Bone Cancer Guide
Bone cancer is rare, comprising under 1% of all tumors. Primary locations are less than 0.2%.
The specific chromosome changes are detected in 95% of patients with Ewing sarcoma.
Only every third with osteosarcoma has night bone pain, and every five with Ewing sarcoma.
With today's surgery, 90% of people with bone cancer in an arm or leg might not need an amputation.
Briefly about the bones
Two hundred and six bones hold the body together with a rugged exterior and spongy interior. The periosteum covers them and may have a medullary cavity containing bone marrow. Bones start as cartilage, which turns into bone with added calcium. Cartilage cushions bone ends and forms joints.
Bone cells include osteoblasts, creating new bone, and osteoclasts, breaking down old bone. Bone marrow makes blood cells, including red and white blood cells and platelets. Cancer can start in any bone cell.
What is bone cancer?
It happens when abnormal cells grow and divide out of control, making a mass or tumor. Cancer that begins in the bone is called primary bone cancer. Secondary one happens when malignancy from somewhere else in the body, like the lungs or breast, spreads to the bone.
Bone malignancies, both primary and secondary cancer in the bone, can affect different parts of the skeleton, like the long bones in the arms and legs, the pelvis, or the spine.
Cancer that starts in the bones is not very common, but cancer that begins in other organs spreads to the bones.
What are the bone cancer types?
Most bone tumors are benign and don't cause cancer, but a few do. Cancer of the bones is also known as bone sarcoma. There are several types of it:
Osteosarcoma
It is the most deadly form of bone cancer and the most common. The 5-years survival rate is around 40%. It arises from osteoblasts in immature bone tissue, typically in the arm or leg, in children and young adults. The average age of the patient is 15 years old. Osteosarcoma often overgrows and spreads to other body parts. Males, children, adolescents, and people with Paget disease or a history of radiation to their bones are at higher risk.
Chondrosarcoma
The tumor starts in cartilage tissue, mainly in older adults' pelvis, upper leg, and shoulder. It usually grows slowly but can spread. A rare type, extraskeletal chondrosarcoma, begins in the soft tissues of the upper limbs. This bone cancer survival rate after five years is 70%, the highest among others.
Ewing sarcoma
It arises in bone but can also occur in soft tissue. Where does bone cancer usually start? Concerning the locations, there are the pelvis, legs, and ribs. That form spreads quickly. Ewing sarcoma is primarily pediatric bone cancer, so children and adolescents, particularly boys, are at risk.
Chordoma
It is a rare neoplasm that forms in the spine, typically at the base of the spine or skull, in older adults.
Some benign bone tumors, like giant cell tumors of bone and osteoblastoma, can rarely become malignant and spread. These tumors typically occur in young and middle-aged adults and can cause bone destruction.
More about metastatic cancer of the bone
Most bone malignant tumors are metastatic bone cancer, meaning the disease comes from somewhere else in the body and spreads to the bones. Concerning what cancers metastasize to bone, they can be cells from a primary tumor site, like the breast, prostate, lung, or kidney, that move to the bones near it and form new tumors. When cancer spreads to the bones from other body parts, it can weaken their structure, leading to the symptoms.
What cause of bone cancer
If you ask how you get bone cancer, researchers still don't know what causes it. For primary tumors, they have found a few factors that may increase the risk:
Risk factors associated with tumors in bones
- Cancer treatments like radiation therapy, chemotherapy, or stem cell transplantation increase the risk of osteosarcoma. People with high doses of external radiation therapy or certain anti-cancer drugs, especially alkylating agents, are more likely to how do you get bone cancer, especially if treated as children. Also, about 5% of children with a particular stem cell transplant may get osteosarcoma.
- Hereditary conditions: Osteosarcoma can also be caused by genetic disorders, like hereditary retinoblastoma, especially after radiation treatment. Here’re some examples:
- Osteosarcoma, chondrosarcoma, and other cancers are more likely to happen in people with Li-Fraumeni syndrome.
- Chondrosarcoma is more likely to happen to people with inherited bone problems. Tuberous sclerosis complex, a genetic disorder, is linked to childhood chordoma.
- Ewing sarcoma isn't strongly linked to hereditary cancer syndromes or childhood diseases present at birth. New suggests that genes play a significant role in its risk.
- Benign bone tumors: Lastly, some harmless bone conditions can increase bone cancer risk—people over 40 with Paget's disease of the bone, which causes bone cells to grow.
Researchers are still investigating the causes of primary malignancies, but some factors may increase the risk. Stay informed about these; you can catch early-stage bone cancer on time.
How to prevent bone cancer?
Doctors are still trying to determine what causes bone sarcoma and how to stop it. Still, no one knows how to prevent bone sarcoma from happening. Most people who get bone sarcoma do not have any known risk factors.
Early detection gives the best chance for effective treatment. People at risk for bone sarcoma should regularly see their doctor and undergo a check-up. It concerns people with Li-Fraumeni syndrome, retinoblastoma, benign bone tumors, or other conditions that make them more likely to get sarcoma.
What are the bone cancer symptoms?
Cancer can happen in any bone. But, most of the time, it occurs in the long bones of the legs or arms. These are the leading local signs:
List of typical cancer signs
- Pain in a bone worsens over time and lasts through the night. Most people with bone sarcoma first notice pain. It appears in a specific area or region, along with tenderness and a limited range of motion. Pain often starts after a minor injury. But, in patients who wake up at night because of bone pain, osteosarcoma is diagnosed in 21-37%, and Ewing sarcoma—in 19%.
- Swelling and redness (inflammation) over a bone can make moving hard if the bone is near a joint—a lump on a bone. A weak bone breaks more quickly than usual. Trouble moving around, like walking with a limp.
- Around 7% to 8% of people with osteosarcoma have a pathology bone break because cancer weakens the bone structure.
Some people ask how long you can have bone cancer without knowing, and the answer depends on the cancer type. Some persons with this tumor feel nothing; others have a lump that doesn't hurt for years. Some people have multiple signs that worsen quickly.
If you or your child have bone pain that worsens or stays the same, you should see a doctor.
Other common signs of bone cancer
There is swelling of soft tissues and fevers that can't be explained. People with Ewing sarcoma can get a fever again after weeks or months without any symptoms. Pain at night and a broken bone that doesn't heal right can be signs of cancer.
When the patient asked, "How did I find bone cancer?” The answer often discovered is persistent bone pain, swelling, fractures, fatigue, fever, unintended weight loss, and limited movement. If you experience these symptoms, consult a healthcare professional for evaluation through tests like imaging studies and biopsies.
How is bone cancer diagnosed?
It typically involves several steps to identify the disease. These may include the following:
Step-by-step diagnosis
- Medical history and physical exam: The oncologist will discuss any symptoms you're experiencing and review your medical history, followed by a physical exam to check for signs of bone cancer.
- Imaging tests: Various imaging tests such as X-rays, CT scans, MRI scans, or bone scans may be conducted to examine the affected area, identify the presence of a tumor, and determine if it is spreading to other parts of the body.
- A biopsy is the best way to diagnose bone cancer, where a sample of the affected bone tissue is collected and examined under a microscope. Depending on the circumstances, doctors can do this through a needle or surgical biopsy.
- Blood tests: While not definitive in diagnosing bone cancer, blood tests may be used to check for elevated levels of specific markers, such as alkaline phosphatase, which could indicate the presence of a bone tumor.
Bone cancer stages
Once the diagnosis is confirmed, doctors will determine the stage of the disease to guide the treatment plan. It means evaluating the size of the tumor, its location, and its spreading.
The grade indicates how abnormal the cancer cells are and their growth rate. It ranges from low-grade (slow-growing, less aggressive) to high-grade (fast-growing, more aggressive).
- Stage 1 The cancer is in the bones only and has not spread. It is considered low-grade, with overall 5-year survival is 91%.
- Stage 2 Bone cancer is still limited to the bone but is high-grade, meaning it grows more quickly and is more likely to spread.
- Stage 3 Bone cancer is high-grade and has multiple areas within the same bone. It has not yet spread to other organs.
- Stage 4 Bone cancer has spread beyond the bone to other body parts, such as the lungs, liver, or other bones. The survival rate varies.
Consult with the doctor to understand how fast bone cancer spread, discuss can bone cancer be cured entirely, and find the most appropriate treatment options.
Countries for bone cancer treatment
Bone cancer treatment options
The treatment for cancer in the bones depends on the tumor characteristics. Doctors specializing in cancer (oncologists and radiation oncologists) and orthopedic surgeons (specialists in bones and joints) are often on the treatment teams.
Conventional treatment
Surgical options
Surgery for bone cancer is necessary to remove tumors, prevent cancer spread, and maintain the patient's function. Depending on the tumor's location, size, stage, and the patient's overall health, surgeons choose the method of how bone cancer is treated. Each has benefits and challenges, but the goal remains to achieve the best result for the patient.
The main surgical approaches are:
- Limb amputation surgery is the cancer bone treatment when the tumor is in an arm or leg. This procedure involves removing the affected limb to prevent cancer from spreading. It's usually considered when other treatments are unsuccessful or aren't feasible. The goal is to remove all cancerous cells while preserving the patient's function and quality of life as much as possible. After amputation, patients often use prosthetic limbs and undergo rehabilitation to regain mobility.
- Limb-salvage surgery aims to remove the tumor while preserving the limb. This approach is preferred over amputation, as it maintains the patient's mobility. During limb-salvage surgery, the surgeon removes the cancerous bone with surrounding tissue and reconstructs the limb using metal implants, bone grafts, or prosthetic devices. It allows the patient to retain their limb and regain function after rehabilitation. The success of limb-salvage surgery depends on the tumor's features and the patient's overall health.
Chemotherapy
Doctors use bone cancer medicines to kill or slow the growth of cancer cells. Chemo drugs can be administered orally or through injections to decrease tumors. For instance, before surgery, it helps shrink cancer, making it easier for the surgeon to remove it entirely and possibly saving the limb from amputation. After surgery, it aims to reduce the risk of cancer recurrence or shrink any remaining cells. Chemotherapy can also be combined with surgery, radiotherapy, or both for cases of Ewing sarcoma, with an 80% 5-year survival rate. Furthermore, chemotherapy can help treat advanced bone cancer by relieving symptoms and improving the patient's quality of life.
Immunotherapy
The therapy uses the immune system to fight the tumor, targeting and killing cancer cells while sparing healthy cells. Bone cancer immunotherapy includes, for example, immune checkpoint inhibitors that block signals cancer cells use to hide from the immune system, allowing immune cells to recognize and fight them.
Bone cancer immunotherapy is still under research, and its success rate depends on numerous factors. Immunotherapy may be coupled with chemotherapy, radiation, or targeted therapies to improve cancer control.
Targeted medicine
In targeted therapy, drugs attack certain molecules or proteins that let cancer cells grow and spread. This approach results in fewer side effects compared to traditional chemotherapy.
Targeted therapies are used for specific types of cancer or situations. For example, adding mifamurtide to regular chemotherapy increased the survival rate from 70% to 78%. It works by activating immune cells that attack and destroy malignant cells. The effectiveness of targeted therapies depends on the type and stage of cancer and the presence of specific molecular targets. Oncologists may combine it with chemotherapy, radiotherapy, or surgery to enhance treatment outcomes.
Radiation
Radiotherapy uses high-energy x-rays. A linear accelerator machine generates high-energy x-rays directed at the tumor from outside the body. Radiation therapy is vital for Ewing sarcoma and other forms. It is used to treat bone cancer stage 4 and recurrent cancer. Patients typically undergo multiple sessions over several weeks. The process is non-invasive and involves multiple sessions to reduce healthy tissue damage.
Radiotherapy is used to treat bone cancer pain. External Beam Radiation Therapy (EBRT) is the most common method, with 1-year recurrence-free rates of 74% and 90%, respectively, for short- and long-course.
Patients often ask what the best treatment for bone cancer is. Each treatment has benefits and challenges, and doctors may combine them. Each patient has a unique situation, and the medical team considers all factors in determining the most appropriate combination of treatments and achieving the best possible outcome.
Best bone cancer hospitals
New treatments for bone cancer
New methods are continuously being researched and developed to increase survival rates and minimize side effects. Advancements in medical technology and a deeper understanding of cancer biology have led to the discovery of novel therapies that target specific features of bone cancer cells or help the patient's immune system combat the disease. Some of these treatments include:
Advanced radiotherapies
Proton Therapy
Radiation oncologists use protons instead of x-rays. Protons release their energy at a specific depth, minimizing damage to healthy tissue around the tumor. This method is promising for Ewing sarcoma and osteosarcoma but is still relatively rare and has yet to be widely available for bone cancer treatment.
Brachytherapy
It is a radiation therapy in which radioactive seeds or pellets are placed inside or near the tumor, providing a high dose of radiation to cancer cells while minimizing damage to surrounding healthy tissue.
Brachytherapy is a treatment for bone cancer pain in patients with advanced or metastatic bone cancer that cannot be removed by surgery. By delivering targeted radiation directly to the tumor site, brachytherapy can help alleviate pain and potentially slow the cancer's progression.
Due to the study, after implanting I-125 seeds for brachytherapy, pain relief improved from 54% initially to 66% at week 1, 74% at week 4, 76% at week 8, 80% at week 12, and 88% at week 24.
Gamma Knife
It is a stereotactic radiosurgery (SRS) that uses multiple focused beams of gamma radiation. It targets and treats minor, precise areas within the body. This kind of treatment sends a high radiation dose to the tumor without hurting the healthy tissue around it too much.
Gamma Knife radiosurgery is used for smaller tumors or when surgery is not an option. Although it is not a standard treatment, it may be considered for specific cases, particularly when treating metastatic bone cancer or bone tumors in challenging areas, such as skull base chordomas.
New immunotherapy options
CAR T-cell therapy is a type of immunotherapy in which a patient's T cells (a type of immune cell) are genetically changed to find and kill cancer cells. The modified T cells, called chimeric antigen receptor (CAR) T cells, are then returned to the patient to fight cancer.
CAR T-cell therapy is still in the research and development stage for bone cancer. Some preclinical studies and early-phase clinical trials have shown promise in using CAR T cells to target specific proteins expressed by osteosarcoma cells.
Alternative bone cancer treatments
Non-traditional treatments complement conventional therapies, potentially helping to manage symptoms and improve well-being. Some options include acupuncture, herbal medicine, nutrition therapy, mind-body techniques like meditation and yoga, aromatherapy, immunotherapy, and hyperthermia.
It's crucial to consult a professional before including alternative treatments in your care plan, as these approaches should be used alongside standard treatments like surgery, radiation, and chemotherapy.
Treatments for bone cancer metastasis
Common treatments for bone metastasis include medications, radiation therapy, and surgery, with the best approach depending on each individual's situation. Medicines used to treat bone metastasis include bone-building drugs, intravenous radiation, chemotherapy, hormone therapy, pain medications, steroids, and targeted therapy. These medications can help strengthen bones, reduce pain, lower the risk of developing new bone metastasis, and target specific abnormalities in cancer cells.
External radiation therapy uses high-powered energy beams to kill cancer cells and alleviate pain. Surgery can help stabilize or repair bones at risk of breaking or being damaged by bone metastasis. Other treatments for metastatic bone cancer include heating and freezing cancer cells through radiofrequency ablation or cryoablation, which may be suitable for patients with limited areas of bone metastasis unresponsive to other treatments. It is essential to consult a healthcare professional to determine each patient's most appropriate treatment plan.
Bone cancer doctors
What about statistics and cancer in bones prognosis?
The doctor can't say how the disease will progress because it depends on each person. Many patients ask if cancer in the bones is curable. Still, the prognoses and outcomes of the disease are based on the type of tumor, test results, the rate at which the tumor is growing, and the patient's condition. These predictions are based on years of research into how to treat patients and how long they live.
Bone cancer life expectancy by stages
According to the American Cancer Society, the life expectancy for bone cancer for patients with osteosarcoma between 2010 and 2016 is a 77% chance of living for five years if the tumor did not expand from the bone. When cancer spreads past the bone and into nearby tissues, the possibility of it being a local disease is about 65%.
The survival rate for stage 4 bone cancer depends on its type. It is 26% if cancer spreads to other body parts for osteosarcoma, 55%for chondrosarcoma, 36% for giant cell tumors, and 69% for chordoma. The prognosis for bone cancer metastasis depends on multiple factors.
Prognosis on the chart
It's important to know that people with bone cancer live longer than the statistics show because treatments get better every year.
At AiroMedical, we understand the prognosis for bone cancer and what challenges exist with its treatment. Our team is committed to guiding patients through this journey, connecting them with expert healthcare professionals to find the most effective treatment plan. AiroMedical focuses on patient demands and provides customized solutions to fight the disease and increase the quality of life.
References:
- Thanindratarn, P., Dean, D. C., Nelson, S. D., Hornicek, F. J., & Duan, Z. (2019). Advances in immune checkpoint inhibitors for bone sarcoma therapy. J Bone Oncol, 15, 100221. https://doi.org/10.1016/j.jbo.2019.100221
- Múdry, P., Kýr, M., Rohleder, O., Mahdal, M., Staniczková Zambo, I., Ježová, M., Tomáš, T., & Štěrba, J. (2021). Improved osteosarcoma survival by adding mifamurtide to conventional chemotherapy – Observational prospective single institution analysis. J Bone Oncol, 28, 100362. https://doi.org/10.1016/j.jbo.2021.100362
- Kubota, H., Soejima, T., Sulaiman, N. S., Sekii, S., Matsumoto, Y., Ota, Y., Tsujino, K., Fujita, I., Fujimoto, T., Morishita, M., Ikegaki, J., Matsumoto, K., & Sasaki, R. (n.d.). Predicting the survival of patients with bone metastases treated with radiation therapy: a Katagiri scoring system validation study. Radiation Oncology.
- Feng, S., Wang, L., Xiao, Z., Maharjan, R., Chuanxing, L., Fujun, Z., Jinhua, H., & Peihong, W. (2015). 125I Seed Implant Brachytherapy for Painful Bone Metastases After Failure of External Beam Radiation Therapy. Medicine (Baltimore), 94(31), e1253. https://doi.org/10.1097/MD.0000000000001253
- Roeder, F., Timke, C., Zwicker, F., Thieke, C., Bischof, M., Debus, J., & Huber, P. E. (2010). Intensity-modulated radiotherapy (IMRT) in benign giant cell tumors is a single-institution case series and a short literature review. Radiation Oncology, 5, 18. https://doi.org/10.1186/1748-717X-5-18
- Zakaria, W. K., Hafez, R. F., & Taha, A. N. (2018). Gamma Knife Management of Skull Base Chordomas: Is it a Choice? Asian Journal of Neurosurgery, 13(4), 1037-1041. https://doi.org/10.4103/ajns.AJNS_61_17
- Köksal, H., Müller, E., Inderberg, E. M., Bruland, Ø., & Wälchli, S. (2019). Treating osteosarcoma with CAR T cells. Scandinavian Journal of Immunology, 89(3), e12741. https://doi.org/10.1111/sji.12741
