Saturday, February 20, 2016

Bone Cancer

Bone cancer is rare and may arise from cells within or around the bone. These cancer cells arise denovo and multiple aggressively to destroy the bone. The cancer cell may spread through blood circulation to multiple systems like the lung commonly and may spread to other bones and tissues. These tumors grow to a large size and impair the function and may lead to death.

Bone cancer is of different types based on the cell of origin. Bone cancers like Osteosarcoma, Ewings Sarcoma are more common in children between the age of 5 to 20 years. Cancers like Multiple Myeloma, Chondrosarcoma are more common in late adult and old age. Cancers arising from any part of the body like breast, thyroid, lung etc may secondarily spread to the bone and these are called as Secondary (or Metastatic) Bone Cancers.

Patients suffering from Bone cancers may present with persisting pain which is not relieved by rest or pain medication. This may be associated with progressive swelling of the involved part. Tumors which arise from the spine may present with weakness in the hand, foot or even paralysis.

Diagnosis of Bone cancer:
Bone cancers are not easily detected and hence the diagnosis is delayed. As these cancers are rare, the awareness in public as well as the doctors is poor. As early detection is most essential aspect of bone cancer management, it is important for people to consult the concerned doctors at the earliest. Thorough examination and appropriate investigations is essential for making the correct diagnosis. Investigations like Xray, CT scan, MRI scan, Bone scan, PET scan may be needed. Biopsy is a very important investigation which should be performed by the treating surgeon to confirm the diagnosis.

Treatment of Bone cancer:
In the past bone cancers where considered to be incurable and procedures like amputation surgery where performed to relieved patients of pain. Various advances have been made in the management of these cancers. High end investigation modalities like MRI scan, PET scan etc have made diagnosis easier. Various limb salvage procedures are now available for upper limb, lower limb and pelvic cancers. Various reconstruction techniques are now available which includes Megaprosthetic replacement, Allo bone graft, Vascularized fibula, Rotationplasty etc. For children with bone cancer, special implants like expandable megaprosthesis are also available.

Patients with metastatic bone cancer, palliative surgeries are performed to relieve them of cancer pain and improve quality of life and function.

Multimodality approach is now recommended which may include chemotherapy, Surgery and Radiotherapy. Chemotherapy helps prevent cancer spread and save lives. Radiotherapy may be used as an adjuvant to surgery.

Prognosis of Bone cancer:

With an advent of newer technology and skills primary bone cancers can be detected early and cured. The cure rates have improved from 25 % to 70 %. Patients who present late with large local disease and metastasis (spread) where cure is not possible, care is directed towards relieving pain and improving function. Quality of life may thus be improved.


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