Rare but malignant, bone cancer occurs in one in 100 cases of cancer. Bone cancer, which can start from any bone in the body, is usually seen in the long bones of the arms and legs and in the pelvis. Bone cancers can metastasize to distant organs as well as to neighboring organs. Some types of bone cancer affect children, while others affect adults.
What is Bone Cancer?
Bone cancers are malignant tumors that invade the skeletal system and damage the tissues there. Bone cancer is a type of cancer that starts in the cartilage tissue in bones or joints and whose primary site of cancer is these tissues. The term bone cancer is not used for cancers that start in another organ and metastasize to the bone. The main treatment for bone cancer is surgery. They show great success especially in bone cancers diagnosed at an early stage.
Symptoms of Bone Cancer
Bone cancer is often diagnosed at late stages because its symptoms are vague. The most characteristic symptoms of bone cancer are swelling and pain. However, both symptoms can be caused by many diseases, such as sports injuries or osteomyelitis.
Symptoms of bone cancer in children also include pain. However, these pains are often thought to be related to growth. The biggest difference between pain caused by cancer and growing pains is that growing pains occur only at night. The pain of bone cancer, on the other hand, is constant but gradually increases in intensity.
The other most common symptoms of bone cancer are as follows.
- Involuntary weight loss,
- Fatigue,
- Lumps that appear on the bones,
- Bones break more easily than usual,
- Bone pain that worsens over time, especially at night,
- Limitation of movement if the affected area of the bone is close to the joint,
Causes of Bone Cancer
The causes of bone cancer are generally unknown. However, certain risk factors increase the likelihood of bone cancer. These risk factors are:
- Babies born with an umbilical hernia are 3 times more likely to develop Ewing’s sarcoma type of bone cancer in childhood.
- People who had retinoblastoma, a type of eye cancer, as a child are more likely to develop bone cancer as an adult. In addition, both types of cancer are thought to be the result of genetic predisposition.
- People with Li-Fraumeni syndrome, which is caused by a mutation in a gene that suppresses the growth of cancer cells,
- People with Paget’s disease, which is characterized by a disorder of the bone regeneration cycle,
- Those who have previously undergone radiotherapy treatment for another reason,
Types of Bone Cancer
The classification of bone cancers is based on the cell type in which the cancer started. The most common types of bone cancer are as follows.
Ewing Sarcoma
This type of cancer, which usually occurs in young people and children, is seen in the bones of the legs, arms and pelvis. In addition to bone tissue, it can also occur in vessels, muscle or fatty tissue.
Chondrosarcoma
It is the second most common type of bone cancer. This type of cancer starts in the articular cartilage and then spreads to the bone. It is usually seen in middle-aged and older adults. It is seen in the arm, leg and pelvis.
Osteosarcoma
Osteosarcoma, the most common type of bone cancer, starts from a bone cell called osteoblast. It usually occurs in the bones of the arms and legs of children and young adults. In rare cases, this type of cancer can also occur in tissues other than bone. These types are called extraskeletal osteosarcoma. It is especially common for people with Paget’s disease to develop this type of cancer.
How is Bone Cancer Diagnosed?
The first method used for the diagnosis of bone cancer is bone X-ray. Because tumor and bone tissue can be easily distinguished in these images.
However, it is very important to determine the location and type of tumors in order to plan the treatment. Imaging methods such as scintigraphy, computed tomography and MRI are also used for this purpose. These imaging techniques can be used to examine the tumor’s relationship with surrounding tissues, its extent and blood supply.
The purpose of computed tomography is to see the details in the bone. MRI I is used to see the distant spread, soft tissue or extension of the tumor in the bone.
Bone scintigraphy is used to detect the presence of metastases. X-ray is the first method used in bone pain, especially in children.
After all these techniques have been applied, a biopsy must also be performed to obtain a definitive diagnosis.
Bone Cancer Treatment Methods
Some criteria are taken into account when determining the treatment of bone cancer. These criteria used to determine the treatment method include the stage of the cancer, the type of cancer, the location of the cancer, how aggressive the cancer is and whether it has metastasized.
Benign Bone Tumors
Benign bone tumors in children can disappear spontaneously. For this reason, it is sufficient to carry out regular controls and follow them closely.
Benign bone tumors need to cause bone fractures to be operated on. In addition, surgery may be necessary to prevent the bone from growing, to take a biopsy sample if there is a suspicion about the diagnosis, or to create a curvature in the bone.
The aim of surgery for benign bone tumors is to remove only the tumor tissue and patch the empty space with the patient’s own bone tissue or tissue from a bone bank.
Surgical Treatment
The aim of surgical treatment is to remove the cancerous tissue and the surrounding tissues. It is the most common treatment used to treat bone cancer. In order to talk about complete success, the surgeon must remove all tumor tissue. Even a small piece of cancerous tissue can cause the cancer to progress and spread. In these cases, additional radiotherapy is required.
Limb-sparing surgery means removing only the damaged tissues without amputating the entire limb. However, after these surgeries, patients lose function in their limbs. In order to solve this problem, reconstructive surgical procedures should be applied to patients afterwards. To do this, the bone fragment removed must be replaced with a bone fragment from another part of the body or an artificial bone.
In some patients, preventive surgery is not possible to remove all cancerous tissue. In these cases, the cancerous limb must be amputated. On the other hand, there is less need for such surgeries as surgical advances are rapid.
Fibula Method
This method is usually applied in children. In bone cancers in children, growth cartilage and the articular surface are removed together with the bone. However, with this method, the bone called fibula is transplanted to the patient together with the growth cartilage. In this case, children’s bone growth continues normally and children do not encounter any problems.
Another group of patients in whom the fibula bone is used are those in whom the tumor has spread to cover the entire thigh bone. In these patients, the space inside the thigh bones can be filled with fibula. After this operation, which has a waiting period of one year, patients regain their former health if the body does not reject the bone.
Finally, it can also be used instead of bone cement in frozen bone treatments. In this method, the bone frozen with nitrogen at -180 degrees is embedded in the fibula-filled bone.
Radiotherapy
As in many other cancers, high-energy X-rays are used in the treatment of bone cancer. Radiotherapy is administered both after surgery and in patients who do not need surgery. It is the standard treatment for Ewing sarcoma and is used in combination for other types of bone cancer.
Chemotherapy
It is a treatment that uses powerful drugs to destroy bone cancer cells. It is a treatment method generally used for bone cancers such as Ewing sarcoma and osteosarcoma. It gives more effective results when used together with radiotherapy.
Immunotherapy
It is a drug treatment that targets the molecule that causes cancer cells to grow. It is usually suitable for patients with osteosarcoma type of bone cancer. It is applied to these patients in addition to other treatment methods.
