Bone Cancer : Types, Causes, Signs & Symptoms

Bone sarcomas are malignant tumours of bone tissue that can spread to nearby structures when they metastasize in malignant form, whereas some remain benign and are restricted to a single area of bone tissue.

Types of Bone Sarcoma

Origin-based

1. Osteosarcoma: Originates in bone cells and is seen more in children aged 5 to 20 years. 
2. Ewing’s sarcoma: Commonly seen in the arms, legs, and pelvis. Its origin is not clear. 
3. Multiple myeloma: Seen in late adult and old age.
4. Chondrosarcoma: Originates in cartilage cells and is also seen in late adulthood or old age.

STAGES

• TNM CLASSIFICATION

1. T for ‘tumour’ 
2. N for ‘nodes’ 
3. M for ‘metastasis’ 

• GRADING OF CANCER

1. GRADE 1- Cells differ from normal cells and are well differentiated having mild dysplasia.
2. GRADE 2- Cells are abnormal and moderately differentiated. 
3. GRADE 3- Cells are very abnormal and are poorly differentiated. 
4. GRADE 4- Cells are immature and undifferentiated. A cell of origin is difficult to determine. 

• STAGES OF CANCER

1. STAGE 0- Carcinoma in situ.
2. STAGE 1- Tumour limited to the tissue of origin.
3. Smaller than 8 cm and doesn’t spread to lymph nodes (Grade-0).
4. STAGE 2- limited growth and locally spread. Less than 8 cm and spreads to lymph nodes (High-grade Grade-2 and Grade-3). 
5. STAGE 3- Extensive local and regional spread. More than one place on bone and has not spread to lymph nodes with no distant spread (Grade-2 and Grade-3).
6. STAGE 4- Distant metastasis may or may not spread to lymph nodes. Can reach the lungs (Grade 4).

Risk factors/causes of bone sarcoma

• Previous radiotherapy treatment. 
• Paget’s disease of the bone.
• Genetic conditions, such as Li-Fraumeni syndrome.
• Retinoblastoma and umbilical hernia ETC.

Signs and Symptoms of Bone Sarcoma

• Pain at persistent to the affected site
• Swelling, lumps, and tenderness
• Sudden weight loss
• Weakness and fatigue
• Numbness
• Tingling sensation
• Fractures

Diagnostic procedures associated with bone sarcoma

History

Asking for expected signs and symptoms of the patient. Like the History of pain, fractures, etc.

Physical examination

Tenderness, tingling sensation, swelling, etc. over the affected site.

Investigations

(Bone/Site Imaging Tests)

• Bone Scan 
• Computerised Tomography (CT) Scan
• Magnetic Resonance Imaging (MRI) 
• Positron Emission Tomography (PET)
• X-ray

Biopsy

Samples of tumor tissue are removed for microscopic examination to study whether they contain cancerous changes by inserting a needle through the skin or into the tumor or by surgery to determine the stage of cancer.

What is the survival rate for bone cancer?

Survival rates are based on the outcomes of a large number of people who have had the disease. The patient’s prognosis determines the survival rate. The 5-year survival rate implies the percentage of people surviving 5 years after diagnosis of their disease.

The overall health of the patient, stage, and size of the tumour can be the other factors that determine survival. The 5-year survival rates for various circumstances are mentioned:

• For all cases of bone cancer: about 70%
• For chondrosarcomas: about 80% 
• For localized osteosarcomas and Ewing’s sarcoma: 60-80%
• For cancers that spread to distant parts: 15-30%

Early Signs to catch Bone Cancer

While bone cancer can start in any bone, it is most frequently found within an arm or leg bone and can produce several symptoms based on its location and how advanced it is. Signs of bone cancer include:

Pain

The most common sign of bone cancer. The pain may come and go initially, often being worse at night or when the bone is being used. For example, cancer in a leg bone may be more noticeable while walking or running. As cancer grows, the pain will increase and become constant.

Swelling

Swelling may not occur until weeks after the pain is first detected. Depending on the location of cancer, it may be possible to feel a lump or mass. The swelling may impact body functions. For instance, cancer in the neck bones can make it difficult to swallow or breathe.

Numbness and tingling

If bone cancer presses on nerves, it can cause numbness, tingling, or weakness in areas served by the nerves.

Fatigue and weight loss

Bone cancer that spreads to other organs can cause fatigue and weight loss. If it spreads to the lungs, it may make it hard to breathe.

Bone fractures

Bone cancer can weaken the affected bone. While fractures are not common, they can happen. When a fracture occurs, a person will often feel a sharp pain in an area that was previously just sore.

Prevention and treatment of Bone Sarcoma

• Complete surgical removal of carcinogenic tissues.
• Medical procedure – tissue scraping.
• Reconstructive surgery – Megaprosthetic Replacement, Allo Bone Graft, Vascularized Fibula, Rotationplasty, etc.
• Implants – expandable mega prosthesis.
• Chemotherapeutic drugs regime to be followed.
• Palliative care – to relieve pain and promote end-stage care.
• Radiotherapy- targeting cancer-causing tissues by active x-rays.
• Cryosurgery – killing cancer cells by freezing them in liquid nitrogen.
• Prevention – spreading awareness regarding the condition. Enabling self-care techniques.
• Routine follow-ups to the oncologist even after complete recovery as bone sarcoma has chances of metastasis even after recovery. 

Specialists in Yashoda Cancer Institute, Sanjay Nagar, Ghaziabad for Sarcoma cancer.

Dr A.K. Tyagi (Surgical Oncologist)

Dr. (Brig.) Arvind Kumar Tyagiis the Director of Surgical Oncolo gy at Yashoda Cancer Institute. He possesses more than 30 years of medical experience.

He pursued his fellowship and training in surgical oncology at Tata Memorial Hospital, Mumbai. He has had an exceptional career in the armed forces where he served for almost 30 years.

Dr B.N. Kapur (Medical Oncologist)

Dr. (Maj. Gen.) B.N. Kapur, the Director of Medical Oncology at Yashoda Cancer Institute, specializes in the practice of medical oncology and treatment of blood and blood-related disorders including leukaemia, myelodysplastic syndromes, lymphomas, multiple myeloma, etc.

Having completed his M.B.B.S. in 1983 from Pt. J.N.M. Medical College, Raipur, he joined the M.D. General Medicine program at the same hospital in 1989. Thereafter, he pursued his medical oncology training at Tata Medical Hospital, Mumbai.

Later, he joined the Armed Forces Medical College and Command Hospital, Pune as a medical oncologist. He has served in the army for more than 36 years and has been the recipient of many awards in the field of haematology and oncology.

Treatment of bone sarcoma in Delhi NCR

The Department of Orthopedic Oncology at Yashoda Cancer Institute, an exclusive cancer centre with NABH and NABL accreditations and ISO 9001 and ISO 14001 certifications in Delhi NCR, Yashoda Cancer Institute has the right combination of technology and workforce to ensure world-class bone and soft tissue tumours. This makes it the best treatment hospital in Sanjay Nagar Ghaziabad.

Cost of treatment of bone sarcoma in India

Bone sarcoma investigations range from 40k to 60k INR and surgical interventions range from 3.5 lacs to 6 lacs.

Conclusion

With the advent of newer technology and skills, primary bone cancers can be detected early and cured. The cure rates have improved from 25 to 70 percent. In some cases, the cure is not possible due to the delay in detection (patients with extensive local disease and metastasis).

Special care is directed at relieving pain and improving function. Quality of life may thus be improved. The Department of Oncology at Yashoda Hospital, Sanjay Nagar Ghaziabad, has a comprehensive cancer care unit that follows a trans-disciplinary and multi-modal approach and provides supportive care through all stages of cancer whenever needed.

A full range of treatment options, including standard & experimental treatments with chemotherapy and other biological therapies. At Yashoda, people have access to more treatment options and experience better outcomes and higher rates of survival.