Definition Cancer of the bone occurs when cells in the bone undergo changes that make the cell grow and divide uncontrollably. This is called primary bone cancer. Cancer can also affect the bone when a cancer spreads from another part of the body to the bones. This is called bone metastasis. Many types of cancer can spread to the bone.
When a cancer spreads from one place to the bone, it is not considered cancer of the bone. The bone metastasis is the same type of cancer as the original tumour, such as breast or lung cancer. The bone metastasis is called by the original tumour name.
What is going on in the body? The bones support the body and make it possible to move about. Cancers affecting the bone will weaken the bone, and the affected area may break easily. The break can occur for no apparent reason. That is, it is not caused by an injury or trauma, such as a fall.
Primary bone cancer is usually osteosarcoma. It can spread from the bone to other parts of the body if untreated. Osteosarcoma is a rare cancer. It occurs most often in children but can occur in adults.
Any kind of cancer can spread to the bone. This bone metastasis usually occurs late in the disease. breast, prostate, and lung cancer are the most common types of cancers that spread to the bone. The bones of the spine, pelvis, and ribs are the most commonly affected. The bones of the upper arm and upper leg also may be affected. multiple myeloma, a type of leukaemia, can affect the bones early in the disease.
What are the signs and symptoms of the disease? A fracture in a bone that causes severe pain may be the first sign that cancer has invaded the bone. Sometimes the person will have pain in the area for some time before the fracture occurs. In other cases, there is no pain before the bone breaks.
For people with some types of cancers, the bone metastasis will destroy so much of the bone that calcium is released into the blood. Calcium is the hard mineral that makes up most of the bone. When too much calcium is in the blood, the person may have
What are the causes and risks of the disease? Osteosarcoma is rare. A person who has been exposed to radiation may be more at risk for primary bone cancer. A person who has uncontrolled cancer of the Breast, lung, or prostate is at high risk for developing bone metastases.
What can be done to prevent the disease? There is no way to prevent primary bone cancer. There is also no way of keeping cancer from spreading to the bone except to treat the primary cancer.
How is the disease diagnosed? Most people with primary bone cancer are diagnosed after there has been an unexplained fracture of a bone. An x-ray will show a tumour on the bone. A piece of tissue must be removed with a bone lesion biopsy to determine if the tumour is cancerous.
If a bone metastasis is suspected, a special x-ray called a bone scan can show damage to a bone before a fracture occurs. It is not always necessary to take a sample of suspected bone metastasis to prove it is cancer. This is especially true if a person has active cancer that has spread to other areas of the body.
What are the long-term effects of the disease? osteosarcoma, or primary bone cancer, is fatal if it is not effectively treated. In bone metastasis, cancer that has spread to the bone from another part of the body means that the cancer is at an advanced stage. Treatment is aimed at reducing pain and keeping the cancer from spreading further. It may not be possible to cure the cancer at that point.
What are the risks to others? There are no risks to others.
What are the treatments for the disease? Removing a small tumour may offer long-term control of primary bone cancer. Radiation therapy may be offered once a small tumour is removed. This may help slow the return of the tumour. Osteosarcoma that has spread to other parts of the body may be treated with chemotherapy and radiation therapy.
Radiation therapy is used to treat bone pain in a person with bone metastasis. Radiation to the affected areas can also prevent further weakening of the bones. The total dose of radiation that can be given is limited, however. chemotherapy is sometimes used to help control the underlying cancer.
Some bone metastases cause calcium to leave the bone. This weakens the bone even more. Medications known as bisphosphonates can be given to help the bones keep the calcium in the bone. Bisphosphonates may also help strengthen bones. This approach is commonly used in advanced breast cancer and Multiple myeloma, a type of leukaemia.
What are the side effects of the treatments? The side effects to a person with primary bone cancer depend on the treatment given. Surgery to a bone may affect the movement of the bone. The side effects of Chemotherapy depend on the particular medications given. Often chemotherapy can cause significant side effects. Radiation therapy may not cause side effects unless other areas are affected.
In a person with bone metastasis, the goal of treatment is to relieve symptoms and prevent additional problems. Bisphosphonates cause very few side effects. Radiation will relieve pain. Other therapy will be given to help improve a person's quality of life. Side effects will be minimised. Surgery may be performed in certain cases to pin weakened bones to make them stronger.
What happens after treatment for the disease? The person with osteosarcoma will need to be followed closely to watch for any signs that the disease has come back or became worse. A person with a bone metastasis will need to be followed closely to monitor for new metastases or bone fractures.
How is the disease monitored? Physical examination will reveal the general condition of the person with either osteosarcoma or bone metastasis. Specialised x-rays like CT scans will indicate the progress of the disease itself. Bone scans will generally be used to monitor a person with known or suspected bone metastases. Regular x-rays will be used to monitor suspected problems from multiple myeloma.
Author: Reviewer: eknowhow Medical Review Panel Editor: Dr John Hearne Last Updated: 18/06/2005 Contributors Potential conflict of interest information for reviewers available on request
