About bone cancer

What is bone cancer?

What is bone cancer? What is metastatic bone cancer?

Bone cancer is a cancer of the cells that make up the bones of the body. When cancer is found in bones, it has usually started in another organ or another location in the body and has spread to the bones. This is known as metastatic cancer and is named for the site at which the original cancer started (for example, metastatic colon cancer) and is not referred to medically as bone cancer. It is much more common than true, or primary, bone cancer, where the bone cells themselves become malignant. Primary and metastatic bone cancers are often treated differently and may have a different prognosis.

There are other cancers that may begin in the bone even though they are not considered to be true bone cancers. Lymphoma is a cancer of the cells involved in the immune response. Lymphoma usually begins in the lymph nodes, but it sometimes begins in the bone marrow. Multiple myeloma is another cancer of the immune cells that typically begins in the bone marrow. These tumors are not considered to be primary bone cancers because they do not arise from bone cells.

Who is at risk for bone cancer?

Each year, around 2,300 cases of cancer of the bones are diagnosed in the U.S. Primary bone cancers are not common and make up far less than 1% of all cancers. Bone cancers are more common in young adults and children than in older people. Cancer found in the bones of an older adult most likely is metastatic from another location in the body.

Risk factors have been identified for the development of certain bone cancers. Risk factors include the following:

  • Previous treatment with radiation therapy
  • Previous chemotherapy with drugs known as alkylating agents
  • Mutation in a gene known as the retinoblastoma (Rb) gene
  • Associated conditions, such as hereditary retinoblastoma, Paget's disease of bone, Li-Fraumeni syndrome, and Diamond-Blackfan anemia



What are the symptoms for bone cancer?

Signs and symptoms of bone cancer include:

  • Bone pain
  • Swelling and Tenderness near the affected area
  • Weakened bone, leading to fracture
  • Fatigue
  • Unintended weight loss

When to see a doctor

Make an appointment with your doctor if you or your child develops Bone Pain that:

  • Comes and goes
  • Becomes worse at night
  • Isn't helped by over-the-counter Pain relievers



What are the causes for bone cancer?

The cause of most bone cancers is unknown. A small number of bone cancers have been linked to hereditary factors, while others are related to previous radiation exposure.

Types of bone cancer

Bone cancers are broken down into separate types based on the type of cell where the cancer began. The most common types of bone cancer include:

  • Osteosarcoma. Osteosarcoma is the most common form of bone cancer. In this tumor, the cancerous cells produce bone. This variety of bone cancer occurs most often in children and young adults, in the bones of the leg or arm. In rare circumstances, osteosarcomas can arise outside of bones (extraskeletal osteosarcomas).
  • Chondrosarcoma. Chondrosarcoma is the second most common form of bone cancer. In this tumor, the cancerous cells produce cartilage. Chondrosarcoma usually occurs in the pelvis, legs or arms in middle-aged and older adults.
  • Ewing sarcoma. Ewing sarcoma tumors most commonly arise in the pelvis, legs or arms of children and young adults.



What are the treatments for bone cancer?

Surgical removal of the tumor is the mainstay of treatment for bone cancers. Improved surgical techniques allow for most bone cancers to be removed without requiring amputation of an affected limb. However, reconstructive surgery is often done in addition to tumor removal in order to maximize function.

For most types of bone cancers, chemotherapy drugs are given in addition to surgery. One exception is chondrosarcoma, which is typically not treated with chemotherapy. Radiation therapy is often used for chondrosarcomas and for Ewing sarcomas.

Ewing sarcomas that do not respond well to other treatments are sometimes treated with high-dose chemotherapy followed by a stem cell transplant. In this procedure, the patient's stem cells (blood cells that have the potential to make all the different kinds of blood cells) are harvested from the bloodstream in a way similar to a blood donation. After high doses of chemotherapy medications to destroy the bone marrow, the harvested stem cells are returned to the body as with a blood transfusion. Over the next three to four weeks, the stem cells produce new blood cells from the bone marrow.

How is bone cancer pain managed?

The pain of bone cancer is medically treated with analgesic (pain-relieving medications). These may be nonprescription or prescription medications. Mild-to-moderate pain is treated with medications such as acetaminophen (Tylenol) or nonsteroidal anti-inflammatory medications (NSAIDs), including ibuprofen and naproxen. However, people taking anticancer chemotherapy drugs may need to avoid the use of NSAIDs due to the increased risk of bleeding.

Prescription medications may be used for moderate-to-severe cancer pain. Opioids -- stronger narcotic pain medications -- like codeine, morphine, oxycodone (Oxycontin), hydromorphone (Dilaudid), and fentanyl may be required to control severe pain. Sometimes a combination of medications is used to treat cancer pain. Opioid medications can be associated with side effects like drowsiness, constipation, and nausea.

What is the prognosis for bone cancer?

The prognosis, or outlook, for bone cancer depends upon the particular type of cancer and the extent to which it has spread. The overall five-year survival rate for all bone cancers in adults and children is about 70%. Chondrosarcomas in adults have an overall five-year survival rate of about 80%.

The five-year survival rate specifically for localized osteosarcomas is about 60%-80%. If metastases are present, meaning that the cancer has spread beyond bone, the survival rate is about 15%-30%, but there are factors that may affect the prognosis. Osteosarcomas tend to have a more favorable prognosis if they are located in an arm or leg, respond well to chemotherapy, and are able to be completely removed at surgery. Younger patients and females also tend to have a more favorable prognosis than males or older patients.

Ewing sarcomas have a five-year survival rate of about 70% when they are found in a localized stage. If they have spread to other sites (metastasized), the survival rate drops to 15%-30%. Certain factors have been associated with a more favorable prognosis for Ewing sarcomas, including smaller tumor size, patient age less than 10, having a tumor in an arm or leg (in contrast to a tumor in the pelvis or chest wall), and having a good response to chemotherapy drugs.

 

 



What are the risk factors for bone cancer?

It's not clear what causes bone cancer, but doctors have found certain factors are associated with an increased risk, including:

  • Inherited genetic syndromes. Certain rare genetic syndromes passed through families increase the risk of bone cancer, including Li-Fraumeni syndrome and hereditary retinoblastoma.
  • Paget's disease of bone. Most commonly occurring in older adults, Paget's disease of bone can increase the risk of bone cancer developing later.
  • Radiation therapy for cancer. Exposure to large doses of radiation, such as those given during radiation therapy for cancer, increases the risk of bone cancer in the future.



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