Bone cancer

What is bone cancer?

In adults, bone cancer is very rare. In the cells that make up the bone, it begins. Cancer begins when cells start developing out of control. Cells can become cancer in virtually every part of the body, and can spread to other areas of the body.

Types of bone tumor

Bone tumors that are not cancer

Many tumors that begin in the bone are benign (not cancer). Benign tumors are not normally life-threatening and do not spread to other tissues and organs. Sometimes with treatment, they may be healed. Benign bone tumors include forms of:

• Osteoid osteoma
• Osteoblastoma
• Osteochondroma
• Enchondroma
• Chondromyxoid fibroma.

Bone metastases

When someone with cancer is told most of the time that they have cancer in their bones, the doctor is concerned about a cancer that has spread from somewhere else to their bones. Metastatic cancer is called such. Many different forms of advanced cancer, such as breast cancer, prostate cancer, and lung cancer, can cause it. When viewed under a microscope, the cancer cells in the bone appear much like the tissue they come from.

So the cancer cells in the bone look and behave like lung cancer cells if someone has lung cancer that has spread to the bone. And if they’re in the bones, they do not look or behave like bone cancer cells. They need to be treated with medications that are used for lung cancer because these cancer cells also behave like lung cancer cells.

Blood cancers

In the blood-forming cells of the bone marrow, other kinds of cancers that are often called “bone cancers” start, not in the bone itself.

The most common cancer that begins and induces bone tumors in the bone marrow is called multiple myeloma. Leukemia is another cancer which starts in the bone marrow. Lymphomas, which start more frequently in the lymph nodes, can start in the bone marrow sometimes. They do not mention these blood cancers here.

Bone cancers

In the bone itself, true (or primary) bone tumors start and are called sarcomas. There are tumors that are malignant, indicating they’re cancer.

In bone, muscle, fibrous tissue, blood vessels, fat tissue, as well as some other tissues, sarcomas start. Anywhere in the body, they can grow. Below, they’re sealed.

Malignant bone tumors

Primary bone cancer is present in several different forms. They are named on the basis of the infected section of the bone or surrounding tissue and the type of cells that shape the tumor. Some are very unusual.

Osteosarcoma

The most common primary bone cancer is osteosarcoma (also known as osteogenic sarcoma). In the bone cells, it begins. It more commonly occurs in young people between the ages of 10 and 30, but in people in their 60s and 70s, about 10 percent of osteosarcoma cases develop. In middle-aged adults, it is rare, and is more common in males than in females. Most commonly, these tumors arise in the bones of the arms, legs, or pelvis. Osteosarcoma refers to this form of bone cancer.

Chondrosarcoma

In cartilage cells, chondrosarcoma begins. It’s the second most prevalent primary cancer of the bone. It is rare for people younger than twenty. The risk of chondrosarcoma rises after the age of 20 until around the age of 75. Women, as much as men, get this cancer.

Chondrosarcomas can start anywhere cartilage is present. In bones such as the pelvis, legs, or arms, the majority develop. Chondrosarcoma frequently begins in the trachea, larynx, or wall of the chest. The scapula (shoulder blade), ribs, or skull are other places.

In cartilage, benign tumors (not cancer) are more prevalent than malignant ones. These are referred to as enchondromas. A bony projection capped by cartilage called an osteochondroma, is another type of benign cartilage tumor. These benign tumors seldom develop into cancer. There is a significantly greater risk of developing cancer in people who have several of these tumors, but this is not normal.

Chondrosarcomas are graded according to grade, which measures how rapidly they develop. The pathologist assigns the grade to (a doctor specially trained to examine and diagnose tissue samples with a microscope). The lower the grade, the more slowly the cancer can spread. The risk that it will spread is smaller when a cancer is developing slowly, so the outlook is better. The majority of chondrosarcomas are either low-grade or intermediate-grade grade I) (grade II). Less popular are high-grade grade III) chondrosarcomas, which are the most likely to spread.

There are distinctive characteristics of certain chondrosarcomas which can be seen with a microscope. These chondrosarcoma subtypes also have a distinct prognosis (outlook):

• Differentiated chondrosarcomas begin as normal chondrosarcomas, but then certain parts of the tumor become cells, such as high-grade sarcoma cells (such as high grade forms of malignant fibrous histiocytoma, osteosarcoma, or fibrosarcoma). In older patients, this form of chondrosarcoma tends to develop and will grow faster than normal chondrosarcomas.
•  Clear cells Chondrosarcomas are unusual and develop slowly. Unless they have already returned many times in the original position, they rarely spread to other areas of the body.
• Mesenchymal chondrosarcomas can develop rapidly but are vulnerable to radiation and chemotherapy treatment.

Ewing sarcoma

The third most common primary bone cancer is Ewing sarcoma, and the second most common in adolescents, teenagers and young adults. It’s unusual for people over the age of 30. This cancer is named after Dr. James Ewing, who identified it for the first time in 1921. In bones, most Ewing tumors form, but they may begin in other tissues and organs. The pelvis, the chest wall (such as the ribs or shoulder blades), and the long bones of the legs or arms are the most common places for this disease. In white individuals, Ewing tumors occur most frequently and are very rare among African Americans and Asian Americans.

Malignant fibrous histiocytoma

In soft tissue (connective tissues such as ligaments, tendons, fat and muscle), malignant fibrous histiocytoma (MFH) most frequently starts; it’s rare in bones. This cancer, especially when it begins in soft tissues, is also known as pleomorphic undifferentiated sarcoma. When MFH occurs in the bones, the legs (often around the knees) or arms are typically affected. In elderly and middle-aged adults, this cancer most commonly occurs. In children, it’s fairly rare. MFH appears mainly to expand locally, but like the lungs, it can spread to distant locations.

Fibrosarcoma

This is another form of cancer in soft tissues that occurs more frequently than it does in bones. In elderly and middle-aged adults, fibrosarcoma generally occurs. Most frequently, bones in the legs, arms, and jaw are affected.

Giant cell tumor of bone

It has benign (not cancer) and malignant types of this type of primary bone tumor. The most popular is the benign kind. Typically, giant cell bone tumors affect young and middle-aged adults’ legs (usually near the knees) or arms. They do not always spread to distant places, but they prefer to return to where they started after surgery. (Local recurrence is called this.) This can happen several times. The tumor becomes more likely to spread to other parts of the body with each recurrence. A malignant giant cell bone tumor seldom spreads to other parts of the body without first locally reoccurring.

Chordoma

This primary bone tumor typically occurs at the base of the spine of the skull and bones. In adults older than 30, it occurs more frequently. In males, it’s around twice as common as in females. Chordomas tend to slowly develop and do not spread to other parts of the body sometimes. If they are not removed completely, they often return to the same place. The most common locations for tumor distribution are the lymph nodes, the lungs, and the liver.

Other cancers that develop in bones

Other cancers can be found in the bones, but in the individual bone cells, they do not start. Like primary bone cancer, they are not treated.

Non-Hodgkin lymphomas

Generally, in lymph nodes, non-Hodgkin lymphoma occurs but also begins in the bone. Primary bone non-Hodgkin lymphoma is also a widespread disease since it typically includes multiple bones. The outlook is close to that of the same subtype and stage of other non-Hodgkin lymphomas. Primary bone lymphoma is handled in the same way as lymphomas that begin in the lymph nodes, and is not treated like primary bone sarcoma. See Non-Hodgkin Lymphoma for more information.

Multiple myelomas

Multiple myeloma nearly always occurs in the bones, but since it begins in the plasma cells of the bone marrow, it is not primary bone cancer (the soft inner part of some bones). While it causes bone loss, leukemia is no longer a cancer of the bone. It’s considered a widespread disorder. Myeloma can often be discovered as a single tumor called a plasmacytoma) in a single bone, but it spreads to the marrow of other bones much of the time.

Treating Bone Cancer

Treatment depends on:

• the stage of cancer
• your age
• your overall health
• the size and location of the tumor

Medications

Medications that treat bone cancer include:

• chemotherapy drugs for multiple myeloma
• pain medications to relieve inflammation and discomfort
• bisphosphonates to help prevent bone loss and protect bone structure
• cytotoxic drugs to prohibit or stop the growth of cancerous cells

Radiation Therapy

In order to destroy your cancer cells, your doctor can prescribe radiation therapy.

Surgery

Tumors or affected tissue can be surgically removed by your doctor. Surgery to remove and repair the weakened bone is a choice to avoid rapidly spreading cancers. Amputation may be required for severe bone damage in the arms or legs.

Alternative Therapy

Your doctor can add to your care plan alternative therapies that include herbal treatments. This must however, be done with due thought, as chemotherapy and radiation treatments can interfere with some alternative treatments.

Chemotherapy for bone cancer

The use of medications to cure cancer is chemotherapy (chemo). Chemo is systemic therapy. This ensures the medications go into the bloodstream and spread all over the body to enter and kill cancer cells.

For Ewing sarcoma and osteosarcoma, chemo is also part of the treatment.

For other bone cancers, such as giant cell tumors, chordomas, and chondrosarcomas, it is not commonly used. They’re not very receptive to chemo for these forms, so it doesn’t work well. For a certain form of chondrosarcoma called mesenchymal and high-grade dedifferentiated chordomas, it may be helpful. For certain giant cell tumors, it can be used along with targeted therapy.

Chemo is often used for cancer of the bone that has spread to the lungs and/or other organs through the bloodstream.

Commonly used chemo drugs

The drugs mainly used to treat bone cancer include:

• Doxorubicin (Adriamycin^®)
• Cisplatin
• Etoposide (VP-16)
• Ifosfamide (Ifex^®)
• Cyclophosphamide (Cytoxan^®)
• Methotrexate
• Vincristine (Oncovin^®)

In most cases, several drugs (2 or 3) are given together.

Side effects of chemotherapy

Chemo destroys cancer cells, but certain normal cells are also harmed by it. During recovery, you will be closely watched and your team will seek to avoid or restrict side effects. The side effects of chemo depend on the form of treatment used the doses used and the amount of time taken.

Some common short-term side effects include:

• Nausea and vomiting
• Loss of appetite
• Hair loss
• Mouth sores

In order for them to be treated, it is important to tell the cancer care team about any side effects you have.

The blood-producing cells in the bone marrow may be damaged by chemotherapy, so you could have low blood cell counts. Low counts of blood cells will result in:

• Increased chance of infection (too few white blood cells)
• Easy bleeding or bruising after minor cuts or injuries (too few platelets)
• Fatigue or shortness of breath (too few red blood cells)

Your doctor will order lab tests when you are having chemo to make sure your blood cell counts are at healthy levels.

Certain adverse effects are related to certain medications. For instance:

• Ifosfamide and cyclophosphamide can damage the lining of the bladder and cause bloody urine. This is called hemorrhagic cystitis. It can be prevented by giving a drug called mesna along with the chemo.
• Cisplatin may cause nerve damage (called peripheral neuropathy) leading to problems with numbness, tingling, and even pain in the hands and feet. Kidney damage (called nephropathy) can also occur after treatment with cisplatin. Giving lots of fluid before and after the drug is infused can help prevent this. Cisplatin can sometimes cause problems with hearing (known as ototoxicity). Most often patients with this problem notice they have trouble hearing high-pitched sounds. Your doctor may have you get a hearing test (called an audiogram) before giving cisplatin.
• Over time, doxorubicin can damage the heart. The risk of this goes up as the total amount of the drug given goes up. Before giving doxorubicin, your doctor may test your heart function to make sure that it’s safe to give you this drug.

It is important to remember that many severe side effects are unusual, but they do occur. Speak to your cancer care team so that you know what to expect from the chemo that you receive.

Doctors and nurses will monitor the side effects closely. For most side effects, there are medications, but it is necessary to avoid them. After care is over, most side effects, if not all of them, can go away over time. Do not hesitate to answer any concerns about side effects to your cancer care team.

Surgery for Bone Cancer

Surgery is often the primary treatment for bone cancer. When operating to remove bone tumors, our surgeons remove some of the surrounding bone and muscle to be sure they are eliminating as much cancerous tissue as possible. If the cancer is in an arm or a leg, we try to preserve the limb and maintain its functionality. In most bone cancer surgeries, we are able to do so.

Sometimes we can replace bone that has been removed with either bone from another part of the body or an implant. We have developed replacements that are more durable and functional than those that were previously available.

We may use chemotherapy or radiation, or both, as part of your treatment, in combination with surgery. This is done either to shrink the tumor before surgery or to manage and control the tumor after surgery.

Preserving limbs in bone cancer

While any diagnosis of cancer can be frightening, a bone cancer diagnosis often carries with it the additional worry about losing an arm or a leg. In some cases, the limb can be saved even when the bone needs to be removed. Doctors can even recreate functioning joints, such as knees, so that your limbs will still flex naturally.

When amputation is necessary, our surgeons are skilled in performing the operation in a way that will allow you to have the best possible quality of life. There will always be a period of adjustment — both emotionally and physically — to the loss of a limb. But new surgical techniques and improved prostheses have made this adjustment easier. Usually you will be able to resume an active — even athletic — life after losing a limb or part of a limb to bone cancer.

Prostheses in bone cancer

Many changes to artificial limbs have been made by our doctors. We have created replacements that are more robust and usable than traditional replacements; have participated in clinical trials to test limb replacement devices that can last longer than conventional prostheses; and have led research to manufacture longer-lasting prostheses, such as a compress implant, which ensures that the thigh bone is replaced by the knee. In infants, we also use specially crafted expandable prostheses that “grow” as a child grows.

Cryosurgery in bone cancer

In addition to surgery for certain bone cancer patients, cryosurgery (the freezing and killing of cancer cells) is also used. We use liquid nitrogen to freeze the tumor cavity at subzero levels after the removal of the bone tumor. This destroys the cells of the microscopic tumor and reduces the likelihood that the tumor will recur (come back). The frozen bone is preserved to avoid fractures by covering the tumor cavity with bone graft, cement, or rods and screws.

The first to use cryosurgery on bone tumors were our surgeons. To decrease tumor recurrence, maintain the function of the limb and its joints, and minimize the need for amputation, they have perfected their use.