What is Bone cancer?

In good health normal body cells have a limited life span so after completing their function or duty, they get destroyed and are replaced by new functional cells regularly by a process called cell cycle. In cancer these old cells escape the killing mechanism and start multiplying in uncontrolled fashion consuming nutrition and oxygen, overtaking the cell cycle these cells keep accumulating, forming a lump called tumour. The cancer cells from tumour may also spread to other parts of the body and damage other organs too. Bone cancer cells mainly spread to lungs and other bones.

What are the common bone cancers?

Most common bone cancers are Osteosarcoma and Ewings sarcoma, they mainly affect children of age group between 5-25 yrs Chondrosarcoma, which is seen later, after 40 years of age.

What are the symptoms of Bone cancer?

Most common symptom is persistent pain Followed by swelling which gradually increases in size Less common presentation is fracture following trivial trauma

What are the causes of bone cancers?

There is no specific reason/cause of bone cancer. Its not associated with hereditary or environmental causes and it does not run-in family.

How do we diagnose bone cancer?

Few tests are mandatory to confirm bone cancer and plan treatment of the same First investigations we order are x ray and MRI of the affected bone. They give information about type of lesion, nature of lesion and bone quality, exact size and extent of lesion, its relation to important structures like blood vessels and nerves of limb and it also helps in planning biopsy and surgery. Most important investigation is biopsy –this test is mandatory because there are many varieties of bone cancer and treatment of each cancer is different and specific. Biopsy gives information regarding type of cancer and grade of cancer, which is very important to plan treatment. In this procedure a small piece of abnormal bone is taken from cancerous part of the affected bone with the help of needle and subjected to microscopic examination in the laboratory by a pathologist.

Few important things we need to understand about biopsy are

- There is No role of a simple FNAC test
- Biopsy Should be performed by a surgeon trained in orthopaedic oncology at a Bone cancer centre
- It’s a simple day care/outpatient procedure, which takes just 10-15 mins
- No major anaesthesia is required
- Opening of the bone and taking tumour tissue is not advisable (open biopsy)
- Most importantly cancer does not spread by doing needle biopsy

PET CT is done once the cancer type is confirmed, It is used to find out whether cancer has spread to other parts of the body and also it gives information regarding biological activity of the tumor.

How is bone cancer treated?

Depends on type, grade and spread of tumor, bone affected, and which part of bone is affected. Bone cancers need multimodality treatment in the form of combinations of chemotherapy, surgery, and radiotherapy. Treatment differs from patients to patients based on many factors like age, bone affected and spread of cancer, so each patient treatment should be planned in a multidisciplinary team meeting in the presence of surgeon, medical oncologists, radiation oncologists, radiologist, and pathologists.

- Treatment of osteosarcoma - We start with injectable medicines called chemotherapy, it helps in stopping the spread of cancer to other parts of the body and reduces cancer size thus making surgical excision of tumour easier. It is followed by surgery where the affected part of the bone is surgically removed from the body. After which again chemotherapy are given again.
- Treatment of Ewings sarcoma - Treatment is started with Chemotherapy for 9-12 weeks – followed by surgery to remove bone cancer or in few cases where surgery is morbid, we can treat with only radiotherapy followed by chemotherapy again for 4-5 months.
- Treatment of chondrosarcoma - In chondrosarcoma only treatment option is surgical removal of bone cancer, no role of chemotherapy or radiotherapy

When to Consult a Doctor?

You can also get in touch with the expert Oncology doctors at Narayana Healthcare based in your city to get immediate attention and medical support during injuries, health disorders or any other health concern.

FAQ

Q. Is amputation the only answer in bone cancer?

A. Few decades back all bone tumor patients were treated with amputation – where entire affected limb is surgically removed. With advance in imaging techniques, adjuvant treatment like chemotherapy/ radiotherapy and dedicated trained orthopaedic oncosurgeons, we can save limbs in more than 90 percent of our patients. Today we perform surgery called limb salvage/saving surgery, in which cancer only affected part of bone is removed in one piece with good cover of normal muscle all around and defect created is reconstructed with various options available. For more details on limb salvage surgery watch my educational videos on limb salvage and reconstruction methods. After these limb salvage surgeries patient can live near normal life and perform all the daily activities like walking, climbing steps, riding bike, driving car etc

Q. Does the cancer come back after complete therapy?

A. In majority of the patients, it won’t come back but in small percentage of patients it can come back at local site or other part of the body. It depends on multiple factors like tumor size, response to chemotherapy and initial spread of cancer.

Q. Is bone cancer curable?

A. Answer is A big yes. If detected early and treated with multimodality approach 60-80 percent of the patients can be completely cured of cancer.