Confronting Bone Cancer: Understanding and Overcoming the Odds

Receiving a diagnosis like bone cancer can feel overwhelming and daunting. Accepting this reality is an important first step on the journey to recovery. However, it's equally vital to equip yourself with knowledge and resources to navigate the path ahead. Consider what information you need and the questions you want to ask your healthcare team. By seeking answers and gaining a deeper understanding of your condition, you empower yourself to face the challenges ahead with resilience and hope.

Bone cancer arises from the uncontrolled growth of cells within the bone. Cancer developing directly in the bone is termed primary bone cancer. Conversely, when cancer originates elsewhere in the body and metastasises to the bones, it is referred to as secondary bone cancer, which is far more common than primary bone cancer. The most frequent types of cancers that spread to the bones include those of the breast, prostate, and lung. Primary bone cancers make up about 0.2% of all cancers.

Primary bone cancer is classified into four main types based on its point of origin:

• Osteosarcoma

Originating in osteoblasts, the bone-forming cells, osteosarcoma typically develops at the ends of large bones, such as those in the arms and legs. It is more common in children and teenagers.

• Ewing Sarcoma

Ewing sarcoma is most prevalent in children and young adults, often found in the long bones of the legs, hips, ribs, and shoulder blades or in the surrounding soft tissues.

• Chondrosarcoma

This type arises in the cartilage—the soft connective tissue between joints. It is more common in individuals over 40, and the shoulder, leg, and pelvis are frequently affected sites.

• Chordoma

A rarely occurring bone cancer that begins at the base of the spine or skull. While it primarily affects older adults, it is usually located at the base of the neck and skull when present in children and adolescents. 

In some instances, bone cancer may not cause any noticeable symptoms, making it very difficult to detect until it is identified during a medical examination for unrelated issues. Symptoms of bone cancer can be of different types depending on the type and location of the tumour, but they often include:

• Bone pain that disrupts sleep at night
• Painful swelling or a lump around a bone
• Persistent fever or fatigue
• Unexplained weight loss
• Brittle bones that fracture easily

Dr Kunal Sharma, Associate Director & Section Head, Mumbai, says, “Bone cancer pain can be distinguished from pain caused by injuries or overuse as it tends to be constant, worsens over time, and often becomes more severe at night. Swelling near the affected area may also occur, along with tenderness.”

Although the causes of bone cancer remain unknown, several factors can increase the risk, including:

• Family history of bone cancer.
• Previous treatment with radiation therapy or chemotherapy.
• Paget’s disease is a chronic bone disorder characterised by the unusual breakdown and formation of bone tissue.
• Hereditary conditions such as Li-Fraumeni syndrome (a condition which increases the risk of various cancers due to a gene mutation) or retinoblastoma (a childhood eye cancer that starts in the retina).

Your doctor will thoroughly discuss your symptoms when they began, and your medical and family history. Diagnosing bone cancer involves several steps, each overseen by expert healthcare professionals with specific roles. Initially, tests are conducted to confirm the presence of bone cancer. Once confirmed, further tests may be required to pinpoint the tumour's location, growth, and spread within the body.

Your healthcare team will suggest treatment options based on the type and aggressiveness of the cancer, its location, and whether it has metastasised. Treatments may involve medications, surgery, high-intensity energy beams, and supportive therapies like physiotherapy, counselling, yoga, and meditation to promote overall well-being. In certain cases, doctors may provide an option of participating in clinical trials for bone cancer treatment.

Primary bone cancer is staged based on the tumour's location, size, growth, and spread within the body. The stages are as follows:

Stage 1: The tumour is less than 8 cm in size, contained within the bone, and has not spread. Stage 1 tumours are the most easily treatable.

Stage 2: The tumour remains localised but is more aggressive and classified as high-grade.

Stage 3: A high-grade tumour that has spread to other areas within the same bone but has not yet reached the lungs or lymph nodes.

Stage 4: Bone cancer has metastasised to organs which are distant, such as the lungs or liver, and tumours are present at multiple sites in the body.

When faced with the reality of bone cancer, it’s important to recognise the signs. Common symptoms may include persistent bone pain, especially at night, swelling near the bone, fatigue, fever, weakness, and bones that fracture easily. Your journey is unique, and so is your treatment plan. After identifying the type and progression of the cancer, your doctor will create a personalised treatment approach that meets your individual needs, empowering you to face the challenges ahead with hope and resilience.

Imaging tests may be recommended for individuals with symptoms resembling bone cancer as a part of the initial diagnosis.

Bone cancer is curable, particularly when detected early and classified as low-grade.

Intense bone pain, though a significant symptom, does not always indicate bone cancer. It’s important to look for additional signs and symptoms related to bone cancer.

Bone cancer cannot be completely prevented, as genetic and environmental factors both play a role. However, leading a healthy lifestyle and minimising exposure to toxins may minimise the probability of developing any type of cancer.

Not all bone cancers spread rapidly; the aggressive nature of the cancer is determined by its genotype and location within the body.