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Bone Cancer

About the Condition

Bone cancer is incredibly rare, with only 600 cases diagnosed in the UK every year*. Bone cancer occurs when the genetic material of cells in the bone become damaged or changed, producing mutations that affect normal cell growth and division. The abnormal cells then replicate, causing cancer. If undetected, the cancer can spread beyond the bones and move to other parts of the body.


Known risk factors include:
 

  • A condition known as Paget’s disease of the bone, where the normal cycle of bone growth is disrupted
  • Fast-growing bones – as the majority of cases of bone cancer develop in teenagers it is thought the rapid growth spurt that occurs during puberty may in some way make bone tissue more vulnerable to cancer
  • Previous exposure to high doses of radiation, such as undergoing radiotherapy; however, the increased risk associated with radiotherapy is small.
  • Rare genetic conditions such as Li-Fraumeni syndrome, which affects around 1 in every 142,000 people.
  • A history of retinoblastoma, which is a rare type of childhood cancer which develops in the eye. People who have had this condition have an increased risk of developing bone cancer.


There are many different types of bone cancer, all of which are extremely rare, but the four most common are:
 

  • Osteosarcoma, which is the most common type of bone cancer and usually develops in teenagers and young adults, although it can be contracted at any age. It usually develops in the larger bones like the thigh bone (femur) or the shin bone (tibia). Most cases develop in teenagers and young adults, but you can get it at any age.
  • Ewing's sarcoma, which is most common in teenagers, although it can also develop in adults, and usually develops in the pelvis, thigh bone or shin bone.
  • Chondrosarcoma, which usually develops in adults aged between 30 and 60, and mostly affects the pelvis, thigh bone, upper arm bone, shoulder blade and ribs
  • Spindle cell sarcoma, which is very similar to osteosarcoma in terms of its symptoms and treatment, but it affects older adults aged 40 or over*.


Symptoms

The main symptom of bone cancer is persistent bone pain. This usually begins with tenderness in the affected bone, which progresses to a constant ache that often gets worse at night or when the bone is in use.


Less common symptoms of bone cancer include:
 

  • a high temperature (fever) of 38C (100.4F) or above
  • unexplained weight loss
  • sweating; usually at night
  • swelling and redness around the affected bone
  • a noticeable lump on or around the affected bone


In some cases, bone cancer can weaken the bone, which can lead to fractures caused by relatively minor falls or injuries.


If any of these symptoms apply to you, or if you have any concerns about similar symptoms, it is essential that you see your doctor at once, as your chances of recovery are much higher if your cancer is diagnosed early. Bone pain that persists for more than three days is unlikely to be the result of growing pains, and while it is also highly unlikely to be bone cancer it is important that the symptom is investigated immediately as it could be a symptom of arthritis, which also benefits from an early diagnosis.


Diagnosis

If you’re referred to CCL for diagnosis, your consultant or oncologist will advise you on which tests are relevant to your individual symptoms. Because bone cancer is so rare, it can be difficult to diagnose. The tests for this cancer usually include:
 

  • A physical examination of the affected area
  • A blood test, to rule out other conditions such as arthritis or an infection, and to test for any cancer indicators
  • A Magnetic Resonance Imaging (MRI) scan, which is a procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body
  • An X-ray, which is when low level radiation is used to create an image of the body
  • A Computerised Tomography (CT) scan, which shows a 3D image of the area being looked at
  • A bone scan, which is when a small amount of radioactive material is injected into your veins, as abnormal areas of bone absorb this at a faster rate than healthy bone. The damaged areas then show up as ‘hot spots’ on the scan
  • A core needle biopsy, which is performed under anaesthetic (depending on where the bone is located this could be a local anaesthetic or general anaesthetic). A thin needle is inserted into the bone and used to remove a sample of tissue.
  • An open biopsy, which is performed under a general anaesthetic. The surgeon makes an incision in the affected bone to remove a sample of tissue.


Staging

Once these tests have been completed and the results have come through, it should be possible to tell you what stage and grade the bone cancer is at. Staging is a description of how far a cancer has spread and grading is a description of how quickly the cancer is likely to spread in the future.


A widely used staging system in England uses three stages to assess cases of bone cancer:


Stage 1 – the cancer is low-grade and has not spread beyond the bone. Stage 1 can be further divided into two sub-stages:

  • Stage 1A – the cancer is still limited to the inside of the affected bone.
  • Stage 1B – the cancer has started to spread into the outer layer of the bone.

Stage 2 – the cancer has still not spread beyond the bone but it is a high-grade type of cancer; again this can be divided into two sub-stages:

  • Stage 2A – the cancer is still limited to the inside of the affected bone.
  • Stage 2B – the cancer has started to spread into the outer layer of the bone.

Stage 3 – the cancer has spread into other parts of the body, such as the lungs.


Treatment

At CCL, patients with bone cancer are treated by a team of different specialists, called a Multi-Disciplinary Team, or MDT. This team works together to create a treatment plan to suit the individual needs of the patient. The treatment protocol for bone cancer varies a great deal depending on the stage of the disease. Treatment options include:
 

  • Surgery, where there are two main options
    • Limb-sparing surgery – this is usually possible when the cancer has not spread beyond the bone, and the bone can be reconstructed, either by a bone graft or some form of prosthetic
    • Amputation – this may be required if you develop a serious complication after limb-sparing surgery, if the cancer involves structures which are important for the function of the limb, or if the cancer:
  • has spread beyond the bone into major blood vessels or nerves
  • has spread beyond the bone into your skin
  • has developed in a part of the body where limb-sparing surgery is not technically possible, such as in the ankle


Some treatments can be used before surgery, to attempt to shrink the treatment to limit the extremity of the operation, as well as after surgery to improve outcome. These include:
 

  • Radiotherapy, which is where high-energy rays are used to destroy the cancer cells.
  • Chemotherapy, which involves the use of chemical agents which are toxic to cancer cells, destroying them and preventing them from spreading to different areas. This can be given by injection or in tablet form.


Support Services

Cancer doesn’t just leave a physical impact on an individual, it can have a huge emotional effect as well. Cancer and its treatment can be overwhelming, causing a wide variety of emotions, and it is important to remember that there is no right or wrong response. Reactions vary hugely from person to person, and most people find that it becomes easier to cope when they’re given additional support, so that’s what we do.


At CCL we provide support that caters to both the physical and emotional needs of the patient, before, during and after treatment. We offer a wide range of services for patients, as well as their loved ones, designed to make a very difficult time as easy as possible, and to give our patients the best treatment and support possible. These include counselling, physiotherapy, Pilates, group sessions and many more.


As treatment for bone cancer could leave you with decreased mobility, or dealing with a limb amputation, we have dedicated specialists on hand to help you readjust to the physicality of life.

 

 

 

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