Bone cancer occurs when the cells in the bone divides out of control.
For every 1,000 Malaysians, 10 males and 6 females were newly diagnosed with bone cancer during 2012-2016. Although it can occur at any age, certain bone cancers more commonly affect children, teenagers and young adults as compared to older adults.
Bone cancer can be classified into primary or secondary bone cancer.
Primary bone cancer originates in bone cells, and is uncommon:
- Osteosarcoma is the most common primary bone cancer. It starts in the cells where new bone tissues are formed, usually affecting the ends of large bones, such as the arms, legs, or pelvis (hip bone). It mostly occurs in young people between age 10 and 30, but 1 in 10 cases happen in older adults aged 60 and above.
- Ewing’s sarcoma usually affects children, teens, and young adults below age 30. Common sites are the pelvis, the ribs or shoulder blades, the bones of the spine and the long leg bones.
- Chondrosarcoma is the second most common primary bone cancer that begins in the cartilage. It occurs more frequently in older adults and is rarely seen among patients below age 20. Common sites include the bones of the arms, legs, or pelvis.
- Chordoma is a rare rumour that occurs in the bones of the spine, usually at the bottom of the spine (sacrum) or the base of the skull. It is more often seen in adults older that age 30, and it is twice as common in men as in women.
Secondary bone cancer, also known as bone metastasis, refers to cancer that originated from elsewhere and then spread to the bones.
It usually happens with advance cancer of the breast, prostate, or lungs. The spine is the most commonly affected site, with other common sites including the pelvis, femur (upper leg bone), humerus (upper arm bone), ribs and the skull.
The following risk factors put you at a higher risk of developing bone cancer:
- Previous exposure to radiotherapy
- Certain non-cancerous bone conditions: Paget’s disease, hereditary multiple osteochondromas, fibrous dysplasia
- Inherited cancer syndromes: Hereditary retinoblastoma, Li-Fraumeni syndrome
The symptoms of bone cancer depend on the type, location, and size of the tumour, including:
- Unexplained weight loss
- Difficulty moving around
- Fracture due to weak bones
- Pain and swelling of the affected bones
- Bone pain that worsens at night or when bone is used
- Numbness, tingling or weakness in different body parts
For a bone cancer diagnosis, your doctor will evaluate your medical history and symptoms. Your doctor will also perform a physical examination and blood tests may also be requested.
Common diagnostic tests include:
- X-ray is usually the first test done if bone cancer is suspected. Sometimes, a chest x-ray is conducted in adult patients to check if the cancer has spread to the lungs.
- Magnetic resonance imaging (MRI) provides more details for bone abnormalities observed on an x-ray and determines the exact extend of the tumour to plan for surgery.
- Computed tomography (CT) scan shows detailed cross-sectional images of parts of the body. It is useful for detecting possible cancer spread in other parts of the body.
- Bone scan shows if the cancer has spread to other parts of the body through “hot spots” on the skeleton, as a result of injected radioactive material displaying areas of active bone changes. Other tests, such as x-rays, MRI scans, or bone biopsy, are necessary to make an accurate diagnosis.
- Biopsy confirms the diagnosis of bone cancer if results from imaging tests are suggestive of the disease. Cells from the abnormal area is removed and examined under the microscope.
Learn more about the different types of screening and diagnostic procedures performed to diagnose bone cancer.
The treatment of choice for bone cancer depends on the type of cancer, the tumour's position and size, and the stage of cancer. The key treatments used are surgery, chemotherapy, and radiotherapy.
- Surgery removes all cancer cells by removing the tumour and some healthy cells around it. The doctor may repair or rebuild affected bones with real or artificial bone grafts, and a prosthetic (artificial limb) may be used if an entire limb is removed.
- Chemotherapy employs potent cancer-killing medications. It is an important part of treatment for osteosarcoma and Ewing’s sarcoma, but it is less commonly used for chondrosarcomas and chordomas as these cancers are not as sensitive to chemotherapy.
- Radiotherapy uses high-energy radiation to shrink tumours, destroy cancer cells, and relieve symptoms associated with advanced cancer. Radiotherapy is not a typical treatment for all types of bone cancer as a higher dose is needed to kill cancer cells, which may damage nearby healthy cells. However, for Ewing’s sarcoma, it can be a significant component of treatment.
Learn more about the different types of treatment technologies to treat bone cancer.
There are no known ways to prevent bone cancers, as experts remain unsure of the causes. Certain lifestyle changes like maintaining a healthy weight or quitting smoking may be helpful to reduce the risk of bone cancer in adults.
Despite no widely recommended screening tests for bone cancer in people with average risk of bone cancer, most bone cancers were detected early, thanks to symptoms like bone pain or swelling.
Doctors may recommend close monitoring for individuals at higher risk of bone cancers due to certain bone conditions or hereditary diseases to catch the disease early.
Gleneagles Hospital works with oncologists to assist patients through cancer treatment. The caring and multidisciplinary team of healthcare professionals are available for consultation and to provide the best care.