Malignant Bone Tumors

The exact cause of bone cancer is not always clear, most of them not hereditary so no risk to immediate family

Persistent bone pain that worsens over time

Swelling or tenderness near the affected area

Fractures that happen without significant trauma

Primary Bone Cancer: This is when the cancer starts directly in the bones. It is relatively rare compared to cancers that spread to the bones from other parts of the body (secondary bone cancer). Types of primary bone cancers include:

Osteosarcoma: The most common type, usually affecting children, teens, and young adults. It often starts in the long bones like the arms and legs.

Chondrosarcoma: Cancer that originates in the cartilage, and it typically affects adults.

Ewing's Sarcoma: Often diagnosed in children and adolescents, this cancer can develop in the bones or in soft tissue around the bones.

Chordoma: A rare cancer that typically occurs at the base of the skull or in the spine.

Secondary (Metastatic) Bone Cancer: This is when cancer from other parts of the body, like the breast, lung, or prostate, spreads (metastasizes) to the bones. This is much more common than primary bone cancer.

Persistent bone pain that might get worse over time

Swelling or a noticeable lump in the affected area

Unexplained fractures or breaks in the bone

Osteosarcoma: This is the most common primary bone cancer, and it primarily affects children, teenagers, and young adults. It is most commonly diagnosed in people between the ages of 10 and 30, with a peak incidence in adolescents and young adults during periods of rapid growth.

Ewing's Sarcoma: This cancer primarily affects children and adolescents, typically between the ages of 10 and 20. It is less common in adults but can still occur.

Chondrosarcoma: Unlike osteosarcoma and Ewing's sarcoma, chondrosarcoma tends to affect adults. It is most commonly diagnosed in individuals between the ages of 30 and 60. It is rare in children and young adults.

Imaging Tests

X-rays: The first imaging test performed to look for abnormalities in the bone, such as a mass, changes in bone structure, or areas that might indicate cancer. X-rays can show if there is any bone destruction or unusual growth.

MRI (Magnetic Resonance Imaging): MRI scans provide more detailed images than X-rays and are particularly useful for assessing the extent of the tumor and how it may have spread to surrounding soft tissues (muscles, tendons, etc.).

PET Scan (Positron Emission Tomography): In some cases, a PET scan may be used to determine whether the cancer has spread to other parts of the body. It helps to see how the tumor is behaving by tracking glucose metabolism in the cells.

Biopsy

A biopsy is often the definitive test to confirm the diagnosis of bone cancer. During a biopsy, a small sample of tissue from the tumor is removed and examined under a microscope. There are two main types of biopsies:

Needle Biopsy: A thin, hollow needle is inserted into the tumor to remove a tissue sample. This can be done percutaneously (through the skin) under local anesthesia or sedation.

Surgical Biopsy: Is not recommended. It requires cut opening the tumor to take tissue for biopsy, it can lead to spread of cancer

The treatment for bone cancer depends on the type of bone cancer, its stage (how far it has spread), its location, and the patient’s overall health. The main treatment options for bone cancer include surgery, chemotherapy and radiation therapy,

Surgery:

Limb Salvage Surgery: In many cases, only the tumor and a small amount of surrounding tissue are removed. In some cases, the surgeon may be able to save the bone and reconstruct it if necessary (using bone grafts, prosthetics, or metal implants).

Amputation: In rare cases, especially if the tumor is too large or in a difficult location to remove, an amputation may be required to remove the affected limb. Afterward, prosthetics may be used to restore function.

Chemotherapy

Neoadjuvant chemotherapy: This is given before surgery to shrink the tumor, making it easier to remove.

Adjuvant chemotherapy: After surgery, chemotherapy is given to kill any remaining cancer cells that might have spread, reducing the risk of recurrence.

Systemic chemotherapy: In some cases, chemotherapy is used to treat metastatic bone cancer (cancer that has spread to other parts of the body).

Radiation Therapy

Before surgery: To shrink the tumor and make it easier to remove.

After surgery: To kill remaining cancer cells that could cause a recurrence.

Palliatively: To relieve pain and symptoms in cases where the cancer is advanced and not curable.

Treatment for Specific Bone Cancer Types:

Osteosarcoma: Typically treated with a combination of surgery and chemotherapy. Radiation is not usually effective for osteosarcoma.

Ewing’s Sarcoma: Treated with chemotherapy, radiation therapy and surgery.

Chondrosarcoma: Primarily treated with surgery, as chemotherapy and radiation are not as effective.

Chordoma: Surgery is the main treatment, but radiation therapy may be used if surgery is not possible or to treat any remaining tumor.

Yes, limb-salvage surgery is a type of surgery used to treat bone cancer that allows the limb to be preserved while removing the tumor, it helps maintain function and quality of life after treatment. With Modern surgical techniques we can save limb (hand/leg) in more than 90-95 percent of patients

What is Limb-Salvage Surgery?

Removing the Tumor: The surgeon removes the cancerous tumor and a small margin of surrounding healthy tissue to ensure that all cancer cells are excised. The goal is to take out the tumor completely while avoiding excessive damage to the surrounding muscles, nerves, and blood vessels.

Bone Reconstruction: After the tumor is removed, the surgeon reconstructs the bone to restore function and prevent the limb from becoming unstable.

Bone Grafting: Healthy bone or synthetic bone material is used to fill the gap left by the tumor.

Prosthetic Implants: In some cases, a metal or plastic prosthetic device is used to replace the removed portion of the bone, especially if the tumor is in the knee or hip area.

Custom-made prostheses: For some patients, a custom prosthetic can be designed specifically for their needs, allowing them to regain mobility and use of the affected limb.

SSoft Tissue Reconstruction: If the tumor affected muscles, tendons, or other soft tissues, the surgeon may perform additional procedures to repair or reconstruct these tissues to restore function.

Benefits of Limb-Salvage Surgery:

Preserves the Limb: The most obvious benefit is that the limb is preserved, which can lead to better functional outcomes compared to amputation.

Improved Quality of Life: Patients who undergo limb-salvage surgery often experience better mobility and quality of life compared to those who have an amputation.

Psychosocial Benefits: Retaining the limb can have important psychological benefits, including improved self-esteem and social integration.

Cure Rates and Prognosis:

Osteosarcoma: When caught early and treated with surgery and chemotherapy, Chance of cure is 60-80%.

Ewing’s Sarcoma: When caught early and treated with surgery + chemotherapy and plus or minus radiotherapy, Chance of cure is 70-80%.

Chondrosarcoma: This cancer is often treatable with surgery and cure rate is 70-90%

No, bone cancer is not typically hereditary and does not directly spread to family members. Bone cancer is caused by mutations in the cells of the bone, and while these mutations are not contagious.

Yes, bone cancer can come back after treatment, and this is known as a recurrence. Usually, recurrence is seen in first 2-3 years after treatment, after that risk significantly comes down. After 5 years chance of recurrence becomes negligible. High risk patients are large size cancer, if cancer has spread to other part of the body, Recurrent Cancer, Poor responder for Chemotherapy, if surgical removal is not possible.

Expertise in Bone Cancers:

Orthopedic oncologists specialize in cancers of the bones and soft tissues, including bone cancer (like osteosarcoma, Ewing’s sarcoma, etc.). They have the specialized knowledge to understand the unique nature of these cancers and how they affect bones, joints, and surrounding structures.

Precise Diagnosis:

Bone cancer requires accurate diagnosis and staging to determine the exact type of cancer and whether it has spread. Orthopedic oncologists have experience using advanced imaging techniques (X-rays, MRI, CT scans, etc.) to evaluate bone tumors and decide on the best course of action.

Limb Salvage and Preservation:

Orthopedic oncologists focus on preserving the function of limbs affected by bone cancer. One of their key goals is limb-salvage surgery, where they attempt to remove the tumor while saving the limb (arm or leg). In cases where amputation is not necessary, orthopedic oncologists are highly skilled in performing surgeries that allow patients to retain use of their limbs after cancer removal.

Surgical Expertise:

Orthopedic oncologists are skilled in complex surgeries required for bone cancer. Whether it's removing a tumor, reconstructing bones after tumor removal, or performing other procedures, they are trained to perform surgeries that minimize complications and optimize recovery.

Comprehensive Treatment:

Bone cancer often requires a combination of surgery, chemotherapy, and radiation therapy. An orthopedic oncologist will work closely with other specialists, such as medical oncologists and radiation oncologists, to develop a tailored treatment plan. They can guide the patient through each step of the treatment process and help manage the side effects.

Treatment of Rare Cancers:

Some bone cancers, like chordoma or Ewing's sarcoma, are rare and require specialized knowledge to treat effectively. Orthopedic oncologists are trained to handle these less common bone cancers and can provide the most appropriate treatment options.

Long-Term Care and Follow-Up:

After the initial treatment of bone cancer, regular follow-ups are necessary to monitor for any recurrence of cancer or complications from treatment. Orthopedic oncologists offer long-term care and surveillance to ensure that patients remain cancer-free and can recover fully, especially in cases of limb-salvage surgery where functional rehabilitation is important.

Multidisciplinary Approach:

Orthopedic oncologists often work with a team of medical professionals, including radiologists, pathologists, medical oncologists, and rehabilitation specialists. This collaborative approach ensures that all aspects of the patient's care—diagnosis, treatment, rehabilitation, and emotional support—are handled effectively.