Primary bone cancer is cancer that arises in the bone. This is not to be confused with secondary, or metastatic bone cancer, where cancer has spread to the bone from another part of the body. Primary bone cancer is rare with approximately 2,500 cases diagnosed each year in the United States.
The most common form of bone cancer is osteosarcoma. It is seen most often in those ages 10 to 25, and most often occurs in the knees, upper legs, and upper arms.
Ewing’s Sarcoma is another form of bone cancer that primary affects children and young adults. It originates in the bone marrow and is most commonly found in the pelvis, upper legs, ribs, and arms.
Chondrosarcoma is a bone cancer that normally arises in the cartilage of the pelvis, upper legs, and shoulders and primarily affects adults. Although these cancers most often appear in these primary sites, bone cancer can affect any bone in the body.
There are many other forms of bone cancer including:
- Multiple myeloma
- Non-Hodgkins Lymphoma of Bone
- Primary Hodgkins Lymphoma of Bone
- Malignant Fibrosarcoma
- Leukemia Granulocytic Sarcoma
- Chordoma, Adamantinoma of Long Bones
- Angiosarcoma
Symptoms and Diagnosis
The most common symptom of bone cancer is pain. Depending on the size and location of the tumor it can also cause swelling, pain in movement, fatigue, fever, loss of appetite, or anemia. If bone cancer is suspected, a complete medical examination would be followed by blood tests (to detect proteins that tend to be elevated when cancer is present) and x-rays or bone scans. If a tumor is present, a biopsy will be performed so the tumor cells can be examined to determine what type of cancer is present.
Treatment
Treatment of bone cancer is usually a combination of surgery, chemotherapy, and/or radiation therapy. Surgery involves the removal of the cancerous tissue along with surrounding tissue. In a number of cases this may involve the amputation of a limb, although the cancerous section of a bone is sometimes replaced with a prosthetic device. The use of pre- and post-operative chemotherapy has also made limb-sparing surgery more common.
After surgery, chemotherapy is often prescribed to kill malignant cells that may be circulating throughout the body. Radiation therapy used by itself or in conjunction with chemotherapy may be used to kill any other remaining cancer cells left at the surgery site.
Although once associated with a grim prognosis, great strides have been made in both survival rates and preservation of limb function after bone cancer surgery in recent years.
Metastatic or Secondary Bone Cancer
Cancers that can spread to the bones include:
- Breast
- Esophageal
- GI tract
- Kidney (Renal Cell Sarcoma)
- Liver (hepatoma)
- Lung
- Skin
- Merkle cell
- Cutaneous T-cell lymphoma
- Prostate
- Stomach
- Testicular
- Thyroid cancer
The ribs, pelvis, and spine are usually the first bones involved.
Metastases are established when a single tumor cell or a clump of cells gain access to the blood stream, reach the bone marrow through blood vessels, and then multiply. Treatment is normally palliative, but varies depending on the type of cancer that is involved.
Early symptoms include persistant bone pain or sudden atraumatic pathologic fracture may be the presenting symptom.
Dr. Randall Holcomb M.D.