Bones are made up of cells called:
- Osteocytes - are cells that reside inside bone. They are derived from osteoblasts as new bone is being formed and then become surrounded by the new bone.
- Osteoclasts – An osteoclast is a large cell that is 40 micrometer in diameter. It contains 15-20 closely packed oval-shaped nuclei. Osteoclasts are found in pits in the bone surface which are called resorption bays.
- Osteoblasts - are mononucleate cells that are responsible for bone formation.
Cartilage is a tough, flexible material that is more elastic than bone; it stops the bones from rubbing against each other and lets them move freely at the joints, like levers.
The skeleton is made up of 206 bones of different shapes and sizes. The skeleton is the inner framework that supports your body. They also make and store blood cells in the marrow. Marrow is a soft, spongy material that fills most bones.
Throughout your life, bones constantly renew themselves by breaking down old bone cells and replacing them with new ones. If an abnormal cell develops, a tumour (benign or malignant) may start to grow in the bone.
What is Bone Cancer?
Bone cancer is a malignant (cancerous) tumor of the bone that destroys normal bone tissue. Primary bone cancer starts in the cells of your bones. Primary bone cancer is rare and is not the same disease as cancer that started somewhere else in the body and spread to the bones (called secondary bone cancer, or bone metastases).
There are several types of bone cancer.
Osteosarcoma – is the most common type of bone cancer. It starts in new tissue in growing bones, most often in the knee area. Osteosarcomas tend to spread to other parts of the body, especially the lungs.
Chondrosarcoma – begins in the cartilage cells and can either be very aggressive or relatively slow growing. It usually grows slowly and rarely spreads to other parts of the body. Chondrosarcoma most commonly affects the bones of the pelvis and hips.
Ewing’s sarcoma – begins in the cavity of the bone, most often in the leg, arm or pelvis. It tends to grow quickly and spread to other parts of the body. Ewing’s sarcoma is the most aggressive bone tumor and affects younger people between 4-15 years of age.
Osteosarcoma and Ewing’s sarcoma are more common in children, teenagers and young adults. Chondrosarcoma is more common in adults.
There is no single cause of bone cancer, but some factors increase the risk of developing it:
- Osteosarcoma occurs more frequently in people who have had high-dose external radiation therapy or chemotherapy for other conditions especially at a young age
- Having Paget’s disease (a non-cancerous disease of the bone)
- Having a genetic condition, such as Li-Fraumeni syndrome,retinoblastoma or Rothmund-Thompsom syndrome
- Family history of bone cancer
- Some develop bone cancer without any of these risk factors
Bone cancer is not caused by injury or a knock to the bone. Sometimes, a doctor finds bone cancer when examining or treating a person for another reason, such as an injury that doesn’t heal or pain that doesn’t go away.
Symptoms of bone cancer
- Pain -The pain and tenderness in the area of the tumour of bone cancer usually occurs in the neck or back. The pain of bone cancer can cause continuous pain, which can lead to discomfort.
- Swelling or a lump
- Broken born
- Persistent ache that may feel worse at night
- Problem moving the affected joint
- Body becomes weak
- Unintended weight loss
- Weight Loss
- Incontinence - Incontinence symptoms similar to the symptoms of the body becomes weak, which can lead to weak controls on the bladder and bowel.
After taking your medical history and completing a physical examination, your doctor may suspect you have bone cancer. To confirm the diagnosis, your doctor will arrange special tests. These tests may also be used to “grade” and “stage” the cancer. You may have one or more of the following tests.
- Blood tests: Blood is taken and studied to see if the different types of blood cells are normal in number and appearance. The results show how well your organs are working and may suggest whether or not you have cancer.
An enzyme known as “bone specific alkaline phosphatase” or (BSAP) will increase in your blood test if you have bone cancer.
- Imaging studies: Imaging studies allow tissues, organs and bones to be looked at in more detail. Using:
- Computerized tomography (CT) - which is a series of detailed pictures of areas inside the body, taken from different angles, that are created by a computer linked to an x-ray machine.
- Bone scan - which is a test in which a small amount of radioactive material is injected into a blood vessel and travels through the bloodstream; it then collects in the bones and is detected by a scanner.
- Positron emission tomography (PET) - in which a small amount of radioactive glucose (sugar) is injected into a vein, and a scanner is used to make detailed, computerized pictures of areas inside the body where the glucose is used.
- X-ray – in which can show the location, size, and shape of a bone tumor.
- Magnetic resonance imaging (MRI) - which uses a powerful magnet linked to a computer to create detailed pictures of areas inside the body without using x-rays.
*These tests are usually painless and do not require an anesthetic.
- Biopsy: A biopsy is usually necessary to make a definite diagnosis of cancer. Cells are removed from the body and checked under a microscope. If the cells are cancerous, they may be studies further to see how fast they are growing. There are many ways to do a biopsy.
- An incisional Biopsy is an operation to remove part of the tumour. This may be done with a local anesthetic or under a general anesthetic (you will be unconscious). The kind of anesthetic used depends on where the tumour is and how deep it is within the body.
- For a core needle biopsy, your doctor inserts a needle through a small cut in the skin to remove one or more samples of tissue from the tumour. The doctor may use ultrasound or CT images to help guide the needle to the right spot. A local anesthetic (freezing) will be used to numb the area.
Once a definite diagnosis of cancer has been made and your healthcare team had the information it needs, the cancer will be given a grade and a stage. Grading
To find out the grade of a tumour, the biopsy sample to examined under a microscope. A grade is given based on how the cancer cells look and behave compared with normal cells. This can give your healthcare team an idea of how quickly the cancer may be growing. There are several grading systems that may be used for bone tumours. A 2-grade system is used most often. The most common grading system for bone cancer uses two grades:
- Low-grade – Grows slowly, less likely to spread
- High grade – In high grade tumours the cells look very abnormal Tends to grow quickly, more likely to spread.
For bone cancer, the stage includes the tumour grade and tells whether it has special beyond the place where it started to grow. There are four stages.
- Stage One - The cancer in low grade. It has not spread to lymph nodes or any other part of the body.
- Stage 1A - The cancer is low-grade and is still completely inside the bone it started in.
- Stage 1B - The cancer is low-grade and has grown through the bone wall.
- Stage 2A - The cancer is high-grade and is still completely inside the bone it started in.
- Stage 2B - The cancer is high-grade and has grown through the bone wall.
It is important to know the grade and stage of the cancer. This information helps you and your healthcare team choose the best treatment for you. Treatments for Bone Cancer
Your healthcare team will consider your general health and the location, type, grade and stage of the cancer to recommend what treatments will be the best for you.
Treatments affect everyone in different ways. It’s hard to predict which side effects you will have. Your healthcare team will tell you what to expect with each treatment.
For bone cancer, you might receive one or more of the following treatments.
- Radiation therapy
- Clinical Trails
Surgery is the main treatment for bone cancer. Sometimes it is necessary to remove (amputate) the limb. However, it is often possible to remove the cancerous part of the bone and replace it with internal prosthesis (such as artificial bone) or bone graft (bone from another part of the body).
These operations are types of limb-sparing surgery.
The type of surgery you have depends on a number of factors specific to you. Your surgical team will discuss the different types of surgery.
Chemotherapy: Chemotherapy may be given as pills or by injection. Chemotherapy is usually given before you have surgery or radiotherapy. When given before surgery, it can shrink the tumour and make it easier to remove. It can also reduce symptoms such as pain and reduce the chances of the cancer spreading.
Side Effects: from Chemotherapy treatment:
- Loss of appetite
- Hair loss
- Sore mouth
Side effects: will be different depending on what part of the body receivers the radiation.
- Changes to the skin (it may be red or tender)) where the treatment was given.
Follow-up care helps you and your healthcare team monitor your progress and you recovery from treatment.
The schedule of follow-up visits is different for each person. You might see your doctor more often ain the first two years after treatment, and less often after that. After treatment has ended, you should report new symptoms and symptoms that don’t go away to your doctor without waiting for your next scheduled appointment.
The end of cancer treatment may bring mixed emotions. You may be glad the treatments are over and look forward to returning to your normal activities. But you could feel anxious as well. If you are worried about your treatment ending talk to your healthcare team. They are there to help you through this transition period.
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