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What is bone cancer?

Bone cancer is abnormal growth of cells in the bones, which is uncontrolled and unregulated.  It is of two types- Primary bone cancer (cancer that starts within the bone) and Secondary bone cancer (cancer starting in some other organ of the body and spreading to the bone from there). Secondary bone cancers are much more common than primary bone cancers. There are essentially three most common forms of primary bone cancer- OsteosarcomaEwing Sarcoma, and Chondrosarcoma.  The first two types are commonly seen in children and young adults, while the third variety is more commonly seen in older age group.

Know the symptoms of bone cancer

The patient with bone cancer usually has pain in the affected area, the knee being the most common site. The pain may be severe, may cause the patient to limp, and may even be there when the patient is not walking, e.g.  at night.  There may also be a swelling of the bone or even a fracture that happens without any significant injury. Because these symptoms are not exclusive to bone cancer, it may be mistakenly diagnosed as injury/ infection or some other disease of bone. Hence a high index of suspicion is needed to pick up a cancer of bone early enough.

How is bone cancer diagnosed?

The diagnosis of bone cancer is considered when the suspicion of any such possibility leads the physician or orthopaedic surgeon to ask for an X ray. Further tests like MRI and CT scan may help in obtaining further detailed information. However, the definitive diagnosis of cancer and the type of cancer is done only by performing a biopsy.

What is a biopsy and why is it important?

A biopsy is a procedure where some tissue is taken out from a suspicious area of an organ (bone in this case) to determine the presence of a disease and to make further detailed studies. It is extremely important that the biopsy of a bone tumour is performed only at a centre where there are specialised teams dealing exclusively in bone and muscle cancer, and where the final surgical procedure for these tumours is going to be performed.

How is a biopsy performed?

In the musculoskeletal oncology department of Max Institute of Cancer Care, the vast majority of biopsies, known as core needle biopsy, are done as an OPD procedure, by using a hollow needle and is used to take out small pieces of tissue under local anaesthesia.  A small percentage, however, may require an incisional biopsy (a short surgical procedure under general anaesthesia).  

Is bone cancer curable?

This will depend on the stage and type of cancer. Talking of osteosarcoma, the commonest primary bone cancer, if detected in time (before the disease has spread to other parts in the body), the long term survival rates are up to 65- 70%. Which means a good percentage of these patients can get rid of this disease if detected early.

What is the treatment of bone cancer?

Bone cancer treatment depends on the type of bone cancer. Every patient is evaluated in detail by a multidisciplinary team consisting of musculoskeletal/ orthopaedic oncologist, paediatric/ adult medical oncologist, radiation oncologist, radiologist, pathologist, and other specialities. A treatment plan is thus made on day one, and started as soon as possible after the initial evaluation. Talking specifically of osteosarcoma, the patient receives chemotherapy followed by surgery and then further chemotherapy.

Does surgery for bone cancer means the limb will be amputated?

No.  Nowadays, at centres where these patients are routinely treated, up to 90% of patients undergo “limb salvage surgery”, where the tumour is completely removed while at the same time saving the form and function of the limb.  Amputation is required in only a small percentage of patients.