Bone Cancer, Osteosarcoma/Malignant Fibrous Histiocytoma

Bone tumor is an inexact term, which can be used for both benign and malignant abnormal growths found in bone, but is most commonly used for primary tumors of bone, such as osteosarcoma. It is less exactly applied to secondary, or metastatic tumors found in bone. Bone tumors may be classified as "primary tumors" which originate in the bone, and "secondary tumors" which originate elsewhere. Primary tumors of bone can be divided into benign tumors and cancers. Common benign bone tumors may be neoplastic, developmental, traumatic, infectious, or inflammatory in etiology. Examples of benign bone tumors include osteoma, osteochondroma, aneurysmal bone cyst, and fibrous dysplasia. Malignant primary bone tumors include osteosarcoma, chondrosarcoma, Ewing's sarcoma, malignant fibrous histiocytoma, fibrosarcoma, and other sarcoma types. Multiple myeloma is a hematologic cancer which also frequently presents as one or more bone tumors. The tailbone is a common location for a teratoma, known as a sacrococcygeal teratoma, and related germ cell tumors.

Secondary bone tumors include metastatic tumors which have spread from other organs, such as the breast, lung, and prostate. Metastatic tumors more frequently involve the axial skeleton than the appendicular skeleton. Tumors which originate in the soft tissues may also secondarily involve bones through direct invasion. The most common symptom of bone tumors is pain, but many patients will not experience any symptoms, except for a painless mass. Some bone tumors may weaken the structure of the bone, causing pathologic fractures. Symptoms combined with other findings during a physical exam may suggest the presence of bone cancer, but additional tests are needed to confirm any suspicion. Imaging tests, like x-rays, MRIs, and CT scans, help identify any bone abnormalities. Other tests may include a bone scan, a specialized nuclear imaging test that allows doctors to see the metabolic activity of the bone. Bone scans identify areas in the bone that have new growth or have broken down -- excellent indicators of conditions.

Ultimately, it is a bone biopsy that will rule out or confirm the presence of cancer. A bone biopsy involves the removal of a small amount of bone tissue to be examined under a microscope. It usually takes less than an hour and can be done as an outpatient or surgical procedure.

Doing a biopsy on someone with primary bone cancer can be complex because there is a risk of spreading the cancer during the procedure of the cancer. The procedure should be done by a surgeon who has experience performing bone biopsies on those with primary bone cancer.

If cancer is detected, it is then graded and staged by a pathologist. Grading and staging classifications vary based on the type of bone cancer. Ideally, the pathologist examining the sample will be experienced in diagnosing bone cancer. The key to successful treatment is having a treatment team that is experienced in primary bone cancer. Many types of bone cancer are very rare, and having a team that is highly experienced in managing bone cancer is a necessity. Several different types of doctors make up these unique treatment teams and include medical oncologists, radiation oncologists, radiologists, surgical oncologists, orthopedic oncologists, and specialized pathologists.

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There are three standard forms of treatment for primary bone cancer: surgery, radiation therapy, and chemotherapy. Many times, more than one treatment method is required, such as surgery along with radiation therapy. Treatment varies based on type of bone cancer, if it has spread (metastasized), and other general health factors.

Surgery: Bone cancer is most commonly treated with surgery. Surgical treatment for bone cancer that has not spread involves removing the cancerous tissue and a small margin of healthy bone tissue surrounding it. Some tumors may require chemotherapy or radiation therapy in addition to surgical treatment.

Radiation Therapy: Radiation therapy uses specific types high energy beams of radiation to shrink tumors or eliminate cancer cells. Radiation therapy works by damaging a cancer cell's DNA, making it unable to multiply. Although radiation therapy can damage nearby healthy cells, cancer cells are highly sensitive to radiation and typically die when treated. Healthy cells that are damaged during radiation are resilient and are often able to fully recover.

Chemotherapy: Chemotherapy is often prescribed to treat bone cancer. Chemotherapy drugs work by eliminating rapidly multiplying cancer cells. However, there are other healthy cells in the body that multiply just as quickly, such as hair follicle cells. Unfortunately, many chemotherapy drugs may not be able to discern the two, attacking healthy cells and causing side effects like hair loss.

Follow up care :

Follow-up care after treatment for bone cancer is important. Even when there are no longer any signs of cancer, the disease can return if there are undetected cancer cells that remain somewhere in the body after treatment. During follow-up care after treating bone cancer, your doctor will monitor your recovery and check for recurrence of the cancer. Checkups help ensure that any changes in your health are noted and treated if needed. Between scheduled visits, you should contact your doctor if you have any health problems. It is important to eat well during and after treatment, because eating well may help patients feel better and have more energy. However, eating well can be hard, especially during or soon after treatment. Side effects of bone cancer treatment can cause poor appetite, nausea, vomiting, diarrhea, and food to taste differently. A registered dietitian can suggest ways to deal with these problems.

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