Cancer of the bone occur both in the young and the old, in males and females. This cancer is of various types. The common among them are as follows:
1. Osteogenic Sarcoma.
2. Ewing’s Sarcoma.
3. Multiple Myeloma.
Osteogenic Sarcoma
This cancer occurs predominantly in males between the ages of 10 to 25 years. Any bone may be involved.
Causes
It is not known.
Symptoms
· Pain and tender swelling of the bone and the tissues around it.
· Loss of weight.
· Fatigue.
· Involved bone may break without much of an injury.
· Spread may occur in the lungs and bones.
Diagnosis
· Routine: Blood: Hb, TLC, DLC may show no change. ESR may be raised.
· Special: X-ray of the bone which shows destruction of the bone at the site of the cancer.
· Bone biopsy establishes the diagnosis of cancer and also the type of cancer.
· Additional: In order to look for the spread of the cancer, the following tests are done:
· X-ray of the chest.
· Liver scan.
Treatment
· Surgery: This involves amputation of the long bone much above the cancer site.
· Many cases of spread of the cancer to other parts are seen even after the surgery.
· Radiation: Radiation is given before the surgery in some centres, in order to shrink the tumour or to eliminate it.
· Chemotherapy: Most centres use chemotherapy after surgery and radiation to kill the metastases which even though small may have yet occurred. The drugs commonly used are:
· Methotrexate
· Adriamycine
· Vincristine
· Cyclophosphamide
The treatment is given intermittently for 1 to 2 years. If an obvious spread has occurred in the lungs or bones, surgical removal is attempted, and then chemotherapy given.
Prognosis
If detected when localized, the chances of cure after surgery, are above 50 per cent Some osteogenic sarcomas are slow-growing; in them the chances of success are 70 to 80 per cent.
Ewing’s Sarcoma
This is a tumour of the bones, occurring in children, more often boys, between the age of 5 to 15 years. It may involve any bone of the body.
Causes
It is not known.
Symptoms
· Continuous and increasing pain over a bone.
· Swelling of a bone.
Diagnosis
· Routine: Blood: Hb, TLC, DLC are normal. ESR is raised.
· Special: X-ray of the bone which shows swelling and destruction.
· Biopsy examination of the involved bone which shows the exact nature of the cancer.
· Additional: If the cancer has spread, then X-ray of the chest is taken which can confirm it.
· Bone scan of the other suspected bones is done.
Ultrasound examination of the liver is done to look for the secondaries.
Treatment
Surgery: This is unhelpful.
Radiation: In high doses, it is given over the diseased area 4 to 5 days a week for 6 to 8 weeks. Soreness and reddening and later thickening of the skin occurs as a side-effect.
Chemotherapy: Chemotherapy is indicated when the cancer has spread to other parts of the body. The drugs most commonly used are:
· Vincristine
· Cyclophosphamide
· Adriamycin
· Actinomycin D
· Treatment is given intermittently for some months.
Prognosis
Two decades back, Swing’s sarcoma was described as the most lethal primary cancer of the bone, reported 5-years survival being 0 to 12 per cent. Availability of new chemo-therapeutic agents has, however, changed the picture. Initial trials were limited to single agent chemotherapy with Cyclophosphamide, Vincristine, Melphalan and 5-Fluorouracil with some improvement. Addition of drugs like Adriamycin, Actinomycin D, Bleomycin, and CCNU have changed the picture for the better dramatically. With such chemotherapy, 5-year survivals are reported to be around 70 per cent.
Radiation and chemotherapy together can cause a cure in case the cancer is localized and has not spread in other parts. In cases where the cancer has spread, this treatment prolongs life and lessens suffering.
Multiple Myeloma
This is cancer of one of the cells called plasma cell of the bone marrow and occasionally of the soft tissues. Plasma cell normally produces antibodies. When this cell becomes cancerous, it cannot produce those antibodies, with the result that the patient is very susceptible to infections.
This cancer is very uncommon under the age of 30 years. It becomes increasingly frequent thereafter, having its peak incidence between 60 and 70 years. Males are involved rather more frequently than females. There is a long pre-clinical phase, in some instances up to 25 years, the disorder being discovered incidentally by laboratory tests during this phase. The patient may thereafter be observed for years before symptoms appear.
Causes
It is not known.
Symptoms
· Fatigue
· Loss of weight
· Fever
· Recurrent infections
· Bone fractures
Symptoms usually reflect bone involvement, impairment of immune function, kidney damage and anaemia. The diffuse osteoporosis and local erosion of bone by myeloma cells results in stress, pain and eventual pathological fracture. The stress pain is often wandering, difficult to locate and described as rheumatic. On the other hand, the first intimation of trouble may be the sudden onset of acute localized pain due to pathological fracture. These symptoms arise mainly in weight-bearing bones, the vertebrae, pelvis and femur being particularly susceptible.
Collapse of a vertebra is common and produces severe nerve root pain. Weight-lifting may also cause pain in arms. Patients are often severely crippled. The progressive impairment of immune function due to the deficiencies of normal immunoglobulins and the excess of abnormal immunoglobulins, render these patients susceptible to infection, particularly of the respiratory tract. Pneumonia is quite frequently the presenting illness and often the cause of death.
Diagnosis
· Routine: Blood: Hb and RBC may be markedly decreased. TLC and DIC may be normal. ESR is markedly raised.
· Urine shows proteins in it, of a particular variety called Bence-Jones proteins.
· X-ray of the involved bone shows typical punched out cavities.
· Special: Bone marrow biopsy examination confirms the diagnosis.
· Additional: X-ray of the chest and bones are taken for locating the spread of the cancer in these areas.
Treatment
· Surgery: It is of no use.
· Radiation: It relieves pain in the bones effectively.
· Chemotherapy: The commonly used drugs are Melphalan and Prednisolone. This course of treatment is given every 4 to 6 weeks.If this has failed, a group of drugs is given.
Prognosis
After chemotherapy, most of the patients, live longer for many years and comfortably. When chemotherapy becomes ineffective, patient is treated only for the relief of symptoms.
Early Detection
Signs & Symptoms
· Pain and swelling of a bone or bones and areas around
· Bone fracture without injury.
· Loss of weight.
· Low-grade fever.
· Anaemia.
· Fatigue.
Investigations
· Biopsy examination of the involved bone.