Bone Cancer

What is bone cancer?

When you have bone cancer, abnormal cells multiply and form tumors in the bones. The cancer damages or destroys bones, nerves, blood vessels, and other tissues. The disease is usually life threatening. If cancerous cells get into the bloodstream, they can spread to other parts of the body and affect healthy organs, usually the lungs. However, successful treatment is possible, particularly if the cancer is found early.

What are the types of bone cancer and how do they occur?

When bone cancer starts in the bone, it is called primary bone cancer. Types of primary bone cancer and the areas usually affected are:

• osteogenic sarcoma, which is most often in the thighbones (femurs) of children and young adults
• Ewing's sarcoma, which most often starts in the pelvic or upper leg bones
• chondrosarcoma, which affects the cartilage, usually at the ends of large bones, especially the thighbone at the knee.

The most common bone cancers that affect young people are osteogenic sarcoma and, less often, Ewing's sarcoma. Chondrosarcoma affects adults and is much less common.

Primary bone cancer is rare in adults. Adults are more at risk for primary bone cancer if they:

• were exposed to high doses of radiation, usually for a prior cancer in that area
• have Paget's disease of the bones

Adults usually get bone cancer when a cancer from somewhere else in the body spreads to their bones. This type of bone cancer is called secondary or metastatic bone cancer. The most common places where a cancer starts before spreading to the bones are the lungs, women's breasts, men's prostate gland, and the kidneys.

What are the signs and symptoms?

The main signs and symptoms of osteogenic sarcoma are pain, tenderness, and swelling, usually just above the knee.

The main signs and symptoms of metastatic bone cancer in adults are:

• pain and swelling in the bones or joints that often gets worse at night
• fragile, weakened, or broken bones

Sometimes, depending on where the cancer started, the bones may actually be thicker than normal. This is seen most often in cancer that has spread from the prostate. It happens less often from breast cancer. More often the affected bones have holes in them from the cancer. The holes weaken the bones. The bones may be fragile and may break, even without a fall or other trauma. The broken bone may be the first sign of bone cancer.

Bone cancer of the spine may collapse or crush the bones of the spine (vertebrae). This may damage the spinal cord, causing weakness or even paralysis.

How is it diagnosed?

Your healthcare provider will examine you and ask about the history of pain and swelling in your bones or joints. You may have tests, such as:

• blood and urine tests
• a bone biopsy, in which a sample of bone is taken to be checked for cancer
• X-rays
• a bone scan, which uses radioactive materials given in a vein (IV) to see if the cancer has spread to other bones
• MRI scan of bones.
• PET or CT scan

How is it treated?

The treatment depends on the type of cancer, where the cancer started, how advanced it is, and the parts of the body affected. Possible treatments are:

• radiation treatments to shrink the tumor, slow its growth, and relieve the pain
• hormone therapy if the cancer started in the breast or prostate gland
• anticancer drugs (chemotherapy) if the cancer started in the lungs or other organs
• a medicine called zoledronic acid (Zometa) given intravenously (IV) to slow bone damage and strengthen bones
• surgery to remove diseased bone if you have primary bone cancer
• a metal piece put into a weakened bone segment to strengthen it
• rarely, surgery to remove hormone-producing organs (ovaries or testes) when there is secondary cancer in the bones due to the spread of cancer from the breast or prostate.

Often, more than 1 treatment is used.

How long will the effects of bone cancer last?

In advanced cases, treatment may slow or temporarily stop the growth of the cancer. Treatment may even shrink the cancer for a time. Treatment may ease symptoms for up to 4 or 5 years and sometimes longer.

The effects of bone cancer vary depending on the type of cancer, the extent of the disease when found, and when treatment began. Your age and physical condition are important factors as well. The chances for successful treatment are best when the cancer is found and treated early. Metastatic cancer to bones is almost never curable.

How can I take care of myself?

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

During your treatment for bone cancer, follow these guidelines:

• Ask your provider what side effects you may have from radiation, hormones, or chemotherapy. It may help to be prepared for some side effects, such as baldness. Your hair should grow back, however, when the treatment ends.
• Complete the full course of medicines, radiation, or chemotherapy treatments.
• Try to keep a hopeful and positive outlook throughout your treatment and recovery.
• Eat healthy meals and exercise regularly according to your provider's recommendations.
• Join a cancer support group.

For more information on cancer, contact:

• American Cancer Society, Inc.
  Phone: 800-ACS-2345 (800-227-2345)
  Web site: http://www.cancer.org
• AMC Cancer Research Center and Foundation
  Phone: 800-525-3777 (cancer information counseling line)
  Web site: http://www.amc.org
• Cancer Information Service, National Cancer Institute
  Phone: 800-4-CANCER (800-422-6237)
  Web site: http://www.cancer.gov/aboutnci/cis

How can I help keep bone cancer from spreading or coming back?

You may be able to lower your risk of recurrence or spread of bone cancer by:

• completing the full course of radiation, hormone, or chemotherapy treatments recommended by your healthcare provider
• seeing your healthcare provider right away if you notice a return of any previous signs or symptoms or develop any new ones.