Bone Cancer

Cancer that starts in a bone is uncommon. Cancer that has spread to the bone from another part of the body is more common. The term "bone cancer" does not include cancers that begin elsewhere in the body and spread (metastasize) to the bone. Instead, those cancers are named for where they began, such as breast cancer that has metastasized to the bone.

There are three types of bone cancer:

• Osteosarcoma is the most common type of bone cancer. It occurs most often between ages 10 and 19. It can also occur in adults older than 65 years. It frequently occurs at the ends of long bones, but it can form in any bone.
• Chondrosarcoma is an uncommon form of bone cancer. It begins in cartilage in the pelvis, legs, and arms and usually occurs after age 40.
• Ewing's sarcoma occurs most often in children, teens, and young adults. It is more common in boys than girls. Ewing sarcoma tumors usually form in the hip bones, the ribs, or in the middle of long bones. Ewing tumors are most common in bone but can also form in soft tissue.

The most common symptom of bone cancer is pain. Other symptoms vary, depending on the location and size of the cancer. Surgery is often the main treatment for bone cancer. Other treatments may include amputation, chemotherapy, and radiation therapy. Bone cancer can recur after treatment, so regular follow-up visits are important.

Signs and symptoms of bone cancer include:

• Bone pain
• Swelling and tenderness near the affected area
• Broken bone
• Fatigue
• Unintended weight loss

Pain is the most common symptom of bone cancer, but not all bone cancers cause pain. Persistent or unusual pain or swelling in or near a bone can be caused by cancer or by other conditions. It is important to see a doctor to determine the cause. Other symptoms may vary depending on the location and size of the cancer.

Tumors that occur in or near joints may cause swelling or tenderness in the affected area. Bone cancer can also interfere with normal movements and can weaken the bones, occasionally leading to a fracture. Other symptoms may include fatigue, fever, weight loss, and anemia. None of these symptoms is a sure sign of cancer. They may also be caused by other, less serious conditions. It is important to check with a doctor.

The cause of most bone cancers is unclear. In general, cancer begins as an error in a cell's DNA that tells the cell to grow and divide in an uncontrolled way. These cells continue to live, rather than dying at a set time. The accumulating mutated cells form a mass (tumor) that can invade nearby structures or spread to other areas of the body.

Certain risk factors can increase the chance of developing bone cancer:

• 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.

Tests and procedures used to diagnose bone cancer may include:

• Bone scan
• Computerized tomography (CT)
• Magnetic resonance imaging (MRI)
• Positron emission tomography (PET)
• X-ray

Your doctor may recommend a biopsy – a procedure to remove a sample of tissue from the tumor – for laboratory testing. This testing can tell your doctor whether the tissue is cancerous and, if so, what type of cancer you have. Testing will also reveal the cancer's grade, which helps doctors understand how aggressive the cancer may be.

If you have or have had bone cancer, you can take steps to manage the stress that accompanies the diagnosis:

• Learn about bone cancer so you can make informed decisions about your care.
• Have a schedule of follow-up tests and go to each appointment.
• Take care of yourself so that you are ready to fight cancer. This includes eating a healthy that includes plenty of fruits, vegetables and whole grains, exercising for at least 30 minutes most days of the week, and getting enough sleep so that you wake feeling rested.
• Accept help and support from family and friends.
• Talk with other cancer survivors or attend support groups.

The treatments for bone cancer are based on the type of cancer, the stage of the cancer, your overall health and your preferences. Some bone cancers are treated with surgery alone; some with surgery and chemotherapy; and some with surgery, chemotherapy, and radiation therapy.

The goal of surgery is to remove the entire bone cancer. In most cases, this involves special techniques to remove the tumor in one single piece, along with a small portion of healthy tissue that surrounds it.

Chemotherapy is a drug treatment that uses chemicals to kill cancer cells. Chemotherapy may also be used in people with bone cancer that has spread beyond the bone to other areas of the body. The drugs usually used to treat bone cancer include:

• Doxorubicin (Adriamycin, Doxil)
• Cisplatin (Platinol, Platinol-AQ)
• Carboplatin
• Etoposide(VP-16, Etopophos, Toposar)
• Ifosfamide(Ifex)
• Cyclophosphamide(Cytoxan)
• Methotrexate (Trexall)
• Vincristine(Oncovin)

Radiation therapy uses high-powered beams of energy, such as X-rays, to kill cancer cells. Radiation therapy, typically given along with chemotherapy, is often used before an operation. This may decrease the possibility that amputation will be necessary.

Radiation therapy may also be used in people with bone cancer that cannot be removed with surgery. After surgery, radiation therapy may be used 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.