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Bone Cancer is an uncommon cancer that begins in a bone. The term "bone cancer" doesn't include cancers that begin elsewhere in the body and spread (metastasize) to the bone.

Bone Cancer
What is Bone Cancer?

Bone cancer is an uncommon cancer that begins in a bone. The term "bone cancer" doesn't include cancers that begin elsewhere in the body and spread (metastasize) to the bone.
Most commonly affected sites are:

  1. Lower Femur (Thigh bone)
  2. Upper Tibia ( Shin or leg bone)
  3. Upper Humerus (Arm bone near shoulder)

Most commonly seen bone tumours

  1. Osteosarcoma - begins in the bone cells. Osteosarcoma occurs most often in children and young adults.
  2. Ewing’s’ sarcoma, PNET and Round Cell Tumour group - it is not clear where in bone they begin. It is believed that these may begin in nerve tissue within the bone. They occur most often in children and young adults.
  3. Chondrosarcoma - begins in cartilage cells that are commonly found on the ends of bones. Chondrosarcoma most commonly affects older adults.
  4. Osteoclastoma – locally aggressive bone destroying lesion
  5. Multiple Myeloma - is a cancer of plasma cells

Signs and symptoms of Bone Cancer

  • Bone pain
  • Swelling and tenderness near the affected area
  • Broken bone
  • Fatigue
  • Unintended weight loss
The most common complaint the patient comes to the doctor is – swelling and pain in the bone following an injury which has not healed with pain killers. The bone tumour is usually discovered on the X ray examination of the affected part. However, trauma or injury is not the causative factor for bone tumour. The tumour is already present in the bone, the injury or trauma merely draws one’s attention to the part. One should seek expert advice if any painful swelling of the bone which does not subside in 2 – 3 weeks time. Bone tumour patients are commonly treated on the lines of infection of the bone and in such cases too if there is no relief or subsidence of symptoms one should seek advice from experts to rule out bone tumours.

Imaging Tests for Bone Cancer

  • X-ray
  • Bone scan
  • Computerized tomography (CT)
  • Magnetic resonance imaging (MRI)
  • Positron Emission tomography (PET)
All treatment must be preceded by a proper validation and confirmation of the diagnosis of bone tumour which can be done only by a biopsy. Biopsy means taking a sample of tissue from the tumour for diagnosis. This can be done by a simple procedure like needle biopsy or a more extensive procedure of Open biopsy (incisional or excisional). Determining the type of biopsy you would need and the particulars of how it should be performed requires careful planning by the medical team. It is important that the biopsy be performed in a way that won't interfere with future surgery to remove bone cancer. Ask your doctor for a referral to an appropriate specialist as the surgeon who is proficient in offering the final definitive limb saving operation should do the biopsy for the best possible outcome.

Treatment of Bone Cancer

Bone cancer is often treated by a team of specialists comprising –

  1. Orthopaedic Oncologist – Orthopaedic surgeon who specializes in treating bone tumours
  2. Medical Oncologist – doctors who specialize in treating cancer with medications (chemotherapy)
  3. Radiation Oncologist – doctors who use radiation to treat cancer. Bone cancer treatment typically involves surgery, chemotherapy, radiation or a combination of treatments.

Surgery

The goal of surgery is to remove the entire bone cancer. To accomplish this, doctors remove the tumor and a small portion of healthy tissue that surrounds it. Types of surgery used to treat bone cancer include:

  1. Surgery to remove the cancer, but spare the limb. When bone cancer can be separated from nerves and other tissue, the surgeon may be able to remove the bone cancer and spare the limb. The defect that results from the removal of cancerous bone is reconstructed with bone from another area of your body or with a special metal mega prosthesis.
  2. Surgery to remove a limb. Bone cancers that are large or located in a complicated point on the bone may require surgery to remove all or part of a limb (amputation). With the advent of modern chemotherapy amputation or ablative surgery is becoming less common.

Radiation therapy

Radiation therapy uses high-powered beams of energy, such as X-rays, to kill cancer cells. Radiation therapy may be used in people with bone cancer that can't be removed with surgery. Radiation therapy may also be used after surgery to kill any cancer cells that may be left behind. For people with advanced bone cancer, radiation therapy may help control signs and symptoms, such as pain.

Chemotherapy

Chemotherapy is a drug treatment that uses chemicals to kill cancer cells. Chemotherapy alone or combined with radiation therapy is often used before surgery to shrink a bone cancer to a more manageable size that allows the surgeon to perform a limb-sparing surgery. Chemotherapy may also be used in people with bone cancer that has spread beyond the bone to other areas of the body.


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