Bone Cancer: Symptoms, Causes, Risks, Diagnosis, Treatment and Prognosis

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A hand of a man with illustration of bone cancer

1Overview

Bone cancer initially starts in the bone. Cancer starts when there is an uncontrollable growth of cells in the body. Cancer may grow in any part of the human body and it can metastasize to other nearby areas of the body.

Bone cancer is considered a malignant or cancerous tumor of the bone wherein it damages the normal bone tissue.

There are different types of malignant bone tumors which include:

Osteosarcoma

This is also known as osteogenic sarcoma, the most usual primary bone cancer to occur.  These tumors happen most often in bones of the arms, legs, around the knee or pelvis. This type of cancer creates immature bone. Male patients who are under the age 25 are often times affected by this type of cancer.

Chondrosarcoma 

It is the cancer of cartilage cells. It is mostly perceived in bones such as the pelvis, leg bone or arm bone. Chondrosarcoma will rarely develop in the trachea and sometimes the chest wall.

Ewing tumor

The highest number of Ewing tumors progresses in bones, but they can begin in other tissues and organs. The pelvis, the ribs or shoulder blades, long bones of the arms and legs are the most common sites that are affected.

Malignant fibrous histiocytoma

This type of cancer usually starts in soft tissues and connective tissues like the tendons, ligaments, fat, and muscle than in bones. This affects the bones in the legs, especially around the knees, and arms.

Fibrosarcoma

It develops more often in soft tissues than it does in bones that is why it is considered a soft tissue sarcoma. It starts in the cells called fibrocytes.

Giant cell tumor bone

This tumor affects the legs, especially around the knees, and arm bones. This can a benign one or can become malignant. They don’t frequently extend to distant sites, can come back after surgery which can happen several times. The tumor is likely to spread to other parts of the body.

Chordoma

It usually occurs at the base of the skull and bones of the spine. It tends to mature slowly and often do not progress to other parts of the body, but they often come back in the same area if they are not removed completely. This tumor can spread to the lymph nodes, the lungs, and the liver

In some cases, not all bone tumors are malignant. In fact, there are more benign (noncancerous) bone tumors that are being diagnosed than malignant ones. They are generally treated by surgery.

The following are types of benign bone tumors:

Osteoid osteoma – This begins from osteoblasts and was originally said to be a smaller version of an osteoblastoma. It is tended to be less than 1.5 cm in size. The tumor can be seen in any bone in the body but are mostly seen in long bones, such as the femur and tibia.

Osteoblastoma – This is a single tumor that developed in the spine and long bones of arms and legs. Young adults are the ones affected by this type of tumor.

Osteochondroma – This is considered as the most common benign “mild” tumor that is common for ages under 20 years old. Here, there is the overgrowth of cartilage and bone. Often times, the long bones in the leg, pelvis, and shoulder blades are affected.

Enchondroma – This mostly affects the cartilages. It mostly involves long bones of the hands and feet and manifests no symptoms.

Chondromyxoid fibroma – This is a rare and non-cancerous cartilaginous neoplasm accounting for less than 1 percent of all bone tumors.

However, both benign and malignant tumors may develop and can compress the healthy bone tissues. The difference is that benign or mild tumors don’t cause death, don’t metastasize, and do not damage the bones tissues.

2Symptoms

The following are manifestations of bone cancer.

  • Pain (Pain be felt at the particular time of the day, often at night, or with physical activity. It progresses and exacerbates over time. In some cases, pain may be present for years before seeking treatment.)
  • Mass, swelling, or lump felt around the area of bone cancer
  • Bone fracture due to weakening of the bone
  • Numbness
  • Tingling
  • Tenderness
  • Cold hand or foot with weak or absent pulses due to decrease in blood flow

3Causes

Still, the cause is still unknown but scientists have found that bone cancers are related to many conditions. Bone cancers are the outcome of mutations obtained during the person’s lifetime. These can be due to exposure cancer-causing chemicals or radiation.

Scientists are in the process of understanding this process.

4Risk Factors

Genetic disorders

Some cases of bone cancers particularly osteosarcomas appear to be genetic.
These can be caused by mutations and alterations in the DNA in certain genes.

Li-Fraumeni syndrome

This syndrome makes people develop other types of cancers like brain cancer, breast cancer, and other types of sarcoma. These are caused by mutations in the gene.

Osteosarcoma

Children with certain rare inherited syndromes may have a heightened risk of developing osteosarcoma.

Retinoblastoma

Retinoblastoma is an uncommon type of cancer of the eye in kids. It is hereditary and it is usually caused by the mutation of the RB1 gene. These children may have a higher risk of having bone cancer and soft tissue sarcomas.  In children who underwent radiation therapy in the eye, the bones around it could develop bone cancer.

Chondrosarcomas

This causes many bumps on a person’s bones. These bumps are made mostly of cartilage. They are painful and deform bones. Persons with this illness have a higher risk of chondrosarcoma.

Chordomas

Chordoma is a rare type of malignant bone tumor that is found in the spine or the base of the skull. It usually develops at any age but can occur twice likely in men than in women between the ages of 50 and 70.

Rothmund-Thomson syndrome

Kids with this syndrome are at a heightened risk of having osteosarcoma. This is due to the changes or alterations in the genes.

Paget disease

Paget disease is due to the development of abnormal bone tissues that occurs in individuals who are more than 50 years old. The bones may become heavy, brittle and thick, increasing the risk of fractures.

Radiation

Long exposure to radiation can pose a great risk. Radioactive materials like radium and uranium can also be the cause of bone cancer due to the build-up of minerals in bones.

Radiation emitted by the microwaves and cellular phones, and household appliances like a television, does not increase the risk of having bone cancer.

Bone Marrow Transplantation

Osteosarcoma has developed in some patients who underwent bone marrow transplantation or also known as stem cell

Injuries

In the experience of people who have bone cancer, they remember having accidents and injuries at that part of their bone.

5Diagnosis

Imaging tests

X-rays

Most of the time, bone cancers is seen on x-rays. It appears to be “ragged” in appearance instead of solid shaped bone. A hole in the bone can also be seen in the x-ray plate. A chest x-ray is often done to see if the bone cancer has metastasized.

Computed tomography scans

It is helpful for staging cancer.

Magnetic resonance imaging scans

Are tagged as the best test for outlining a bone tumor.

Radionuclide bone scans

It is used to show if the cancer has metastasized to tissues of other bones and organs in the body. Bone scans can show the image of the bones that have been damaged by cancer.

Positron emission tomography (PET or PET) scans

Are useful in looking for cancer throughout your entire body. It can tell if the tumor in the bone is cancerous or benign (non-cancerous) if a tumor is whether cancerous or benign in nature. PET scan can be combined with other tests like the CT scans and x-rays to better determine other kinds of cancer.

Biopsy

This is done and performed to know if the tumor is cancerous or not. It is also utilized as a basis whether the tumor is benign or malignant and exactly what type of tumor is most likely (based on the bone x-rays and the patient’s age).

6Treatment

Treatment differs on the kind and stage of the cancer. The main types of treatment for bone cancer are:

Surgery

This is the removal of the part of the bone where the cancer is, sometimes total limb removal is done to remove the cancer in the bone. Reconstructive surgery is given as an option to the patient after the surgery to maximize the function of their limbs.

Radiation

This uses high energy beams to target the tumors in the bones.

Chemotherapy: The treatment is either in a pill form or in a liquid form. The chemicals present in the treatment can kill the cancer cells in the gland. Side effects of the drug are present like nausea, vomiting.

7Prognosis

The survival rate of patients who have bone cancer depends on the type of cancer and where the cancer has spread. Moreover, there is an overall five-year survival rate for all bone cancer which is accounted for about 70 percent