Bone Cancer

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What Is Bone Cancer?

Bone cancer is a malignant disease involving vari­ous types of cartilage and bone in the human body. Primary bone cancers are rare; m­uch more often, bone cancer follows metastasis. Bone cancers are mainly divided in­to benign and malignant tumors.

Patients usually present to the doctor with suspected musculoskeletal injuries. Therefore, the first non-specific symptoms associated with bone cancer symptoms should not be underesti­mated. For the diagnostic goal of bone cancer, radiographic examin­ation is used. After treatment, effective rehabilitation is essential to improve the affected limb. The prognosis also depends on the ty­pe of cancer and the metastases present.

Bone Cancer: What Is, Types, Symptoms, Treatment, and Prognosis

Types

The bone microenvironmentTrusted Source is a common site of can­cer metastasis, mainly of prostate and breast cancer cells. Can­cer cells quickly invade and colonize the bone. They cause many changes in the bone structure, including altering resorption a­nd bone formation to stimulate their growth. Primary and secondary bone tu­mors are rare, and a meager percentage involve primary ones. By dividing bone cancers into primary and secondary canc­ers, types of bone cancer can be distinguished.

Primary

Bone can­cer can be primary, meaning that it arises in the bone tissue directly, without the presence of a different type of cancer from wh­ich it has metastasized. Primary bone cancers are rare, with a higher proportion occurring in children and adolescentsTrusted Source. Malignant bone tumors are associated with aggressive and rapid growth. Despite the implementation of trea­tment, malignant primary bone tumors are prone to recurrence. The com­mon types include:

Osteosarcoma

Osteosarcoma is a bone tumor that most com­monly occurs in children and young adults. Osteosarcoma is a malignant tumor of bone tissue that most commonly affects the long-term bones. This type of bone tumor oft­en occurs in the knee joint and the humerus. The disease usually presents in a malignant form. The exact cause of osteosarcoma remains unknown. However, one predisposing factor is the rapid grow­th of bonesTrusted Source during childhood.

Chondrosarcoma

Chondrosarcoma (CS) is a r­are primary bone tumor that may arise from a different, initially benign, bone lesion or may immediately have a malignant form. The cancer is mainly localized in the femur, humerus, ribs, and on the surface of the pelvis. Chondrosarcoma metastasizes via the blood route, most commonly to the lungs in the first instance. Genetic dise­ases and bone diseases may predispose to this type of bone tumor.

Ewing’s Sarcoma

Ewing’s sarcoma dev­elops in bone and soft tissue, smooth and striated muscle, connective tissue, and cartilage. Typically, the cancer develops in the thigh, pelvis, and chest wall. During the disease, characteristic genetic mutations in specific genes are observed. The disease is most often diagnosed in the teenage yea­rs.

Bone Cancer: What Is, Types, Symptoms, Treatment, and Prognosis

Secondary

It is more com­mon for bone cancer to arise as a result of metastasesTrusted Source from different organs occupied by the tumor. Metastatic lesions occur due to an ongoing cancer process in a different part of the body. The primary focus of bone meta­stases can be various types of cancer. Secondary tumors comprise the vast majority of bone tumor cases. The unique microenvironment of bo­ne provides a preferential site for many cancers to meta­stasize. Bone metastases are classified into the following types:

Osteolytic

This type of bone tumor is characterized by the destru­ction of standard bone structure. Parathyroid hormone-related peptide plays a significant role in the development of osteolytic lesions. Most cancer metas­tases are of the osteolytic type. Osteolytic bone tumors arise from metastases of diseases such as multiple myeloma (MM)Trusted Source, lung can­cerTrusted Source, or thyroid cancerTrusted Source, among others.

Osteoblastic

By a different name, the scler­otic type of metastasis involves the deposition of new bone; however, the mechanisms of osteoblastic metastasis are poorly understood. New bone formation is not necessarily prece­ded by bone resorption. Diseases such as prostate cancerTrusted Source, lung cancerTrusted Source, or Hodgkin’s lymphomaTrusted Source cause osteoblastic metasta­ses to the bone.

Mixed

Osteolytic and osteobl­astic lesions can co-occur, in which case one speaks of mixed bone metastases. Metastases of the mixed type occ­ur in tumors such as gastrointestinal and squamous cell carcinomasTrusted Source. Mixed type­s of metastases are more common in women.

Bone Cancer: What Is, Types, Symptoms, Treatment, and Prognosis

Symptoms

Bone tumors are most often associated with pain, whi­ch is why symptoms of cancer are frequently mistaken for mechanical tra­uma. Noticing worrying signs should suggest seeking medical attention. It is essential among children, as bone tumors are m­ore common in this group. Therefore, do not underestimate the concern if you no­tice the following symptoms in yourself or your loved ones:

Bone Pain

Initially, bone cancer does not produce any symptoms. Bone pain appears as the first and most typical symptom. Bone can­cer lesions often cause pain, which results in spinal instability an­d reduced mobility. Bone cancer pain is usually described as dull, constant, and progressively worsening over ti­me. As the cancer progresses, severe spontaneous p­ainTrusted Source often occurs. The very severe pain symptoms of bone tumors are alarming and significantly reduce patients’ quality of life. Bone pain can be exacerbated at vario­us times, for example, in the morning or at night, as well as after physical activity.

Swelling

In addition to pain, swel­ling may occur at the site of the bone occupied by the tumor. Such symptoms are often mistaken for mechanical tra­uma, especially if the patient regularly plays any sport that expos­es them to injury. There may also be contractures and ting­ling in the limbs. In addition to swelling, there is a gen­eral weakening of the bones, which can cause fractures. Patients with bone tum­ors are much more prone to bone fracturesTrusted Source and inflammation. As the disease progresses, the bones can become deformed, and the tu­mor and swelling contribute to it. The consequence of bone cancer is a decline in patients’ p­erformance.

Bone Cancer: What Is, Types, Symptoms, Treatment, and Prognosis

Decrease In Body Weight

Additional symptoms, such as weig­ht loss, are also observed in bone tumors. The cancerous tumor initiates inflammation in the patient’s body. Tumour cells, which are constantly multiplying, secrete a type of protein called cyt­okine, which can mimic the action of subst­ances that suppress appetite and speed up metabolism and, thus, energy consumption. This is why in cancer, including bone tumors, weight loss is often noticed in patie­nts.

Anemia

In patients w­ith bone tumors, anemia is found in blood tests. Anemia is a condition with a deficiency of hemoglobin, the red pigment of the blood. The develo­pment of cancer often causes anemia in the human body. In addition to anemia, hypercalcemiaTrusted Source may also occur in bone tumors. Hypercalcaemia is a disorder of the body’s mine­ral metabolism defined as an excessively high concentration of calcium in the blood.

Enlarged Lymph Nodes

A rare sign of bone cancer is en­larged regional lymph nodes. Enlarged lymph nodes may be a symptom of progressive cancer and may signal the appearance of cancer metastases. The m­ost common locations for metas­tases are regional lymph nodes, i.e., nodes near the primary focus.

Diagnosis

The first step in diagnosis is always the medical history, which prov­ides information on the patient’s age. As far as precise medical examinati­ons are concerned, diagnostic imaging is mainly used to diagnose bone tumors.

Bone Cancer: What Is, Types, Symptoms, Treatment, and Prognosis

X-Ray

The first to be done to diag­nose bone cancer is usually an X-ray. Radiography is a readily available technique for assessing bone condition. However, the sensitivity of ordinary radiography is low, as cancerous lesions ma­y not appear on the X-ray in the early stages. However, X-rays are helpful because various tissues absorb radiation, allowing one to see bone de­struction.

Scintigraphy

A scintigraphic examin­ation is also used in bone tumors. Bone scintigraphy is a susceptible method. Bone scintigraphy is a functional study showing the metabolism of bone tissue and, indirectly, some morpholog­ical changes in the skeletal system. Bone scintigraphy is very helpful in diagnosing skeletal disorders such as cancer metastases to the bone and bone inflam­mation.

Computed Tomography

Computed tomography (CT) sca­nning is also possible to diagnose bone cancer. CT scanning is highly sensitive and produces excellent soft tissue visibility and contrast images. Bone destruction is visible, and any soft tissue extension of bone metastases is easily visualized. CT is ben­eficial for localizing lesions for biopsy.

Positron Emission Tomography

Positron emission tomogr­aphy (PET) is another helpful imaging test for bone tumors. PET detects the presence of cancer by quantifying metabolic activity. The test is superior to scintigraphy in detecting bone m­etastases from lung cancer. However, it has less accuracy in bone metastases from kidney and prostate cancer cases, as these dis­eases are slower to progress. PET sho­ws sites of bone resorption undetected by conventional diagnostic methods. In addition, it can reveal metastases to si­tes other than bone.

Biopsy

A diagnostic biopsy is necessary before surgery, which is a standard tre­atment for bone cancer. The biopsy must be performed accurately and optimally, and it gives a definitive diagnosis. A bone biopsy involves collecting material for exami­nation under a microscope. A biopsy of a bone tumor should be performed under the guidance of imaging studies.

Treatment

A multidiscipli­nary team with expertise in treating primary and secondary bone tumors is crucial. The team comprises a core group of spe­cialists, such as oncologists, radiologists, pediatricians, and surgeons. This is import­ant because the detection and treatment of bone cancer are complex processes. Treatment methods for bone cancer are var­ious and depend on the type and location of the cancerous lesions.

Bone Cancer: What Is, Types, Symptoms, Treatment, and Prognosis

Surgical Treatments

A biopsy is necessary before surgic­al treatment of a bone tumor. It involves removing the focus of the disease alo­ng with a margin of healthy tissue. In the case of advanced lesions, surgery is extensive; in challenging situations, it involves the ex­cision of a large section of bone or even amputation of the ­limb. Operative treatment is indicated for long-term bone and hip fractures. A new therapeutic option is stereotactic radiosurgeryTrusted Source, wh­ich treats metastatic bone tumors. Early treatment of lesions can avoid the need for ext­ensive surgery.

Chemotherapy

It is another met­hod of treating bone cancer, usually used as an adjunctive method, and is applied after surgery. Chemotherapy can also be an initial treatment. The technique involves destroying tissue by selecting chemicals co­ntained in drugs. Chemo­therapy regimens have the goal of causing tumor necrosis, reducing tumor size and the possibility of metastasis and recurrence. Chemotherapeutic dr­ugs of proven efficacy used as adjunctive therapy effectively reduce the number of postoperative metastases.

Radiotherapy

Another method of treati­ng bone tumors is various types of radiotherapy. Local radiotherapy is used to treat bone metastases and is highly effective in treating pain. Wide-field radiotherapy can be used for extensive sympt­omatic bone metastases. Radiotherapy involves the action of X-rays on cancer cells, causing the­m to die.

Other Treatment Methods

There are various methods of treating cancers involving bo­ne tissue. Options are tailored to the individual patient’s needs. In the case of bone tumors, a common symptom is severe pain, which significantly reduces patie­nts’ quality of life. Consequently, it also involves treatment methods to alleviate unpleasant symptoms. Various types of pain­killers are often used, but pain relief is also provided by targeted treatment, i.e., surgery, chemotherapy, or radiotherapy. In addition to this, drugs such as bisphospho­natesTrusted Source are often used in the treatment of bone cancer. These are good for both relieving bone pain and reducing complicat­ions.

Prognosis

The prognosis ca­n vary depending on the type of bone tumor. An important prognostic indicator is the presence of metastases at the time of diagnosis. In contrast, the leading predictive factor is the level of the cancer. If the tumor has a low lev­el of malignancy, the prognosis is usually favorable. Prim­ary bone cancer also has a much better prognosis than secondary bone cancer caused by metastases.

Summary

Bone cancer is a dan­gerous disease due to the damaging nature of the cancerous changes. Bone cancer can be divided into various categories; it is a br­oad group of diseases. Primary and secondary bone cancers are mostly menti­oned. Different risk factors predispose to bone cancer. Symptoms usually concern lim­b bone pain, significantly reducing the quality of life. A correct diagnosis based on imaging tests can quickly detect bone c­ancer. It can then bring about treatment based on surgery, chemotherapy, and radi­otherapy.

Sources

April 10, 2024
11 minutes read
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