Bone Cancer Prognosis and Treatment

Bone cancer can be primary, meaning it originally comes from the bone, or it can be metastatic, meaning it comes from other organs. The latter route of action takes place more commonly and can come from the prostate, breast, thyroid, lung and/or kidney. The most frequent types of these tumors are: osteosarcoma, Ewing's sarcoma and chondrosarcoma. The definitive diagnosis of these tumors is given by biopsy and anatomopathological examination. The biopsy must be done by an experienced surgeon so as not to compromise the definitive surgery. One of the causes that still lead to amputation is a poorly located biopsy, with significant local contamination by the tumor. 

Osteosarcoma is the most common of the primary malignant bone tumors. It is more predominant in males, mainly in children and young adults. It can occur in any bone or even in soft parts, but most of the time, it affects the proximal humerus and tibia and distal femur. Local pain and/or swelling are the first symptoms. Early diagnosis is an important factor for the prognosis and the use of limb-preserving surgeries, which obliges us to rule out the possibility of osteosarcoma in any child or young adult who present pain, mainly in the proximal portions of the humerus and tibia of the distal femur. 

Ewing's sarcoma is the second most common malignant bone tumor in childhood. In most of the patients, the first symptom is pain. Two thirds of them have a palpable tumor and approximately a fifth present fever. The most common local symptoms are: pain and increased volume. The most common sites of impairment are the lungs, bones and bone marrow.

Chondrosarcoma is a malignant tumor from which fundamental neoplastic tissue consists of well-developed cartilage. This tumor occurs mainly in adults between 30 and 60 years and is most frequently located in the femur, tibia, humerus, scapula, ribs and bone iliac. Commonly, they are well-differentiated tumors of slow growth and with rates of metastases smaller than osteosarcoma and Ewing's sarcoma. Surgery is the main form of treatment for chondrosarcomas. The basic principle of surgery is to perform a resection with wide safety margins, avoiding recurrence (one of the factors of poor prognosis). 

Bone metastases can be diagnosed long before the patient experiences the first symptoms associated with the disease. That is why, if there is a diagnosis of cancer, it is important to follow medical advice and perform all the specific tests requested. Among the main ones are: x-ray, bone scintigraphy, computed tomography, magnetic resonance, tumor markers and bone biopsy. There are two main types of bone metastases: lytic metastases, in which malignant cells dissolve bone minerals, leaving them less dense and more fragile; and blastic ones, characterized when specific areas of the bones become denser (the latter type is more common in metastases from prostate and breast cancers). A more specific condition that can occur is metastasis in the bones of the spine. In these cases, the spinal cord can end up being compressed, causing serious damage to the patient, such as the loss of neurological functions, muscle strength and the sensitivity of the lower or posterior limbs. 

Once the condition is acquired, it is important that the patient adopts measures that will guarantee more quality of life during the treatment. The main one is having the support of multidisciplinary professionals, since bone metastases require a series of specific measures. In cases of metastasis in the spine the clinical oncologist, the radiotherapist and the surgeon (orthopedist or neurosurgeon) may be needed, so that each one tackles an aspect of the disease. Each one must act on the different variables during treatment. There are cases when surgery will be necessary; in others, radiotherapy. The clinical oncologist will provide systemic support to the patient to reduce the risk of problems such as fractures, impaired locomotion or spinal cord compression. 

And what are the treatment options? When the situation requires systemic treatment, the main routes are antineoplastic chemotherapy, hormonal treatment (in the case of breast and prostate cancers, for example) and radioactive isotopes. If the lesions are located, the most frequent indication is orthopedic surgery and radiotherapy. As always, the doctor in charge will be able to indicate the best treatment for each case and patient. 

References: 

https://www.cancerresearchuk.org/about-cancer/bone-cancer/survival 

https://www.nhs.uk/conditions/bone-cancer/treatment/ 

https://www.cancer.org/cancer/bone-cancer/detection-diagnosis-staging/survival-statistics.html