10 Jul Bone Cancer
Dr. Navneet Sharda provides this information as an educational source. It is not intended as a substitute for a consultation with a qualified healthcare provider.
Bone cancer, also known as primary bone cancer, is a form of cancer that develops in hard bone tissues and sometimes in the cartilage tissues of the bone. Primary bone cancer is rare, and differs from cancers that develop in: 1). other organs of the body and spread to the bones when metastasis (spreads), or 2). bone marrow cells (such as leukemia, multiple myeloma, and lymphoma).
The human body consists 206 bones. All the bones together with their cartilage and ligaments form a supporting framework for the body. Each mature bone contains:
A). Three layers of tissue:
Compact tissue (called periosteum) – The outer, hard part of the bones formed from a fibrous tissue called matrix that deposits calcium salts.
Cancellous tissue – The inner, spongy tissue that contains the bone marrow.
Subchondral tissue – The smooth bone tissue on the joints. and B). Two types of cells:
Osteoblast – The cells that form the bone tissue.
Osteoclast – The cells that dissolve the bone tissue. The bone marrow, A-2, contains a mixture of fat cells, blood-forming cells (that produce red and white blood cells, and blood platelets), plasma cells, fibroblasts, and reticuloendothelial cells.
The cartilage is a softer bone-like tissue (a mixture of fibrous matrix tissue and gel-like substances) that covers the subchondral tissue, A-3, of each bone. The cartilage works as a cushion for the movement of the joints.
Bone Cancer Symptoms
Bone cancer symptoms vary depending on the tumor’s size and location. The most common symptom is bone pain caused by the tumor’s size either because it grows progressively, or because it causes the bone to break.
Other signs and symptoms of bone cancers are:
Fatigue and fever
Bone lumps and masses,
Bone Cancer Types
There are eight types of bone cancer.
1 Osteosarcoma or Osteogenic Sarcoma is the most common type of primary bone cancer and develops at the end of the bone (more often in the knee, upper arm and upper leg bones) where new bone tissue forms. Osteosarcoma is a cancer of the bone itself, and is more common in children and young adults (with ages between 10 and 25-30) and in males.
2 Chondrosarcoma is the second most common type of primary bone cancer and develops in the cartilage tissue. This type of cancer is common in adults over 50 and develops in the cartilage tissue from the pelvis, upper leg, and shoulder bone.
3 Ewing’s Sarcoma is a type of primary bone cancer that develops in the immature nerve tissue from the middle part of the bones. Usually, it affects the bones from the pelvic area, upper leg, ribs and arms. It is more common in children and young adults.
4 Malignant fibrous histiocytoma is a rare type of cancer that develops in bones. Usually, it occurs in soft tissues like ligaments, tendons, or muscles. This cancer is common in middle age adults and old people, and usually, develops in the leg and arm bones. Malignant fibrous histiocytoma is a progressive form of cancer that often spread to lungs and lymph nodes.
5 Fibrosarcomas is another rare type of bone cancer that usually develops in the soft tissues. It is common in middle-aged adults and older people, and primarily affects the leg, arm and jaw bones.
6 Giant cell tumors is another type of primary bone cancer that displays benign and malignant tumors. This type of cancer often develops as benign tumors in leg and arm bones. It is more common in young and middle-age adults. Less than 10 percent of the giant cell tumors are malignant. Malignant tumors undergo a progressive evolution and can spread to other organs. When surgically removed, the tumors reoccur and become more likely to spread to other areas of the body.
7 Adamantinomas is a type of primary bone cancer that develops in the shin bone.
8 Chordoma is a type of primary bone cancer that develops in the skull and/or spine bones, and is more common in adults over 30 and in males. It can reoccur when it is not completely eliminated through treatment.
Medical Tests & Diagnosis
Anamnesis (detailed medical review of past health state):One of the first steps in establishing a cancer diagnosis is a detailed and complex medical review of a patient’s past health problems and general health state, family medical history, symptoms, and bone cancer risk factors.
Laboratory Tests There are four laboratory tests used to diagnose bone cancer:
1) Alkaline phosphatase test: Alkaline phosphatase is an enzyme that can be measured in blood tests. Normally, this enzyme is present in high levels when bone-forming cells are very active (usually in young children when their bones grow or when a broken bone mends).
2) PTH test: PTH (parathormone) is a protein hormone produced by the parathyroid gland. This protein is the most important regulator of body’s calcium and phosphorus. Lower-than-normal levels of parathormone can be an indicator of bone cancer.
3) Serum phosphorus: This is a test that measures the level of phosphorus in the blood. Higher than normal levels of phosphorus can be an indicator of bone cancer.
4) Ionized calcium and serum calcium: These are two blood tests that measure the amount of calcium in the blood.
1. Bone X-Ray: An x-ray test uses high energy electromagnetic radiation to penetrate the body & bones to create their image on a film. Dense tissues or structures appear white, the air black, and other structures in shades of gray.
There are four types of x-rays used to diagnose bone cancer.
- Joints x-ray: This type of x-ray focuses on the knee, hip, shoulder, wrist, ankle, hip, or other joint bones.
- Hands x-ray: This types of x-ray focuses on the bones of the hands
- Extremities x-ray: This type of x-ray focuses on the hands, wrists and feet bones.
- Chest x-ray: This type of x-ray determines if the bone cancer has spread to the lungs.
2. Computed Tomography (CT scan): This test is similar with an x-ray procedure, and creates a detailed cross-sectional image of the body.
3.Magnetic Resonance Imaging (MRI): This test uses radio waves and strong magnets to reveal a complete image of a targeted area of the body.
4. Positron Emission Tomography (PET): This is another test used in diagnosing bone cancer. Positron Emission Tomography uses radioactive glucose to locate cancer.
5. Radionuclide Bone Scan: This type of scan uses a very low radioactive material (diphosphonate) to “see” whether or not the cancer has spread to other bones and the damage suffered by the bone. Diseased bone cells from the entire skeleton absorb this radioactive material and are then detected by the scanning device.
Biopsies A biopsy is a medical procedure that removes a tissue sample for microscopic examination.
There are two types of biopsies used in bone cancer diagnose. These are: needle biopsy and incisional biopsy.
1. Needle biopsy: During this procedure, the doctor makes a small hole in the affected bone and removes a tissue sample from the tumor.
There are two types of needle biopsies:
a)Fine needle aspiration: During this procedure, the tissue sample is removed with a thin needle attached to a syringe.
b)Core needle aspiration: During this procedure, the doctor removes a small cylinder of tissue sample from the tumor with a rotating knife like device.
2. Incisional biopsy: During this procedure, the doctor cuts into the tumor and removes a tissue sample.
Bone cancer treatment depends on the cancer stage and location, tumor size, the patient’s age and general health state, and can include surgery, chemotherapy, or radiotherapy.
Surgery In many cases, surgery is the primary treatment for bone cancer. Surgery is a medical procedure where the tumor and sometimes the surrounding bone tissue and muscles are removed. There are two main surgeries performed in bone cancer patients: Treatment Surgery and Reconstructive Surgery.
1. Within treatment type surgery, there are 4 types of surgeries performed: limb-salvage surgery, amputation, curettage and cryosurgery.
Limb-salvage surgery: This is a complex surgery where the cancer is removed while preserving the bone’s limb, tendons, nerves and blood vessels. The removed bone is replaced with a bone graft or artificial replacement called endoprosthesis (an internal prosthesis from metal or similar materials).
Amputation: This is another types of surgery where the tumor is removed with the bone to stop the cancer from spreading. Usually, amputation is chosen when the tumor has spread to the bone’s nerves and blood vessels, and the limb cannot be saved.
Curettage: This is a medical procedure where the tumor is “scooped out” from the bone without removing the surrounding bone.
Cryosurgery: This is a type of curettage procedure where the tumor is removed without the bone, and the tumor cavity is treated with liquid nitrogen. The liquid nitrogen freezes the tumor cavity which kills the remaining cancerous cells.
2. Reconstructive surgery, which includes rotatinoplasty.
Rotatinoplasty is a reconstructive surgery used when amputation was performed on:
1). The mid-thigh leg bone – the lower leg and foot are rotated and reattached to the thigh bone, and the ankle functions as a knee joint. After the surgery, the patient’s leg is extended with a prosthetic device.
2). The upper arm bone – the lower arm is reattached to the amputated bone, and the patient will have a shorter but functional arms.
3). The lower jaw bone – the entire lower half of the jaw bone is removed and later replaced with a bone from other parts of the body.
Chemotherapy is another bone cancer treatment method. Chemotherapy uses anti-cancer drugs to stop the growth of the cancerous cells by either killing them or halting the dividing process.
Radiation therapy or radiotherapy is another bone cancer treatment, and uses high-energy rays or particles to destroy cancerous cells. There are two types of radiation therapy:
1. External-Beam Radiation Therapy is a common form of treatment used with bone cancer patients. It uses an external device called linear accelerator to generate high-energy rays that focuses on the targeted area. External beam radiation can be administrated before or after surgery.
2. Internal Beam Radiation Therapy or Brachytherapy uses small radioactive pellets (needles, seed, wires or catheters) implanted into the affected area.