Bone Cancer

What is bone cancer?

In bone cancer, abnormal cells multiply and spread to form tumors in the bones. The cancer damages or destroys bones, nerves, blood vessels, and other tissues. The disease is usually life threatening. If cancerous cells from a primary bone cancer (one that starts in the bone), get into the bloodstream, they can spread to other parts of the body and affect healthy organs, usually the lungs. However, successful treatment is possible, particularly if the cancer is found in its early stages. Chances for successful treatment decrease and the threat to life increases the longer the cancer is untreated.

What are the types of bone cancer and how do they occur?

Types of primary bone cancer and the areas usually affected are:

• osteogenic sarcoma, which is most often in the thighbones (femurs) of children and young adults is the most common type
• Ewing's sarcoma, which most commonly starts in the pelvic or upper leg bones
• chondrosarcoma, which affects the cartilage, usually at the ends of large bones, especially the thighbone at the knee.

The most common bone cancers that affect young people are osteogenic sarcoma and, less often, Ewing's sarcoma. Chondrosarcoma affects adults and is much less common.

You are more at risk for primary bone cancer if you:

• were exposed to high doses of radiation, usually for a prior cancer in that area
• have long-standing Paget's disease of the bones

More commonly, bone cancer may happen when a cancer from somewhere else in the body spreads to the bones. This type of bone cancer is called secondary bone cancer or metastatic bone cancer. The most common organs where a cancer begins and then travels to the bones are the lungs, women's breasts, men's prostate gland, and the kidney. The affected bones often have holes in them from the cancer, making them weaker. However, sometimes, depending on where the cancer started, the bones may actually be thicker than normal.

What are the symptoms?

The main symptoms of osteogenic sarcoma, a type of primary bone cancer, are pain, tenderness, and swelling just above the knee.

The main symptoms of metastatic bone cancer in adults are:

• pain in the bones or joints that often gets worse at night
• fragile, weakened, or broken bones
• fever.

When the affected bones are fragile, they may fracture, even without an injury. Such a fracture may be the first sign of bone cancer.

Bone cancer of the spine may collapse or crush vertebrae. As a result, the spinal cord, which is surrounded by vertebrae, could be damaged, causing weakness or even paralysis.

How is it diagnosed?

Your healthcare provider will examine you and ask about the history of pain and swelling in your bones or joints. You may have tests, such as:

• blood and urine tests
• a bone biopsy, in which a sample of bone is taken to be checked for cancer cells
• X-rays
• a bone scan, which is a procedure that uses radioactive materials given in a vein (IV) to see if the cancer has spread to other bones
• MRI scan of bones.

How is it treated?

The treatment depends on the type of cancer, where the cancer started, how advanced it is, and the parts of the body affected. Possible treatments are:

• radiation treatments to shrink the tumor, slow its growth, and relieve the pain
• hormone therapy if the cancer started in the breast or prostate gland
• anticancer drugs (chemotherapy) if the cancer started in the lungs or other organs
• a medicine called zoledronic acid (Zometa) may be given intravenously (IV) every few months, or so with almost no side effects.
• an operation to remove your diseased bone or limb if you have osteogenic sarcoma, Ewing's sarcoma, or chondrosarcoma
• a metal piece inserted to strengthen a weakened bone segment if the bone has broken or there is worry that it could break (usually for metastatic bone cancer)
• rarely, an operation to remove hormone-producing organs (ovaries or testes) when there is secondary cancer in the bones due to spread of a tumor from the breast or prostate.

Often, more than one treatment is used, such as hormones or chemotherapy in addition to surgery and/or radiation therapy.

In advanced cases, the treatments may slow or temporarily stop the growth of the cancer. They may even shrink the cancer for a time. The treatments may ease the symptoms for up to 4 or 5 years and sometimes longer.

Ask your healthcare provider any questions you may have about treatments, side effects of treatments, and your chances for recovery. It is important to discuss your concerns with your provider.

How long will the effects of bone cancer last?

The effects of bone cancer vary depending on the type of cancer, the extent of the disease when found, and when treatment began. Your age and physical condition are important factors as well. Some treatments are not recommended for frail, older adults. They may be more susceptible to infections due to the lower immunity that can result from radiation or chemotherapy.

How can I take care of myself?

During your treatment for bone cancer, follow these guidelines:

• Ask your provider what side effects you may have from radiation, hormones, or chemotherapy. It may help to be prepared for some side effects, such as baldness. Your hair should grow back, however, when the treatment ends.
• Complete the full course of medicines, radiation, or chemotherapy treatments.
• Maintain a hopeful and positive outlook throughout your treatment and recovery.
• Eat healthy meals and exercise regularly according to your provider's recommendations.
• If possible, join a cancer support group during your illness and recovery.

For more information on cancer, contact:

• American Cancer Society, Inc.
  Phone: 800-ACS-2345 (800-227-2345)
  Web site: http://www.cancer.org
• AMC Cancer Research Center and Foundation
  Phone: 800-525-3777 (cancer information counseling line)
  Web site: http://www.amc.org
• Cancer Information Service, National Cancer Institute
  Phone: 800-4-CANCER (800-422-6237)
  Web site: http://cis.nci.nih.gov

What can be done to help prevent bone cancer from spreading or recurring?

You may be able to reduce the risk of recurrence or spread of bone cancer by:

• completing the full course of radiation, hormone, or chemotherapy treatments recommended by your healthcare provider
• seeing your provider right away if you notice a return of any previous signs or symptoms or develop any new ones.