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Bone cancer

Bone tumor is an abnormal growth of cells within a bone. Bone tumors may be malignant or benign. Though the causes of bone tumors are unknown, some possible causes include hereditary or genetic defects, radiation and injury. In most cases, no specific cause is found. Osteochondromas is a most common non cancerous bone tumor which occurs in people between ages ten and twenty. While primary bone cancers start from bones, secondary or metastatic bone tumors start in another part of the body such as breast, kidney, lung, prostate and thyroid and spread. These forms of cancer usually affect older people.


Symptoms of bone cancer

Some common bone cancer symptoms include:

  • Bone fracture or fracture from slight injury or trauma.
  • The most common symptom of bone cancer is pain. Though mild initially, bone pain gradually becomes intense and tends to worsen at night.
  • A mass or lump may be felt on the bone or the tissues surrounding the bone. This is common with fibrosarcoma.
  • Bones become weakened by tumor and may lead to a fracture. This can occur with both benign and malignant tumors.
  • Mass swelling at the tumor site which may be occasionally found.
  • Pain, numbness and tingling in the extremities can be found if tumor is compressed and this can affect the blood flow to the extremities.
  • Fever, chills and night sweats can occur though these are less common signs.
  • Weight loss can occur in some cases.

Diagnosis of bone cancer

After taking into account the complete medical history and performing a physical examination, the following diagnostic tests would be done.


  • Alkaline phosphatase blood test.
  • CT scan can give a cross sectional picture of the bones and additional information on the size and location of the tumor.
  • MRI of the bone and surrounding tissues can provide cross sectional imaging of the body and better details of soft tissues, including muscles, tendons, ligaments, nerves and blood vessels.
  • X ray of the bone and surrounding tissues.
  • A bone scan is taken on the entire body and is not specific for any type of tumor.
  • Bone biopsy: When the tumor is identified, the doctor may then obtain a biopsy sample of the tumor. This involves taking a small sample of the tumor and examining it in the laboratory by a pathologist. This biopsy can be obtained through a small needle or through a small incision.

Treatment of bone cancer

There are many treatment options for bone cancer depending upon the type of bone cancer and the location of the cancer. It also depends on whether or not the cancer has spread from the bone to surrounding tissues. Treatment options include surgery, chemotherapy and radiation therapy. These can be used individually or in combination with each other.

Although some benign bone tumors tend to go away on their own and hence do not require treatment, close monitoring is essential to see if the tumor shrinks or grows. In case of malignant tumors, surgery would become essential. The goal of surgery is to remove the entire tumor and its surrounding area or normal bone. A pathologist examines the tumor once removed to determine if there is normal bone completely surrounding the tumor. In case the cancer is left behind, chances are it can continue to grow and spread requiring further treatment.


Depending upon the size/amount of bone removed, the surgeon will replace either by bone cement or bone graft from another place in the body or from the bone bank. For larger areas, larger grafts from the bone bank or metal implants are done. Historically, amputation was the technique used to remove bone cancer. However, new techniques adopted have significantly decreased the need for amputation. Treatment for cancers that spread from other parts of the body would depend upon where the cancer started.

Mesenchymal Chondrosarcoma

Mesenchymal Chondrosarcoma is an extremely rare malignancy of bone or soft tissue, often an aggressive form of bone cancer. It is a variant type of the conventional Chondrosarcoma which is a form of bone cancer arising from cartilage cells. Cartilage is a specialized tissue and it serves as a buffer or cushion at joints.


The skeleton of an embryo consists of cartilage which slowly converts into bone. In Mesenchymal Chondrosarcoma, approximately two-thirds affect the bones, especially the spine, ribs and jaws. In other cases, it affects the areas of the body other than bone, in soft tissues such as muscle and fat. Mesenchymal Chondrosarcoma occurs with greater frequency in young adults (aged 10-30). It is present in 2% of all chondrosarcomas and it has no sexual or racial predilection, but females are slightly more affected than males.


Signs and symptoms

Symptoms could vary depending upon the exact location and progression of tumor. Mesenchymal Chondrosarcoma mostly arise in the bones of the jaw, spine or the ribs. Tumors can develop in arms and legs frequently as well and especially in the femur (thigh bone). Tumors appearing as soft tissue masses can affect the muscle or central nervous system.

Some symptoms of Mesenchymal Chondrosarcoma resemble that of many other illnesses and disorders and this can lead to a false diagnosis initially. This is seldom the sickness that doctors perceive when presented with symptoms that match this rare cancer. It can generally be diagnosed without much difficulty when pain and swelling in the specific part of the body is located though other possibilities are usually tested first.


Although specific symptoms associated with Mesenchymal Chondrosarcoma are vague and non specific; yet many develop pain and swelling in the affected area. Lumps and joint stiffness are other clinical symptoms of the tumor. Such symptoms can be present even long before a diagnosis is made. One third of patients are symptomatic for more than one year. A large tumor can compress nearby structures and cause additional symptoms, for instance, a spinal cord paralysis, or if in the eye socket, can cause pain, swelling, visual disturbances and protrusion of the eyeball. Since this is an aggressive form of cancer, it can spread to other areas of the body - lungs, liver, lymph nodes and other bones and can cause life threatening complications.


Causes

While the exact cause of Mesenchymal Chondrosarcoma is unknown and investigations are ongoing, there is no identifiable risk factor for the development of Mesenchymal Chondrosarcoma that has been discovered.

Whereas, due to abnormal changes in the structures and orientation of cells known as oncogenes or tumor suppressor genes, these malignancies can develop. Current research shows that abnormalities of DNA, carrier of the body's genetic code can cause cellular malignant transformation. These abnormal genetic changes appear to occur quite spontaneously for unknown reasons.


Diagnosis

A diagnosis of Mesenchymal Chondrosarcoma may be difficult, but some seek attention due to pain and swelling. Diagnosis may be based upon clinical examination, and detailed patient history. A variety of specialized tests include X rays studies, a procedure in which a small sample of tissue is removed and studied under a microscope. A biopsy of a tumor or mass determines what type of cancer is present by identifying the cell type that makes up the tumor. In those suspected of Mesenchymal Chondrosarcoma, an open biopsy or a needle guided biopsy is recommended.


There are specialized imaging techniques that are used to evaluate the size, placement and extension of a tumor and to serve as an aid for future surgical procedures among those with Mesenchymal Chondrosarcoma. Such imaging techniques include CT scanning and MRI. Often CT scan of the lungs is performed as there is a risk of Mesenchymal Chondrosarcoma spreading to the lungs. Bone scans, tests that can detect areas of increased or decreased bone activity may be performed to determine whether Mesenchymal Chondrosarcoma has spread to affect other bones.


Clinical presentation

Like many other tumors, Mesenchymal Chondrosarcoma may metastasize thorough the blood and attack other organs within the body. It spreads to the lungs, though it may spread to other locations as well. When it appears near the spine, it is particularly troublesome. Depending upon the size of the tumor, it may place significant pressure on the spine and cause pain and partial paralysis. Should tumor be present in the skull, it can cause similar neurological problems.


Treating Mesenchymal Chondrosarcoma

To optimize treatment, a multidisciplinary group of health professionals at the time of suspicion of a bone sarcoma is highly recommended. Coordinated effort of a team of medical professionals is necessary to treat Mesenchymal Chondrosarcoma. While physicians specialize in the diagnosis and treatment of cancer, specialists in the use of radiation can treat cancer along with surgeons, oncology nurses and other specialists.

Specific therapeutic procedures and interventions vary depending upon numerous factors such as primary tumor location, stage of primary tumor and whether the tumor has spread to distant sites, individual's general health and other elements. Radiation may or may not be employed in the treatment of Mesenchymal Chondrosarcoma. Some medical oncologists advocate chemotherapy treatment plan. Radiation therapy post surgery is also typically standard practice for large tumors.


Since chances are that Mesenchymal Chondrosarcoma may recur after optimal therapy, patients should be routinely examined after surgery for follow up care. Surgical resection is the ideal method of treating Mesenchymal Chondrosarcoma assuming that the tumor can be removed without causing much damage to other organs or tissues.

Surgery is often followed up with chemotherapy and radiation to ensure that no cancerous cells are allowed to survive, grow and spread again. In case tumor is in an inoperable location, then radiation and chemotherapy can be used to shrink the tumor enough to allow for safe operation. Local sufficiently radical treatment for prevention of recurrence is vital. Patients have to avoid spicy food, smoking and drinking to avoid recurrence of the disease. Early detection and early diagnosis and treatment are the key to prevention and treatment of this disease.



Bone scan

Bone scans can help identify hidden fractures that cannot be seen in regular x-rays, they can also help detect bone cancer, arthritis, reason for mysterious bone pain and bone infections. In a normal x-ray, the radiation passes through the body and creates an image on the x-ray placed on the other side of the body, whereas in a bone scan the radiation travels to the surface of the body that is in turn detected by a camera. All metal items in contact with the body have to be removed before a bone scan. There are no restrictions on eating and drinking. Bone scans are not performed on pregnant women. You have to arrive 4 hours before the scan and let the tracer settle well into your body.Bone scan procedure involves:

  • An injection with tracers is injected into the vein in your arm.
  • After this you have to wait for 2-4 hours to allow the tracers to circulate and become absorbed by your bones. In organs and tissues such as the bones, this radio nuclide gets accumulated.
  • You will be asked to drink lots of water to pass out the unabsorbed radioactive material through the urine. The absorbed radioactive material will flush out through the urine by 24 hours.
  • During the bone scan, you will be made to lie motionless on the table, as a device with an arm-like gadget holding the gamma camera passes above the body. When the tracers enter the body, they emit gamma waves of radiation that can be detected by a special camera.
  • The camera in turn generates images that can be inferred by radiologists or nuclear medicine specialists.
  • The scan takes about 30-60 minutes for the entire skeletal and even less if only for specified areas.

When no abnormal area is seen with high or low accumulation of the tracers, the radioactive material is evenly distributed. This indicates that the bone area that is scanned is normal. In abnormal cases, radioactive material accumulates in a particular area of the bone. This is known as a hot spot. Hot spots can indicate a healing fracture, bone cancer, bone infection, arthritis or a disease of an abnormal bone metabolism. Certain spots may indicate less absorption of the radioactive material, they are called cold spots. This could indicate cancer or lack of blood supply to the bone.

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Collection of Pages - Last revised Date: December 12, 2017