Bone cancer occurs due to abnormal growth of cells in the bone and it grows out of control. Sometimes cancer can spread from other sites to the bone and this is called bone metastasis and this is not a true bone cancer. Depending on the type of cells involved, there are different types of bone cancers. The most common types are osteosarcoma, chondrosarcoma, and Ewing sarcoma.
Symptoms of bone cancer
Bone cancer usually presents with pain and swelling. The pain usually worsens over weeks to months. Patients can also present with a pathological fracture of the bone due to the tumour.
Investigations for bone cancer
First investigation in any case of a suspected bone cancer is an xray of the part of body where the symptoms developed. If the X-ray shows any features of bone cancer, other investigations should be done which include blood tests, MRI scan of the area, a full-body bone scan and a CT scan of the chest to look for a spread of the cancer to other parts of the body. A biopsy –a minor procedure in which the doctor removes a small amount of tissue from the area suspected to have cancer- is a must to confirm the diagnosis of bone cancer. Ideally, the biopsy test should be done after all the blood and imaging studies are completed. Since the site and technique of the procedure have an impact on the final surgical treatment and outcome, it is recommended that both the biopsy and the surgery should be done by a surgical oncologist specialised in bone tumours preferably at a cancer centre with multidisciplinary tumour board.
Treatment of bone cancer
Depending on the type of bone cancer, treatment includes one or more of the following:
Surgery
In general, surgery is the main treatment for bone cancer. The type of surgery depends on where the cancer is and how big it is. In most cases, surgeons do "limb-preserving" surgery in which the surgeon removes the cancer affected part of bone without removing the entire arm or leg where the cancer is growing and the defect in the bone is reconstructed by a metallic implant. Sometimes, when the tumour is not amenable to "limb-preserving" surgery due to various reasons, surgery might need to involve an amputation in which the surgeon removes all or part of the arm or leg along with the cancer. After an amputation, the patient can ambulate independently with the help of a prosthesis.
Chemotherapy
Chemotherapy is the use of medicines that kill cancer cells or stop them from growing. Most people with bone cancer have chemotherapy before and after their surgery. But chemotherapy alone will not cure bone cancer.
Radiation therapy
Radiation kills cancer cells. Doctors might use radiation when people can't have surgery or when all of the cancer cannot be removed safely with surgery.
After treatment
Patients should come for regular follow up visits in the OPD for clinical examination and x ray evaluation to look for any reappearance of cancer and for rehabilitation. Patients can get various problems related to the metallic implant. Lifespan of the implant is around 10 years. In case of issues like implant loosening or breakage, a revision surgery with new implant may be required.
About the Author
Dr Manu Paul MBBS, MS ORTHOPEDIC SURGERY , MCh (Surgical Oncology Trainee at RCC Trivandrum)