Bone cancer is one of the cancers that affect children, adolescents and young adults more frequently than older people. There are different types of bone cancers, and most affect young males more often than young females. As is the case with most cancers, there are generally no symptoms when the bone cancer is in the early stages. Symptoms usually present only after the cancer has spread (metastasized) to other tissues of the body. Knowledge, that is, information on this sneaky attacker is vital for its early detection and effective treatment.
As August is Bone Cancer Awareness and Prevention Month, today's column will explore what this disease is, how it is diagnosed, treated and detected and highlight some of the risk factors. The awareness color for bone cancer is white. What is bone cancer? Bone cancer is an abnormal growth of new, malignant tissues in bone cells. The most common, primary bone cancers, in order of their occurrence are: Osteosarcoma: Males between the ages of 10 and 25 years old are most commonly affected by this disease. It is often in the long bones of their arms and legs.
This cancer is very aggressive and there is considerable risk of it spreading to the lungs. The five-year survival rate for this cancer is approximately 65 percent. Chondrosarcoma: This is the second most common bone cancer, and accounts for some 25 percent of all bone cancers. These malignant tumors occur in cartilage cells and can be either very aggressive or relatively slow growing. Unlike other bone cancers, Chondrosarcoma is most common in people who are over the age of 40 years. It is also more common in males. This cancer most commonly affects the bones of the pelvis and hips.
The five-year survival rate for the aggressive form is 30 percent, and 90 percent for slow growing tumors. Ewing's sarcoma: This is the most aggressive of all bone cancers, and affects even younger people -- primarily those between ages four and 15 years old. It affects males more frequently than females. It is very rare in people who are older than 30 years old. Ewing's sarcoma most commonly occurs in the middle of the long bones of the arms and legs. The three-year survival rate is approximately 65 percent, however, this rate is considerably lower if the cancer spreads to the lungs or other tissues of the body. Malignant Fibrous Histiocytoma (MFH): This cancer affects the soft tissues around bone -- muscle, ligaments, tendons and fat. It most commonly affects the soft tissues of the leg, behind the knee in older people, aged 50 to 60 years old. Men are affected twice as often as women.
Fibrosarcoma: This is a much rarer type of bone cancer. It most often affects people who are aged 35 to 55 years old, often in the soft tissues of their leg, and behind the knee. This cancer also affects men more than women. Signs and symptoms of bone cancer In the early stages of the disease, there is generally no indication that anything is wrong. The most commonly reported symptom is pain. In most cases, the pain may be present either at night or with activity. Depending on the growth of the tumor, affected persons sometimes suffer and self-treat for pain for extended periods - weeks, months and even years, before seeking professional medical advice.
On occasion, a lump or mass, either on the bone or in the surrounding tissues may be felt. This symptom is most common with MFH or Fibrosarcoma, but it can also occur with other bone cancers. Sometimes, the bones can become weakened by the cancer and this can lead to fractures even when there is little or no trauma -- often just from pressure -- like just standing on the affected leg. Should the cancer press on the surrounding nerve, this may cause pain, numbness, and/or tingling in the feet or hands. If the cancer presses on the surrounding blood vessels, the blood flow to the feet or hands will be affected.
Other less common symptoms may be fever, chills, night sweats, and weight loss. These symptoms are more common after the cancer has spread to other parts of the body. Making the diagnosis The first thing that the doctor will do is to take a complete medical history. This will include a summary of all past health issues, as well as details of any symptoms currently being experienced. Next will be a complete physical examination, including testing muscle strength, sensation to touch, and reflexes as well as certain blood tests, to help identify or exclude a possible cancer.
The doctor will also order imaging studies. These can range from a simple X-ray which can help to diagnose the type of cancer, identify whether the bone had fractured, or weakened and was at risk for a potential fracture. Another more advanced test that may be ordered is a CT scan (CAT scan) which gives the doctor a cross-sectional picture of the bone, and increases the opportunity to identify a possible malignant tumor, including its size and precise location. An MRI (magnetic resonance imaging) may also be used to aid in the diagnosis.
This is another advanced imaging technique that provides even more detailed (clean picture), cross-sectional views of the body, including muscles, tendons, ligaments, nerves and blood vessels. This test also helps to determine whether the bone cancer has spread to surrounding soft tissues. A bone scan many also be done. This test identifies areas of rapidly growing bone. It may be ordered to find out whether there are any other areas of bone cancer throughout the body.
Additionally, the doctor may take a small sample of the tumor, a biopsy, to send to the lab for specific testing. Treatment of bone cancer There are many methods of treating bone cancer, but the best method is based on the type, the location, how aggressive the cancer is, and whether it is localized or has metastasized. There are three main types of treatment for bone cancer -- surgery, chemotherapy, and radiation therapy. These can be used individually or in combination. Surgery is frequently used to treat bone cancer. The goal in surgery generally is to remove the entire tumor along with the surrounding normal bone. Following surgery, the tumor is examined by a pathologist to determine whether there is normal bone surrounding the tumor. If there is, there would be less chance of a recurrence of the cancer.
Depending on the amount of bone removed, the surgeon may replace it with a bone graft or a (metal) implant. Some of the implants used have the ability to lengthen when used in growing children. Should a combination treatment be needed, referral may be made to a medical oncologist for a course of chemotherapy, to stop the growth of cells or kill the cancer cells. Referral may also be made to a radiation oncologist for radiation therapy. This treatment method uses high energy x-rays, directed at the site of the cancer to stop the growth or kill the cancer cells.
Radiation therapy is given in small doses daily over a period of days or months. Risk factors for bone cancer There are many factors that increase the risk for developing cancer, including bone cancer, that are avoidable. Chief among these are certain lifestyle practices such as diet and exercise. There are, however, some specific risk factors for bone cancer which cannot be avoided.
These include being a child or young adult, previous radiation or chemotherapy, a history of Paget's disease, family history of bone cancer and hereditary retinoblastoma. The best protection against cancer is early detection. This means people must pay attention to the signals that their body gives, have regular annual medical check-ups and always seek professional medical attention whenever something feels wrong. o For information on any cancer related topic, or if you would like to have someone speak to your church group, school, club, please call the Cancer Society at 323-4441 or 323-4482. You may also visit our website for up-to-date information, at www.cancersocietybahamas/org.
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