Bone Cancer Overview (cont.)
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Benjamin Wedro, MD, FACEP, FAAEM
Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
In this Article
- What is bone cancer? What is metastatic bone cancer?
- Who is at risk for bone cancer?
- What causes bone cancer?
- What are bone cancer symptoms and signs?
- What are the different types of bone cancer?
- What kinds of bone cancer occur in children?
- What tests are used to diagnose bone cancer?
- What is the treatment for bone cancer?
- How is bone cancer pain managed?
- What is the prognosis for bone cancer?
- Can bone cancer be prevented?
- Find a local Oncologist in your town
What kinds of bone cancer occur in children?
Osteosarcoma, the most common type of bone cancer, is most common in children and young adults. Ewing sarcoma is another bone cancer that typically affects children.
What tests are used to diagnose bone cancer?
A variety of imaging tests may be used to identify bone tumors, including bone cancers. Very early bone cancers may not be apparent on plain X-rays, but plain X-ray images may identify many tumors. CT scans are more precise and may be used to identify bone tumors. MRI scans can provide detail of the soft tissues of the body and can typically reveal whether the cancer has spread beyond the bone into nearby tissues.
A bone scan is a test that uses radioactive material and X-rays to identify areas of rapidly growing or remodeling bone. This may allow the localization of tumors anywhere in the body. This test is not specific for bone cancers and can also reveal areas of inflammation as found with arthritis, fractures, and infections.
While many bone cancers have a characteristic appearance on imaging studies, a biopsy (tissue sample) must be taken in order to precisely determine what kind of cancer is present and confirm the diagnosis. The biopsy is a procedure that samples a piece of the tumor and is examined under a microscope. The tissue sample may be obtained with a needle inserted throuogh the slkin into the tumor or by operation when a surgeon makes an incision thorugh the skin to directly view the tumor.
At present, there are no screening tests available to detect bone cancers in the early stages.
What is the treatment for bone cancer?
An operation to remove the tumor is the mainstay of treatment for bone cancers. Improved surgical techniques allow for most bone cancers to be removed without requiring amputation of an affected limb. Sometimes, muscles and other tissues that surround the tumor also have to be removed. Reconstructive surgery may be needed, in addition to tumor removal, to help maximize function of the limb.
Ewing sarcoma, osteosarcoma, and other bone cancers, may require chemotherapy in addition to surgery.
Chondrosarcoma is typically.treated with radiation therapy.
Ewing sarcomas that do not respond well to high dose chemotherapy may need radiation therapy and even a stem cell transplant. In this procedure, the patient's stem cells (blood cells that have the potential to make all the different kinds of blood cells) are harvested from the bloodstream in a way similar to a blood donation. After high doses of chemotherapy medications to destroy the bone marrow, the harvested stem cells are returned to the body as with a blood transfusion. Over the next 3 to 4 weeks, the stem cells produce new blood cells from the bone marrow.
Targeted therapies are specially designed treatments that aim treatment specifically at the molecular changes found in cancer cells. For example, Denosumab (Xgeva) is a monoclonal antibody that acts to block the activity of specialized bone cells called osteoclasts. This medication has been used in the treatment of giant cell tumors of bone that have recurred after surgery or cannot be removed by surgery. Imatinib (Gleevec) is a targeted therapy drug that can block the signals from certain mutated genes that cause tumor cells to grow. Imatinib has been used to treat some chordomas that have spread or recurred after treatment.
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