Bone cancer guide

What is bone cancer?

The skeletal system consists of 206 bones, protecting internal organs and allowing people to stand straight and move. Bone cancer occurs when a tumour or atypical tissue mass is formed in the bone.

There are more than 30 different types of primary bone cancer. Bone cancer is also called bone sarcoma. The most common types include:

• osteosarcoma - begins in cells that form bone tissue;
• Ewing sarcoma - affects rapidly propagating bone or soft tissue cells.

These two types of bone sarcoma are the most common in children and young people.

• chondrosarcoma - is cancer originating from cartilage;
• chordoma - is a type of bone sarcoma that begins in the part of the spinal cord.

Cancer that occurs in the bone is occasional. It accounts for 1% of the diagnosed cancer. However, the danger of this type of cancer is that it’s highly aggressive, so early diagnosis is essential for successful treatment. Bone cancer such as Ewing sarcoma is diagnosed mainly in children. According to the American Cancer Society statistics, 10% of diagnosed bone cancer is accounted for children and young people under the age of 19.

Diagnostic tests

Bone cancer can affect any bone, but most often, it develops in the pelvic or long bones of the legs or arms. The main symptoms of bone cancer include:

• constant bone pain, which increases over time and lasts for a long time;
• swelling and redness (inflammation) over the bone can make it difficult to move if the affected bone is near the joint;
• noticeable bump over the bone;
• bone weakness manifests itself in the fact that the bone breaks more quickly than usual.

If there are some symptoms, the causes necessarily require further study with the help of some tests:

• Blood test - a full blood test will show the general state of health and the presence of some enzymes that do not directly indicate the presence of bone cancer but signal the need for further detailed examination.
• X-ray - creating an image of structures inside the body using radiation. The use of a radioactive indicator, which is inserted intravenously, allows bone scanning. Special equipment records bone photos where healthy tissue is lighter and affected by oncology is darker.
• CT scan (computer tomography) - takes pictures of the inner body at different angles using X-rays. The computer combines these photos into a detailed three-dimensional image, clearly showing changes and bone tumours, and a doctor can also determine the tumour size.
• MRI scan (magnetic resonance imaging) - uses magnetic fields to obtain detailed images and measure the bone tumour. A contrast agent is used during the procedure to get more detailed images.
• PET-CT scan (positron emission tomography) - is a combination of PET and CT studies, which provides very detailed information about the presence of a tumour. A complex series of X-rays of the whole body is taken. At the same time, a weakly radioactive drug is injected into the vein, showing the abnormal activity of cells in the body.
• Biopsy - with the help of a thin needle or skin incision, a sample of the affected bone is taken for further study under a microscope for the presence of bone cancer cells and their type.

After the examination, the doctor makes a final diagnosis and determines the stage of the disease.

Treatment methods

Bone cancer treatment is based on the type of cancer, location, and degree of spread. Whole teams of doctors usually work with people diagnosed with bone cancer. These teams typically include doctors specializing in cancer (oncologists and radiation oncologists) and doctors specializing in bones and joints (orthopaedic surgeons). Treatment of bone cancer usually consists of combined approaches. The most commonly used treatment methods include:

• Systemic chemotherapy - is a systemic treatment that kills a cancer cell with drugs wherever it is. Treatment is carried out in cycles. Their number and duration are determined individually.
• Targeted therapy - is a treatment aimed at specific proteins and genes of cancer cells. Target therapy drugs can destroy cells with certain changes (mutations) caused by cancer. Thus, the method is harmless to healthy cells, as malignant cells are found and destroyed.
• Immunotherapy - the so-called immuno-oncology, treats cancer using the body's immune system. When cells become cancerous, they acquire new properties marked by the immune system as alien. Immune drugs help the body recognize and destroy such cells.
• Radiation therapy - is the use of high-energy X-rays to destroy bone cancer cells. The radiation is directed directly to the focus of the disease and kills cells in the affected area. In addition, there is external (using external influence) or internal, so-called brachytherapy (using internal implants).
• Surgical treatment - the so-called amputation. When removing a tumour is impossible, a decision is made to remove the limb. It is becoming an increasingly less common method. After the area heals, the replacement limb (prosthesis) is prepared.

For successful treatment, doctors may suggest a combination of several methods.

New treatment options

Over the past decade, progress has been made in studying gene changes in bone cells. As a result, doctors could find more effective treatments based on gene mutations. New treatment methods include:

• Transarterial chemoperfusion (TACP) - antitumor drugs are injected directly into the tumour through the feeding vessels. It provides a point effect, a more extended period of stay and exposure to the bone tumour with a higher concentration of the drug.
• Proton therapy - is radiotherapy in which a beam of radiation (protons) with a given amount of radiation is directed precisely to the bone cancer. Proton particles pass through healthy tissues and affect cancer only.
• Surgical treatment (limb preservation surgery) - during this surgery, the doctor removes part of the bone affected by cancer while maintaining nearby muscles, tendons and other tissues. Instead of bone, an artificial implant or graft made of bone tissue is placed.

After bone cancer treatment, the patient often needs specialists' help to return to everyday life. This process is called rehabilitation. Duration and intensity depend on the characteristics of each case.

Statistics and prognosis

The doctor cannot predict the exact course of the disease, as it will depend on individual circumstances. Nevertheless, there are prognoses, and probable outcomes of the disease, based on the type of bone cancer, test results, the rate of tumour growth, and the patient's condition. These prognoses are based on many years of research for treatment methods and tracking patient survival.

According to the American Cancer Society, for patients with osteosarcoma between 2010 and 2016, the five-year relative survival rate is: for patients with localized cancer (there are no signs that cancer has spread beyond the bone) is 77%. For a regional disease, it is about 65% when cancer spreads beyond the bone and reaches nearby tissues. If cancer spreads to remote parts of the body (metastatic bone cancer), it is 26%. It is essential to understand that yearly treatment improvements allow people with bone cancer to live longer than statistics.

Since bone cancer is a complicated disease with complex treatment options, choosing a medical solution and connecting the patient and the attending team is essential. Therefore, the AiroMedical team selects a treatment program to overcome bone cancer and restore quality of life.

References:

1. Cancer.Net: Bone Cancer (Bone Sarcoma): Symptoms and Signs
2. American Cancer Society: Signs and symptoms of bone cancer
3. American Cancer Society: What's New in Bone Cancer Research?
4. NHS inform: Bone cancer
5. Cancer Council: What is bone cancer?
6. NHS: Overview - Bone cancer
7. WebMD: Bone Cancer