Bone Cancer: Information on Causes, Diagnosis & Treatments

Cancer Xray Bone cancer can be a life-threatening condition if the cancerous cells grow uncontrollably and metastasize (spread) to other areas of the body. Even though a bone appears to be a solid structure, it is made up of highly active tissue that is constantly changing and remodeling itself in three different phases including forming new bone tissue (osteoblasts), maintaining bone structure (osteocytes), and bone tissue breakdown (osteoclasts).

Cancerous tissue that originates in the bone is categorized as primary bone cancer that may or may not spread to other areas of the body. Secondary bone cancer refers to cancerous tissue from other organs or areas of the body that metastasize to bone tissue. Typically, most cases involving primary bone cancer affect the long bones of the legs and arms.

Types of Bone Cancer

There are different types of bone cancer that affect individuals. Primary bone cancer involves sarcomas where the tissue of muscle, bone, fat, blood vessels or connective tissue become cancerous. The major primary bone cancer types include:

  • Osteosarcoma – This form of osteogenic sarcoma is the most common type of cancer of the bone that usually begins in the pelvis, legs, or arms. This type of cancer typically affects individuals during their early years (10 to 30 years old). Males tend to be more at risk of developing osteosarcoma compared to females.

  • Chondrosarcoma – This form of bone cancer affects cartilage cells in any area of the body. Typically, individuals 20 years and older are at greater risk of developing the disease compared to younger adolescents and children, and the chances of cancer developing increases later in life.

  • Chordoma Bone Cancer – This type of cancer affects the base of the skull and spinal cord bones. Men are particularly at risk for developing Chordoma, as are adults over the age of 30. Because this form of bone cancer grows slowly, there is usually a significantly low risk of the cancerous tissue metastasizing to distant sites. However, recurrence rates are high when the surgeon did not completely remove the tumor during the procedure. Metastasized Chordoma usually spreads to the lymph nodes, liver, and/or lungs.

  • Ewing’s Tumor – Ewing’s sarcoma (tumor) cancer typically begins in the bones. However, there is the possibility that it can affect the muscles and tissues first. Teenagers and young children are most susceptible to developing Ewing’s sarcoma. The disease is rare in individuals who are 30 years or older.

  • Malignant Fibrous Histiocytoma and Fibrosarcoma – These forms of bone cancer typically affect soft-tissue surrounding bones including the muscle, fat, ligaments, or tendons. Older adults tend to be at the greatest risk of developing the disease, especially in the jaw, legs, or arms.

  • Giant Cell Tumor of Bone – Malignant forms of this type of cancer are far less common than the others and usually affects the leg or arm bones of both middle-aged adults and young adults. This slow-growing disease rarely metastasizes to distant areas of the body but can recur if the surgeon fails to remove all of it during the procedure.

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Who Gets Bone Cancer?

Typically, cancerous bone tissue is not the result of inheriting a defective gene from an ancestor. However, individuals with a history of parents and grandparents who suffered from Li-Fraumeni syndrome are at risk of developing deadly osteosarcoma.

Children, adolescents, and young adults are more susceptible to developing some bone cancers including osteosarcoma, Ewing’s sarcoma, and giant cell tumor of bone. Older adults have the greatest risk of developing some forms of bone cancer including Chondrosarcoma, Chordoma, and Fibrosarcoma.

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Bone Cancer Symptoms

Patients of all ages should make an appointment with her physician at the first sign or indicator of bone cancer. The most common symptoms associated with the development of bone cancer involve:

  • Bone pain at the affected site

  • Broken bones

  • Tenderness or swelling at the affected site

  • Unintended weight loss

  • Fatigue

  • Tingling sensation in the legs, feet, arms, or hands

  • Overall weakness

These common symptoms can often mimic other conditions including the signs of arthritis or an injury site. Swelling occurring at the affected site might not display itself until some time after the condition has progressed.

Bone Cancer Risk Factors

Even though scientists have yet to make a correlation between risk factors and the development of bone cancer in many cases, there are specific factors related to the increased potential risk of developing the disease. This includes:

  • Inherited Genetic Syndrome – A history of rare genetic syndromes handed down from one generation to the other can increase the potential risk of developing bone cancer including hereditary retinoblastoma and Li-Fraumeni syndrome.

  • Cancer Treatment Radiation Therapy – Patients exposed to high doses of radiation can develop an increased potential risk of developing bone cancer. This includes individuals undergoing radiation therapy to treat this form or other types of cancer.

  • Paget’s Disease of Bone – Older men and women are more likely to develop Paget’s disease compared to younger patients. The disease causes an abnormal disruption of the process when old bone tissue is transformed into newly developed bone tissue.

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Diagnosing Bone Cancer

Because many of the signs and symptoms of bone cancer mimic other types of diseases, the doctor will usually need to perform a comprehensive battery of tests to accurately diagnose the condition. This includes a physical examination, a discussion about symptoms, and results of blood tests and imaging tests. Usually, before confirmation is made in diagnosing bone cancer, the doctor will perform tests that include:

  • Laboratory blood tests

  • Imaging including x-rays, CT (computed tomography) scans, MRI (magnetic resonance imaging) and PAT (positron emission tomography) scans

  • Biopsies were a small portion of tissue is removed for examination that is typically performed under a microscope

  • Radionuclide Bone Scans can help reveal if the cancer has metastasized other bones or areas of the body. This involves injecting the patient with radioactive technetium diphosphate material to reveal “hot spots” that display as dense blackened or gray areas

While there are effective tests that can detect numerous forms of cancer in its early stages, no such early detection test is available for bone cancer.

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Bone Cancer Treatments

Doctors have numerous options for treating bone cancer including using radiation and surgical procedures. Some noncancerous bone tumors do not require any treatment and will simply disappear in time. Recommended treatments include:

  • Medical Procedures including radiation therapy where high-energy x-rays destroy abnormal cells

  • Tissue Scraping where the surgeon scoops or scrapes the tissue away using a curette surgical instrument

  • Surgery Procedures that include:
    • Bone Grafting where new bone is placed around fractures to assist in the healing process

    • Wide Local Excision where the surgeon excises (removes) a small portion of the precancerous or cancerous tissue

    • Arthrodesis where the surgeon fuses bones to form a joint

    • Limb Sparing Surgical Resection where the surgeon removes the diseased area while preserving the affected limb

    • Prescription drugs including Zometa and Reclast are used in the treatment of high blood calcium levels and bone damage caused by multiple myeloma, Paget’s disease, and metastasizing cancers from other areas of the body that attack the bone

These types of procedures are typically performed by oncologists, radiation oncologists, orthopedic surgeons, and primary care providers.

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Sources:

https://my.clevelandclinic.org/health/articles/osteosarcoma

https://www.fda.gov/downloads/Drugs/DrugSafety/UCM433356.pdf

http://www.mayoclinic.org/diseases-conditions/bone-cancer/diagnosis-treatment/treatment/txc-20126509

https://www.cancer.gov/about-cancer/treatment/drugs/bone

http://www.mayoclinic.org/diseases-conditions/bone-cancer/home/ovc-20126418

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