Bone Cancer

In bone cancer, abnormal cells multiply and spread to form tumors in the bones. The cancer damages or destroys bones, nerves, and tissues (including organs). The disease is often life threatening. 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.

There are several types of bone cancer. Bone cancer may begin in the bone itself, which is called primary bone cancer. Several types of primary bone cancer and the areas usually affected are:

• osteosarcoma (thighbones of children and young adults; the most common type of primary bone cancer)
• Ewing's sarcoma (most common in the pelvis or legs)
• chondrosarcoma (cartilage at the ends of large bones).

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

If cancerous cells from the primary bone cancer get into the bloodstream, they can spread to other parts of the body and affect healthy organs, usually the lungs.

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

• were exposed to radiation
• have Paget's disease of the bones
• have overgrowths of bone tissue.

More commonly, bone cancer may result when a cancer from elsewhere 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 breasts in women, prostate gland in men, and lungs in men and women.

A third type of bone cancer is multiple myeloma, which starts in bone marrow, the soft, fatty tissue inside bones. It is a cancer of plasma cells. Normal plasma cells make antibodies to fight infection. In multiple myeloma, abnormal plasma cells grow uncontrollably to form tumors in bone. They make abnormal antibodies, which are not useful, and the tumors interfere with the growth and function of normal cells made by the bone marrow.

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

The main signs and symptoms of secondary bone cancer are:

• pain in the bones or joints that often worsens during the night
• fragile, weakened bones.

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 could be damaged, causing weakness or even paralysis.

Your health care 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 marrow biopsy, in which a small sample of bone marrow is taken from the affected area to be examined for cancer cells
• x-rays
• a bone scan (a procedure that uses radioactive materials to view the bone)
• MRI or CT scan to see if cancer has spread to or from another part of your body.

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

• radiation treatments to shrink the tumor, slow its growth, and relieve the pain
• hormone therapy if the cancer began in the breast or prostate gland
• anticancer drugs (chemotherapy) if the cancer started in the lungs or other organs
• an operation to remove part or all of your diseased bone or limb if you have osteosarcoma 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
• an operation to remove hormone-producing organs (ovaries or testes) when there is risk of secondary cancer due to spread of a tumor from the breast or prostate.

Often combinations of treatment are used, such as chemotherapy in addition to surgery and 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 health care 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.

The effects of bone cancer will vary depending on the type of cancer, stage of disease when detected, 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.

Follow these guidelines:

• See your health care provider if you have pain, swelling, and tenderness around bones or joints that continues for a week or longer, doesn't go away, gets worse, and does not have a ready explanation.
• Ask your provider what side effects you may have from radiation or chemotherapy. It may help to be prepared for severe or distressing side effects, such as baldness. Usually your hair will grow back, however, when therapy ends.
• Complete the full course of medicines, radiation, or chemotherapy treatments.
• Avoid using tobacco in any form.
• Avoid heavy use of alcohol.
• 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

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

• completing the full course of radiation or chemotherapy treatments recommended by your health care provider
• seeing your provider right away if you notice a return of any previous symptoms or develop any new ones
• avoiding use of all tobacco products
• avoiding heavy use of alcohol.