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Bone Cancer

Mohammed Nasir Uddin

Bone Cancer

Bone cancer occurs when a tumor or abnormal mass of tissue forms in the bone. This is called bone sarcoma. Sarcoma can start directly in the bone or spread to the bone from another part of the body.

What is Bone Cancer?
Bone cancer can start in any bone of your body, but it most commonly begins in the pelvic bone or the long bones of the arms and legs, such as the shinbone (tibia), femur, or upper arm.

Bone cancer that starts in the bone itself is relatively rare but can be aggressive, so early detection is important.

Cancer from other parts of the body can also spread to the bones. Cancers are usually named based on where they start.

Types of Bone Cancer

Primary Bone Cancer
Primary bone cancer is the most serious type and develops directly in the bone or nearby tissues, such as cartilage.

Secondary Bone Cancer
When cancer spreads to the bone from another part of the body, it is called secondary bone cancer. Secondary bone cancer is more common than primary bone cancer.

Common types of primary bone cancer:

1. Osteosarcoma (Osteogenic Sarcoma)
Osteosarcoma usually occurs in children and adolescents but can also affect adults. It typically starts at the ends of long bones in the arms and legs.

It can also occur in the hips, shoulders, or other areas. Osteosarcoma affects the hard tissue that forms the outer layer of the bone.

It is the most common primary bone cancer, accounting for about 50% of cases.

2. Ewing’s Sarcoma
Ewing’s sarcoma is the second most common primary bone cancer. It starts in the bone or surrounding soft tissue and is more common in children and young adults.

It typically affects long bones, such as the arms and legs, as well as the pelvis.

3. Chondrosarcoma
Chondrosarcoma most commonly starts in the pelvis, thigh, and shoulder bones, especially in older adults.

It develops in subchondral tissue, the connective tissue within the bone. This type of tumor usually grows slowly and is the least common among primary bone cancers.

4. Multiple Myeloma
Multiple myeloma (MM) is the most common cancer affecting the bones. However, it is not a primary bone cancer because it starts in plasma cells.

It occurs when cancer cells grow in the bone marrow and form tumors in various bones. Multiple myeloma is more common in older adults.

Symptoms of Bone Cancer

Common symptoms may include:

  • Pain and swelling in the affected bone

  • Hard mass felt in long bones like the arms, legs, or pelvis

  • Fatigue

  • Bone pain at night

  • Pain after minor injuries

  • Reduced range of motion

Less common symptoms:

  • Bones breaking easily

  • Weight loss

  • Fever

Pain is the most common symptom of bone cancer, but not all types cause pain.

If you notice any of these symptoms, consult a doctor immediately to determine whether bone cancer is the cause.

Causes of Bone Cancer

The exact cause is not fully known, but some factors can increase the risk:

  • Abnormal cell growth: Healthy cells divide and replace old cells. Abnormal cells survive, form tissue masses, and develop into tumors.

  • Radiation therapy: Some people who have received high-dose radiation therapy may develop osteosarcoma.

  • Chromosomal mutations: About 70% of osteosarcoma patients have chromosomal abnormalities.

  • Genetic mutations: Rare inherited or spontaneous mutations can increase risk.

Who is at Risk?

Risk factors include:

  • Family history of bone cancer

  • Previous radiation therapy

  • Paget’s disease of bone

  • Multiple tumors in cartilage

  • Syndromes like Li-Fraumeni, Bloom, or Rothmund-Thomson syndrome

Diagnosis and Staging of Bone Cancer

Doctors classify primary bone cancer by its location, extent, and spread:

  • Stage 1: Cancer is confined to the bone

  • Stage 2: Cancer is still in the bone but may be aggressive

  • Stage 3: Cancer has spread to one or more areas of bone

  • Stage 4: Cancer has spread to surrounding tissue or other organs, such as lungs or brain

Tests used:

  • Biopsy: Small tissue sample to confirm cancer

  • Bone scans to check bone condition

  • Blood tests for initial assessment

  • Imaging: X-ray, PET, MRI, or CT scan to analyze bone structure

Grading:
After a biopsy, the tumor cells are examined microscopically:

  • High-grade: Highly abnormal, fast-growing, more likely to spread

  • Low-grade: Relatively normal, slower-growing

Grading helps guide treatment planning.

Treatment of Bone Cancer

Treatment depends on:

  • Cancer stage and grade

  • Age

  • Overall health

  • Tumor size and location

Medications:

  • Chemotherapy for multiple myeloma

  • Pain-relief medication

  • Bisphosphonates to prevent bone loss

  • Cytotoxic drugs to stop cancer growth

  • Immunotherapy to boost the immune system

Surgery:

  • Removal of the tumor or affected tissue

  • If aggressive, damaged bone may need replacement or removal

  • Amputation may be required in extreme cases

Radiation Therapy:

  • Destroys cancer cells, sometimes alongside surgery

Complementary Therapy:

  • Herbal treatments, meditation, yoga, aromatherapy, etc., may help with symptoms and quality of life but should be used with standard treatment

Long-term Outlook

The 5-year survival rate depends on cancer type and stage at diagnosis.

  • Osteosarcoma and Ewing’s sarcoma survival depends on whether the cancer has spread at diagnosis. If not, survival is 70–80%.

  • Chondrosarcoma survival depends on tumor grade, usually ~90% for low-grade tumors.

Following the treatment plan precisely is critical to improving outcomes.

Clinical Trials

Clinical trials test new treatments not yet FDA-approved. They may be an option for those who do not respond to standard treatments.

These trials may be free or covered by insurance depending on sponsorship. Many current treatments originated from clinical trials. Discuss participation with your doctor or search for trials in your area.

Key Points

  • Primary bone cancer is rare compared to other cancers.

  • Type and early detection affect survival chances.

  • Diagnosis usually involves a biopsy and imaging tests to stage and plan treatment.

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