Bone Cancer

Primary bone cancer refers to cancer that begins in the cells of the bones. Osteosarcoma and Ewing’s tumors are the most common bone cancers, and they occur most frequently in children and in teenagers. Secondary bone cancer refers to cancer that originated elsewhere in the body and spread to the bone cells. Primary bone cancer occurs rarely.

In India, there is not much information about the incidence of bone cancer.

Symptoms
The common symptoms of bone cancer are:

  • Pain and tenderness around the bone tumor; pain worsens at night
  • Swelling
  • Difficulty in movement
  • Fever and sweating
  • Tiredness
  • Weight loss
  • Breakage of bones (rare)
  • Numbness, tingling, weakness

Causes
The exact cause of bone cancer is not known. People with bone cancer do not have any known risk factors. Inherited DNA mutations may be the cause for a small percentage of bone cancers.

Risk Factors And Complications
Certain risk factors predispose a person to bone cancer:

  • Age – Bone cancer is most common in young people. Ewing’s sarcoma occurs in people between 10 years and 20 years of age. Chondrosarcomas occur in people over the age of 40. Chordomas occur in people aged between 40 years and 60 years.
  • Injuries and knocks
  • Cancer treatments, such as radiotherapy and chemotherapy
  • Bone diseases, such as Paget’s disease of the bone, chondroma, osteochondroma, Maffucci’s syndrome, Ollier’s disease
  • Genetic factors, such as Li-Fraumeni syndrome, hereditary retinoblastoma, hereditary multiple exostoses
  • Ethnicity – Whites are 9 times more likely to get bone cancer than Blacks.
  • Congenital umbilical hernia
  • Exposure to pesticides

Tests And Diagnosis
Currently, there are no special tests to diagnose bone cancer early. If bone cancer is suspected from a person’s signs and symptoms, the following imaging tests may be conducted:

  • X-ray
  • Computed tomography (CT) scan
  • Magnetic resonance imaging (MRI) scan
  • Radionuclide bone scan
  • Positron Emission Tomography (PET) scan

To confirm the diagnosis of bone cancer, a biopsy is done to examine the suspect tissue under a microscope. There are 2 types of biopsies:

  • Needle Biopsy: In a fine needle biopsy, a very thin needle is used to aspirate a small amount of fluid with some cells from the tumor mass. If the tumor is too deep, the needle is guided using a CT scan (CT guided needle biopsy). In a core needle biopsy, a larger needle is used to extract a cylinder of tissue (1/16th inch diameter and ½ inch long).
  • Surgical Bone Biopsy: In an incisional biopsy, the skin is cut to remove a small piece of tumor tissue. In excisional biopsy, the entire tumor is removed. The patient is anesthetized during this procedure.

Treatment
Bone cancer is treated by the following methods:

  • Surgery
  • Radiation: Intensity modulated radiation therapy or proton-beam radiation are used.
  • Chemotherapy: Drugs such as doxorubicin, cisplatin, methotrexate, vincristine, and etoposide are used to kill cancer cells.
  • Targeted Therapy: Drugs that target the molecular and genetic changes occurring in tumor cells, such as imatinib and denosumab are used.

References
1. Jain, K., Sunila, Ravishankar, R., Mruthyunjaya, Rupakumar, C. S., Gadiyar, H. B., & Manjunath, G. V. (2011). Bone tumors in a tertiary care hospital of south India: A review 117 casesIndian Journal of Medical and Paediatric Oncology : Official Journal of Indian Society of Medical & Paediatric Oncology,32(2), 82–85. doi:10.4103/0971-5851.89778

2. Gupta, R., Seethalakshmi, V., Jambhekar, N. A., Prabhudesai, S., Merchant, N., Puri, A., & Agarwal, M. (2008). Clinicopathologic profile of 470 giant cell tumors of bone from a cancer hospital in western IndiaAnnals of diagnostic pathology12(4), 239-248.

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