A bone cancer diagnosis brings with it a host of questions and concerns, with the most pressing being about the path to treatment.
The approach to treating bone cancer is not one-size-fits-all; it is a carefully considered plan that depends on numerous factors, including the specific type of cancer, its size and location, and the individual's overall health. For most people, treatment will involve a combination of therapies, with surgery, radiation, and targeted medications being key components.
Bone cancer is a disease that starts when cells in the bone begin to grow out of control. This is known as primary bone cancer and is quite rare. More commonly, cancer starts in another part of the body, like the lungs or breast, and then spreads to the bones. When this happens, it's called secondary, or metastatic, bone cancer. This discussion will focus on primary bone cancer, where the abnormal cells form a tumor within the bone, which can weaken the bone and spread to other parts of the body if not treated. These cancers most often develop in the long bones of the arms and legs.
The exact reason why most bone cancers develop is still not fully understood. However, certain factors are known to increase the risk. These can include a history of radiation therapy for a previous cancer, certain non-cancerous bone conditions like Paget's disease, and some rare, inherited genetic syndromes.
The symptoms of bone cancer can sometimes be mistaken for more common issues like growing pains in children or arthritis in adults. The most common signs to be aware of include:
Persistent pain in a bone: This is often the most common early symptom. The pain may be worse at night or during activity and doesn't get better with rest.
Swelling or a lump: A noticeable lump or swelling may appear over a bone, and the area might feel tender to the touch.
Weakened bones: The cancer can make the bone weak, leading to a fracture from a minor injury or sometimes for no clear reason.
Other general symptoms: Unexplained weight loss, fatigue, and fever can also be signs of bone cancer.
There are several types of primary bone cancer, each named for the kind of bone cell it starts in. The most common types are:
Osteosarcoma: This is the most frequent type of bone cancer, often found in teenagers and young adults. It typically develops in the bones of the arms, legs, or pelvis.
Chondrosarcoma: This cancer originates in cartilage cells and is more common in adults over the age of 40, often affecting the pelvis, hips, and shoulders.
Ewing Sarcoma: This type of cancer commonly affects children and young adults and can occur in the bones of the legs, arms, pelvis, or ribs.
The early signs of bone cancer can be subtle. Persistent bone pain that doesn't go away is a key warning sign. A new lump on a bone, or swelling that can't be explained by an injury, should also be checked by a healthcare professional. Sometimes, a broken bone that occurs with very little force can be the first indication that a tumor has weakened the bone.
If bone cancer is suspected, a thorough evaluation is necessary to get an accurate diagnosis. This process usually involves:
A physical exam and medical history: A doctor will ask about the symptoms and perform a physical examination.
Imaging tests: An X-ray is often the first step to get a look at the bone. More detailed images may be taken using an MRI (Magnetic Resonance Imaging) or a CT (Computed Tomography) scan. A bone scan can also be used to see if the cancer has spread to other bones.
Biopsy: A biopsy is the only way to be certain if a tumor is cancerous. In this procedure, a small sample of the tumor is removed and looked at under a microscope. It's very important that the biopsy is done by a team experienced in treating bone cancer, as a poorly performed biopsy can affect future treatment options.
Once bone cancer is diagnosed, it is given a "stage." The stage describes how large the tumor is and whether it has spread. This is a crucial piece of information for determining the best course of treatment.
The treatment for bone cancer is tailored to each individual and is often a combination of different approaches. The main treatments are surgery, radiation therapy, and systemic therapies like chemotherapy and targeted therapy.
Surgery is the most common treatment for bone cancer. The main goal of surgery is to remove the entire tumor.
What it is: In most cases, the surgeon will perform a "limb-sparing" surgery. This means they remove the cancerous part of the bone, along with a margin of healthy tissue around it, and then rebuild the bone. This reconstruction is often done using a metal implant, called a prosthesis, or a piece of bone taken from another part of the body (a bone graft). In some situations, if the tumor is very large or has grown into nearby blood vessels and nerves, amputation (removal of the limb) may be necessary.
When it's used: Surgery is the primary treatment for osteosarcoma and chondrosarcoma. It is also a key part of treatment for Ewing sarcoma, often after chemotherapy has been used to shrink the tumor.
Side effects: The side effects of surgery can include pain, infection, and blood loss. With limb-sparing surgery, there can be issues with the implant, such as loosening or breaking over time, which might require further surgery. After an amputation, individuals will need to learn to use a prosthetic limb.
Radiation therapy uses high-energy rays to kill cancer cells.
What it is: The radiation is carefully aimed at the tumor to destroy the cancer cells while trying to minimize damage to surrounding healthy tissues. Newer techniques allow for more precise targeting of the tumor.
When it's used: Radiation is a very important part of treatment for Ewing sarcoma and is often used in combination with chemotherapy. For osteosarcoma and chondrosarcoma, radiation may be used if the tumor cannot be completely removed with surgery, or to help relieve symptoms if the cancer returns.
Side effects: Side effects of radiation depend on the area being treated but can include skin changes (like redness and peeling), fatigue, nausea, and mouth sores. Most of these side effects are temporary.
These are treatments that travel through the bloodstream to reach cancer cells throughout the body.
Chemotherapy
What it is: Chemotherapy uses powerful drugs to kill cancer cells.
When it's used: Chemotherapy is a crucial part of the treatment for osteosarcoma and Ewing sarcoma. It is often given before surgery to shrink the tumor, making it easier to remove, and after surgery to kill any remaining cancer cells and reduce the chance of the cancer coming back.
Side effects: Chemotherapy can cause a range of side effects, including nausea, vomiting, hair loss, fatigue, mouth sores, and an increased risk of infection due to low white blood cell counts.
Targeted Therapy
What it is: Targeted therapy is a newer type of treatment that uses drugs that are designed to attack specific parts of cancer cells. These drugs work differently than standard chemotherapy.
When it's used: Targeted therapies are used for certain types of bone cancer, such as chordomas, that have specific genetic changes. They may be an option when other treatments are not effective.
Side effects: The side effects of targeted therapies can vary depending on the specific drug but are often different from those of traditional chemotherapy.
Dealing with the side effects of treatment is a significant part of the cancer journey. There are many ways to manage these side effects, and it's important to communicate openly with the healthcare team. Medications can help with nausea and pain. Fatigue is very common, and it's important to balance rest with light activity as advised by the care team. Emotional support, whether from family, friends, or a counselor, is also very important.
After treatment, rehabilitation is essential to help individuals regain their strength and function. This is especially important after surgery.
Physical therapy: A physical therapist will help with exercises to improve strength, flexibility, and movement. For someone who has had limb-sparing surgery, it can take up to a year to learn to walk comfortably again.
Occupational therapy: An occupational therapist can help individuals find new ways to do daily activities and can suggest adaptations to the home or workplace to make life easier.
For those who have had an amputation, rehabilitation will involve learning to use a prosthetic limb, which can take several months of dedicated therapy.
Research in bone cancer is continually leading to new and better treatments. Clinical trials are exploring new drugs, including more targeted therapies and immunotherapies, which use the body's own immune system to fight cancer. Advancements in surgical techniques and radiation therapy are also improving outcomes and quality of life for people with bone cancer.
