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Bone Cancer/ Bone Tumor Treatment in India

Bone Cancer

cancer can occur in any part of any bone. Cancer begins when normal cells in the bone change and grow uncontrollably, forming a mass called a tumor. A bone tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can spread to other parts of the body. A benign tumor means the tumor will not spread. Even though a benign tumor does not spread outside the bone, it can grow large enough to press on surrounding tissue and weaken the bone. A malignant tumor can destroy the cortex and spread to nearby tissue. If bone tumor cells get into the bloodstream, they can spread to other parts of the body, especially the lungs, through a process called metastasis

There are different types of bone cancer, including:

  • Osteosarcoma and Ewing sarcoma. These are two of the most common types of bone cancer and mainly occur in children and young adults.
  • Chondrosarcoma. Chondrosarcoma is cancer of the cartilage and is more common in adults.
  • Chordoma. This is a type of bone cancer that typically starts in the lower spinal cord.

Benign Bone Tumors

Osteochondromas :

Osteochondromas develop in adolescents and teenagers.

These tumors form near the actively growing ends of long bones, such as arm or leg bones. Specifically, these tumors tend to affect the lower end of the thighbone (femur), the upper end of the lower leg bone (tibia), and the upper end of the upper arm bone (humerus).

These tumors are made of bone and cartilage. Osteochondroma has been considered to be an abnormality of growth

Nonossifying Fibroma Unicameral

Nonossifying fibroma unicameral is a simple solitary bone cyst. It’s the only true cyst of bone. It’s usually found in the leg and occurs most often in children and adolescents.

Giant Cell Tumors

Giant cell tumors grow aggressively. They occur in adults, and they’re found in the rounded end of the bone and not in the growth plate. These are very rare tumors.

Enchondroma

An enchondroma is a cartilage cyst that grows inside the bone marrow. When they occur, they begin in children and persist as adults

Fibrous Dysplasia

Fibrous dysplasia is a gene mutation that makes bones fibrous and vulnerable to fracture.

Aneurysmal Bone Cyst

An aneurysmal bone cyst is an abnormality of blood vessels that begins in the bone marrow. It can grow rapidly and can be particularly destructive because it affects growth plates.

Causes of Bone Cancer

The cause of bone tumors isn’t known. The tumors often occur when parts of the body are growing rapidly. A few possible causes are genetics, radiation treatment, and injuries to the bones. Osteosarcoma has been linked to radiation treatment (particularly high doses of radiation) and other anticancer drugs, especially in children. However, a direct cause hasn’t been identified. People who have had bone fractures repaired with metal implants are also more likely to develop osteosarcoma later.

Symptoms of Bone Tumors

You may have no symptoms of a bone tumor. This is common. Your doctor may find a tumor when looking at an X-ray of another problem, such as a sprain. But symptoms of a bone tumor may include pain that:

  • Is in the area of the tumor
  • Is often felt as dull or achy
  • May get worse with activity
  • Often awakens people at night

Trauma does not cause a bone tumor, but a bone that is weakened by a tumor may be more easily broken. This may then cause severe pain.

Other symptoms related to bone tumors may include:

Stages of Bone Cancer

Doctors assign the stage of the cancer by combining the T, N, M, and G classifications.

Stage IA: The tumor is low grade (G1 or G2) and 8 cm or smaller (T1). It has not spread to any lymph nodes or to other parts of the body (N0, M0).

Stage IB: The tumor is low grade (G1 or G2) and larger than 8 cm (T2). It has not spread to any lymph nodes or to other parts of the body (N0, M0).

Stage IIA: The tumor is high grade (G3 or G4) and 8 cm or smaller (T1). It has not spread to any lymph nodes or to other parts of the body (N0, M0).

Stage IIB: The tumor is high grade (G3 or G4) and larger than 8 cm (T2). It has not spread to any lymph nodes or to other parts of the body (N0, M0).

Stage III: There are multiple high-grade (G3 or G4) tumors in the primary bone site (T3), but they have not spread to any lymph nodes or to other parts of the body (N0, M0).

Stage IVA: The tumor is of any size or grade and has spread to the lung(s) (any G, any T, N0, and M1a).

Stage IVB: The tumor is of any size or grade and has spread to the lymph nodes (any G, any T, N1, and any M), or the tumor is of any size or grade and has spread to another organ besides the lung (any G, any T, any N, and M1b).

Recurrent: Recurrent cancer is cancer has come back after treatment. If there is a recurrence, the cancer may need to be staged again (called re-staging) using the system above

Diagnosis of Bone Cancer

n addition to a physical examination, the following tests may be used to diagnose bone cancer:

Blood tests. Some laboratory tests may help detect bone cancer. Alkaline phosphatase and lactate dehydrogenase levels in the blood may be higher in patients with osteosarcoma or Ewing sarcoma..

X-ray. An x-ray is a way to create a picture of the structures inside of the body using a small amount of radiation.

Bone scan. A bone scan uses a radioactive tracer to look at the inside of the bones. The tracer is injected into a patient’s vein. It collects in areas of the bone and is detected by a special camera. Healthy bone appears gray to the camera, and areas of injury, such as those caused by cancerous cells, appear dark.

Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. A CT scan can also be used to measure the tumor’s size. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a pill to swallow.

Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI can also be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a pill to swallow. MRI scans are used to check for any tumors in nearby soft tissue.

Positron emission tomography (PET) scan. A PET scan is a way to create picture of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body.

Integrated PET-CT scan. This scanning method collects images from both a CT and a PET scan at the same time and then combines the images. This technique helps the doctor look at both the structure and how energy is used by the tumor and healthy tissue. This information can help doctors plan treatment and determine the benefits of different treatments.

Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis..

Treatment of Bone Cancer

Treatment options depend on the type, size, location, and stage of the cancer, as well as the person’s age and general health. Treatment options for bone cancer include surgery, chemotherapy, radiation therapy, and cryosurgery.

  • Surgery is the usual treatment for bone cancer. The surgeon removes the entire tumor with negative margins (no cancer cells are found at the edge or border of the tissue removed during surgery). The surgeon may also use special surgical techniques to minimize the amount of healthy tissue removed with the tumor.

There are different types of surgery for treating bone cancer such as –

  • Surgery for cancer that does not affect the limbs : The surgical procedure is performed for removing bone and some nearby tissue if the bone cancer takes place in the bones apart from legs and arms. This removed bone is then replaced with a part of bone from a different area of the body or can also be replaced with the help of special metal prosthesis.
  • Surgery for removing the cancer while sparing the limb : The surgical procedure can be performed for removing the bone cancer while sparing the limb if the bone cancer can be separated from other tissue and nerves. The lost bone is then replaced with some other bone from a different area of the body or can also be replaced with the help of a special prosthesis.
  • Surgery for removing a limb : The surgical procedure is required for removing a part or all part of a limb when the bone cancer is very large and is located on a complicated point on the bone.
  • Chemotherapy is the use of anticancer drugs to kill cancer cells. Patients who have bone cancer usually receive a combination of anticancer drugs. However, chemotherapy is not currently used to treat chondrosarcoma
  • Radiation therapy, also called radiotherapy, involves the use of high-energy x-rays to kill cancer cells. This treatment may be used in combination with surgery. It is often used to treat chondrosarcoma, which cannot be treated with chemotherapy, as well as ESFTs . It may also be used for patients who refuse surgery.
  • Cryosurgery is the use of liquid nitrogen to freeze and kill cancer cells. This technique can sometimes be used instead of conventional surgery to destroy the tumor