normal cell growth and proliferation is disrupted, allowing abnormal cells to divide and grow uncontrollably. A number of hereditary and environmental factors are likely involved in the development of bone cancers.

What are bone cancer symptoms and signs?

Pain is the most common symptom of bone cancer. The pain may initially develop at certain times of the day, often at night, or with physical activity. The pain tends to progress and worsen over time. Sometimes, the pain may be present for years before the affected person seeks treatment. Sometimes bone cancer is detected incidentally when X-rays or imaging studies are performed for another reason. Occasionally, a mass, swelling, or lump is felt around the area of a bone cancer. Bone fractures can also occur at the site of bone cancer because the underlying bone structure has weakened. Less commonly symptoms are caused by compression or disruption of nerves and blood vessels in the affected area. These symptoms can include numbness, tingling, tenderness, or a decrease in blood flow beyond the site of the tumor, causing a cold hand or foot with weak or absent pulses.

What are the different types of bone cancer?

There are several different types of bone cancer, and they are often treated differently. Knowing the precise type of bone cancer is essential for developing an optimal treatment plan. Some of the most common types of bone cancer are as follows.

Osteosarcoma

Osteosarcoma is the most common type of bone cancer. Osteosarcoma occurs most commonly in older children, teenagers, and young adults (10-19 years of age), and it is more common in males. Osteosarcoma in young people tends to develop at the ends of long bones in areas of active bone growth, often around the knee, either at the end of the thighbone (femur) or the shinbone (tibia) near the knee. The next most common location for bone cancer is in the bone of the arm (humerus). Nevertheless, it is possible for an osteosarcoma to develop in any bone. Depending on the appearance of the tumor cells under the microscope, there are also several different subtypes of osteosarcoma.

Chondrosarcoma

Chondrosarcoma is the second most common bone cancer. It arises from cartilage cells that are attached to or cover bone. It is more common in people older than 40 years of age, and less than 5% of these cancers occur in people under 20 years of age. It may either grow rapidly and aggressively or grow slowly. Chondrosarcoma is most commonly found in the bones of the hips and pelvis.

Ewing sarcoma

Ewing sarcoma, sometimes referred to as the Ewing sarcoma family of tumors (ESFTs), is an aggressive form of bone cancer that is most common in children 4-15 years of age. It can occur either in the bones or in the soft tissues and is believed to arise from primitive nerve tissue. ESFTs are more common in males than in females. The most common location for Ewing sarcoma is the middle portion of the long bones of the arms and legs.

Pleomorphic sarcoma (malignant fibrous histiocytoma) of bone

Pleomorphic sarcoma is a cancer formerly referred to as malignant fibrous histiocytoma or MFH. This term is still used frequently. Pleomorphic sarcomas are typically not cancers of bone but of soft tissues. However, they may arise in the bone in up to 5% of cases. Pleomorphic sarcomas typically occur in adults and can be found anywhere in the body.

Fibrosarcoma

Fibrosarcoma is an uncommon type of bone cancer. It is most commonly arises behind the knee in adults.

Chordoma

Chordoma is a very rare cancer usually seen in people over 30 years of age. It is most commonly located in either the lower or upper ends of the spinal column.

What kinds of bone cancer occur in children?

Osteosarcoma, the most common type of bone cancer, is most common in older children, teenagers, and young adults. Ewing sarcoma and ESFT are bone cancers that typically affects children.

What tests are used to diagnose bone cancer?

A variety of imaging tests may be used to detect bone tumors, including bone cancers. Very early bone cancers may or may not be apparent on plain X-rays. CT scans and MRI scans are more precise in defining the location of bone cancers.

A bone scan is a test that uses radioactive material to produce images of the entire skeleton. This may allow the localization of bone cancer anywhere in the body. This test is not specific for bone cancers and can also reveal areas of inflammation as found with arthritis, fractures, and infections.

While many bone cancers have a characteristic appearance on imaging studies, a biopsy (tissue sample) must be taken in order to precisely determine what kind of cancer is present and confirm the diagnosis. The biopsy is a procedure to acquire a sample of a piece of the tumor that is examined under a microscope. The tissue sample may be obtained with a needle inserted through the skin into the tumor or with a surgical operation.

At present, there are no screening tests available to detect early bone cancers.

What is the treatment for bone cancer?

An operation to remove the cancer is the mainstay of treatment for bone cancers. Surgical techniques can remove most bone cancers without requiring amputation of the affected limb. Sometimes, muscles and other tissues that surround the cancer also have to be removed. Reconstructive surgery may be needed, in addition to cancer resection, to help maximize function of the limb.

Ewing sarcoma, osteosarcoma, and other bone cancers may require chemotherapy in addition to surgery.

Radiation therapy is the typical treatment for chondrosarcoma.

Ewing sarcomas that do not respond well to high-dose chemotherapy may require radiation therapy and even a stem-cell transplant. In this procedure, the patient’s stem cells (blood cells that have the potential to develop into all the different kinds of blood cells) are harvested from the bloodstream. After high doses of chemotherapy medications to destroy the bone marrow, the harvested stem cells are next returned to the body, as with a blood transfusion. Over the next three to four weeks, the stem cells produce new blood cells from the bone marrow.

Targeted therapies are specially designed treatments that aim treatment specifically at the cancer cells. For example, denosumab (Xgeva) is a monoclonal antibody that acts to block the activity of specialized bone cells called osteoclasts. This medication has been used in the treatment of giant cell tumors of bone that have recurred after surgery or cannot be removed by surgery. Imatinib (Gleevec) is a targeted therapy drug that can block the signals from certain mutated genes that cause tumor cells to grow. Imatinib has been used to treat some chordomas that have spread or recurred after treatment

What specialists treat bone cancer?

Bone cancer is typically managed by surgical oncologists or orthopedic oncologists (for surgical removal of the tumor) and medical oncologists (for administration or chemotherapy). Radiation oncologists are involved in the treatment team if radiation therapy is planned. Palliative care physicians may be involved to manage pain and symptoms.

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