What is bone cancer?

In bone cancer, abnormal cells multiply and spread to form tumors. Healthy bones, nerves, and tissues (including organs) are damaged or destroyed, and the disease can be life-threatening. However, successful treatment is often 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. 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. A third type of bone cancer is multiple myeloma, which starts in bone marrow, the soft, fatty tissue inside bones. Multiple myeloma acts more like a leukemia than a bone cancer. In multiple myeloma the number of plasma cells increases.

Primary bone cancer, a rare form of cancer, starts inside or on the surface of bone. If cancerous cells get into the bloodstream and the lymph system, they can spread to other parts of the body and affect healthy organs.

Several types of primary bone cancer and the areas usually affected are:

• osteosarcoma (leg bones of children and young adults; the most common type of primary bone cancer)

• Ewing's sarcoma (connective tissue around large bones)

• chondrosarcoma (cartilage of large bones)

• fibrosarcoma (bone, tissue around muscle, nerves).

Secondary bone cancer, or metastatic, is more common than primary, but still rare. It results when malignant cells from a primary cancer site, such as the kidney, lung, prostate, breast, or thyroid, spread (or metastasize) to the bones. Common sites of secondary bone cancer include the ribs, skull, pelvis, and vertebrae.

Multiple myeloma begins in the plasma cells of bone marrow. Plasma cells are white blood cells that produce antibodies to fight infections.

What are the symptoms?

The main symptoms of osteosarcoma, a type of primary bone cancer include:

• pain and tenderness just above or below the knee

• swelling, usually just above or below the knee.

The main symptoms of secondary bone cancer include:

• pain of bone or joints that often worsens during the night

• fragile, weakened bones.

The affected bones are very fragile and many facture, even without an injury. Such a fracture may be the first sign that a person has 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 of the affected limbs.

How is bone cancer diagnosed?

Your doctor will examine the affected area and ask about the history of the pain and swelling in your bones or joints. Based on this information, your doctor may recommend a combination of the following:

• 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 or a bone scan (a procedure that uses radioactive materials to view the bone)

• other imaging techniques, such as CT scanning or magnetic resonance imaging (MRI) to determine if cancer has spread to or from another part of your body. (CT scan is a special kind of x-ray that gives more detailed information than regular x-rays. MRI is a technique that produces a detailed picture of the internal organs and structures of the body without using x-rays.)

What is the treatment?

The doctor, usually an oncologist (cancer specialist), will determine the treatment for bone cancer based on the source, stage (severity), and location of the disease when it is diagnosed.

Your doctor may recommend that you have:

• radiation treatments to shrink the tumor, slow its growth, and relieve the pain

• an operation to remove part or all of your diseased bone or limb if you have osteosarcoma, chondrosarcoma, or fibrosarcoma

• a combination of the two along with anticancer drugs (chemotherapy)

• antibiotics to treat infections that may occur from lowered resistance to various bacteria, a side effect of chemotherapy

• a metal piece inserted to strengthen a weakened bone segment

• hormone therapy for secondary cancers from breast and prostate; growth of prostate tumors may be slowed down with estrogen or hypothalamic hormones

• an operation to remove hormone-producing organs (ovaries, testes, or adrenals) when there is risk of secondary cancer due to spread of a tumor from the breast or prostate.

In advanced cases, these steps may slow or temporarily stop the growth of the cancer and ease the symptoms (for up to 4 or 5 years and sometimes longer).

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

How long will the effects of bone cancer last?

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 or elderly people, who may be more susceptible to infections due to lower immunity that can result from radiation or chemotherapy.

How can I take care of myself?

Follow these guidelines:

• See your doctor if you have pain, swelling, and tenderness around bones or joints that continue for a week or longer, don't go away, and get worse.

• Ask your doctor 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 ordered by your doctor.

• Avoid using tobacco in any form.

• Avoid heavy use of alcoholic beverages.

• Maintain a hopeful and positive outlook throughout your treatment and recovery.

• Eat well-balanced meals that are low in fat and high in fiber, exercise regularly, and observe overall good health practices.

• If possible, join a cancer support group during your illness and recovery.

• Avoid quackery.

For more information, contact national and local self-help organizations such as:

• AMC Cancer Information
  1-800-525-3777

• Cancer Information Center
  1-800-4-CANCER, or 1-800-638-6070 in Alaska, or collect from Hawaii 1-808-524-1234.

• American Cancer Society, Inc.
  1599 Clifton Road, NE
  Atlanta, Georgia 30329-4251
  Phone: 1-800-ACS-2345

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 and/or chemotherapy treatments recommended by your doctor

• seeing your doctor immediately if you notice a return of any previous symptoms or develop any new ones.

• avoiding use of all tobacco products

• avoiding heavy use of alcoholic beverages.