Understanding boneBone is a living tissue. The hard bone tissue is made of collagen fibres (tough, elastic fibres) and minerals (gritty, hard material). There are two main types of cells within the hard bone tissue that make and mould bone. One type (osteoblasts) makes and lays down bone material. Another type (osteoclasts) resorbs (dissolves) particles of bone. These cells are active throughout life. They work in a balanced way to make and mould bone, repair damage and keep the bone structure correctly 'woven'. There is a slow but constant turnover of bone. Chondrocytes are cells which make cartilage, the tissue that covers the ends of bones in joints. What is cancer?Cancer is a disease of the cells in the body. The body is made up from millions of tiny cells. There are many different types of cell in the body, and there are many different types of cancer which arise from different types of cell. What all types of cancer have in common is that the cancer cells are abnormal and multiply 'out of control'. What is bone cancer?Bone cancer can be divided into primary bone cancer and secondary bone cancer.
Types of primary bone cancerThere are different types of primary bone cancer. They are classified by the type of cell which occurs in the cancer. Most types of primary bone cancer end with ...sarcoma. A sarcoma is a cancer that originates from cells which occur in and make connective tissues (supporting tissues) of the body. For example, bone, muscle, cartilage, ligaments, etc. OsteosarcomaThis is the most common type of primary bone cancer, but even this is rare. It only affects around 150 people a year in the UK. It arises from bone forming cells. Most cases occur in young people between the ages of 10 to 25, but it can occur at any age. It typically develops in the growing ends of the bone in young people, most commonly in bones next to the knee and the upper arms. However, any bone can be affected. Ewing's sarcomaThis is named after the doctor who first described it in the 1920s. The cells of this cancer look different to the more common osteosarcoma. It only affects around 100 people a year in the UK. Most cases occur in young people between the ages of 10 to 20, but it can occur at any age. It most commonly affects the pelvis and long bones of the leg. However, any bone can be affected. ChondrosarcomaThis type of cancer arises from cartilage forming cells. As well as occurring in the cartilage, a chondrosarcoma may also develop within a bone, or on the surface of a bone. Most cases occur in people between the ages of 40 and 75. It most commonly affects the pelvis, scapula (shoulder blade), ribs, and the bones of the upper parts of the arms and legs. OtherOther rare types of primary bone tumour include fibrosarcoma, leiomyosarcoma, malignant fibrous histiocytoma, angiosarcoma and chordoma. What causes primary bone cancer?A cancerous tumour starts from one abnormal cell. The reason why a cell becomes cancerous is unclear. It is thought that something damages or alters certain genes in the cell. This makes the cell abnormal and multiply 'out of control'. In most cases of primary bone cancer it is not known why cells become cancerous. The most common types, osteosarcoma and Ewing's sarcoma, mainly occur in young people. The cause of these may have something to do with changes in the bone as it is growing.
There is no evidence that having a previous injury to a bone increases your risk of developing bone cancer in the future. What are the symptoms of primary bone cancer?
General symptoms may occur as the cancer becomes larger. For example, tiredness, weight loss, sweats. If the cancer spreads to other parts of the body, various other symptoms can develop. Initial assessment and diagnosisIf a doctor suspects that you may have primary bone cancer, you are likely to have a number of tests. These may include one or more of the following:
If you are confirmed to have primary bone cancer then further tests are usually advised to assess if the cancer has spread. This may include various blood tests, X-rays and scans. Assessing the severity of the cancer - grading and stagingThe results of the biopsy can show the type of the cancer. Also, by looking at features of the cells the cancer can be 'graded'. For primary bone cancers, two grades are used:
The stage of primary bone cancer is based on the grade of the cancer, and how much it has grown or spread. The staging system commonly used is:
The staging is important as the treatment options and outlook (prognosis) differ depending on the stage of the cancer. (See separate leaflet called 'Cancer - Staging and Grading' for more details.) What are the treatment options for primary bone cancer?The main treatments used for primary bone cancer are surgery, chemotherapy and radiotherapy. The treatment or combination of treatments advised in each case depends on various factors such as:
You should have a full discussion with a specialist who knows your case. They will be able to give the pros and cons, likely success rate, possible side-effects, and other details about the possible treatment options for your type of cancer. You should also discuss with your specialist the aims of treatment. For example:
SurgeryThe types of operation vary depending on the type and site of the cancer. If the cancer is in an arm or leg, it is often possible to remove it with 'limb-sparing' surgery. This means surgery where just the affected part is removed, and is replaced with an artificial metal fitting (prosthesis) or a bone graft. Amputation (removing a limb) used to be the main operation, but this is done less often these days due to the improved surgical techniques with limb-sparing surgery. However, amputation is still needed in some cases, depending on the size, spread or site of the tumour. Your specialist will advise on whether surgery is possible, and the types of operation which can be done. RadiotherapyRadiotherapy is a treatment which uses high energy beams of radiation which are focused on cancerous tissue. This kills cancer cells, or stops cancer cells from multiplying. (See separate leaflet called 'Radiotherapy' for more details.) ChemotherapyChemotherapy is a treatment which uses anti-cancer drugs to kill cancer cells, or to stop them from multiplying. Chemotherapy may be given in addition to surgery or radiotherapy, depending on the type and stage of the bone cancer. This may be before surgery to shrink the size of the cancer so a smaller operation can then be performed. Chemotherapy may also be given after surgery or radiotherapy. This aims to kill to cancer cells which may have been left in the body. (See separate leaflet called 'Chemotherapy' for more details.) What is the prognosis (outlook)?It is difficult to give an overall outlook. Every case is different, and the success of treatment depends on the type, site and stage of the cancer - the earlier the stage, the better the outlook. In general, the outlook for primary bone tumours has improved in the last 10-20 years. This is due to improved surgical techniques and improved chemotherapy. Bone Cancer Research TrustTel: 0113 262 1852 Web: www.bonecancerresearch.org.uk Macmillan Cancer SupportTel: 0808 800 1234 Web: www.macmillan.org.uk Cancer Research UKWeb: www.cancerhelp.org.uk provides facts about cancer including treatment choices. Other support groupsSee www.patient.co.uk/selfhelp.asp for a list of self-help and support groups. References
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