The providers at UofL Health – Brown Cancer Center bring together a team of experts that includes specialists from many areas to give personal, customized care for osteosarcoma, or bone cancer. We use specialized therapies and technologies to be sure you receive the most advanced treatment with the least impact on your body.
As a leading cancer center, we constantly work to discover new treatments and innovations.
It is best to have a biopsy to diagnose bone cancer done at the same place you receive treatment. It is essential to go to a specialized cancer center that has experience in osteosarcoma biopsy. If the biopsy is done incorrectly, it may make it more difficult later for the surgeon to remove all of the cancer without also having to remove all or part of the arm or leg. A biopsy that is not done correctly also may cause the cancer to spread.
Facts
Understanding a disease is the first step toward finding the right care. Get the facts about bone cancer, including the different types, how it starts and who’s at risk.
Bone cancer can develop in the bones or spread to bone from other areas of the body.
According to the American Cancer Society, nearly 4,000 people each year in this country are diagnosed with primary cancer of the bones and joints. These cases make up 0.2 percent of all cancers in the United States.
Bone cancer is a sarcoma (type of cancerous tumor) that starts in the bone. Other cancers may affect the bones, including:
- Secondary cancers that metastasize, or spread, from other parts of the body
- Other types of cancer, including non-Hodgkin's lymphoma and multiple myeloma
Bone Cancer Types
Bone tumors can be benign (not cancer) or malignant (cancer). Bone cancer, also known as sarcoma, includes many different types, which are named according to the bone or tissue in which they start.
The most common types of bone cancer include:
Osteosarcoma or osteogenic sarcoma is the most common type of bone cancer, occurring most often in children and adolescents. About 25% of bone cancers in adults are osteosarcoma, with the cancer most commonly being present in men. Each year, about 1,000 people in the United States are diagnosed with this type of bone cancer, which begins in bone cells in the pelvis, arms or legs.
Chondrosarcoma is the most common bone cancer in adults. Cancer of cartilage cells, Chondrosarcoma is typically diagnosed at an early stage. About 70% of adults diagnosed with Chondrosarcoma are over the age of 40.
Ewing's sarcoma accounts for about 8 percent of bone cancers in adults, and is more prevalent in children and adolescents. Ewing’s sarcoma typically starts in bones, tissues or organs.
Less common bone cancers include:
- Chordoma, which is usually in the spine and base of the skull. Chordoma makes up about 10% of adult bone cancer cases.
- Malignant fibrous histiocytoma/fibrosarcoma typically starts in connective tissue.
- Fibrosarcoma is often benign, but tumors should be checked for malignant cells. Fibrosarcoma is found in soft tissue in the leg, arm or jaw.
Secondary (or metastatic) bone cancer is cancer that spreads to the bone from another part of the body. This type of bone cancer is more prevalent than primary bone cancer. For more information about this type of cancer, see the type of primary cancer (where the cancer started).
Risk Factors
Genetic testing and counseling can help you to detect genetic diseases that may double as risk factors, including:
- Li-Fraumeni syndrome
- Rothmund-Thompson syndrome
- Retinoblastoma (an eye cancer of children)
- Multiple osteochondromas
Other risk factors for bone cancer include:
- Paget’s disease
- Prior radiation therapy for cancer, especially treatment at a young age or with high doses of radiation
- Bone marrow transplant
Symptoms
Most cancers have the same symptoms as other, less serious conditions. Still, it’s important to know the signs.
Bone cancer symptoms vary from person to person. They also depend on the size and location of the cancer.
If you have symptoms of bone cancer, they may include:
- Pain
- Swelling or tenderness in or near a joint
- Difficulty with normal movement
- Fatigue
- Fever
- Weight loss
- Anemia (low red blood cell count)
- Fractures
Having one or more of these symptoms does not mean you have bone cancer. However, it is important to discuss any symptoms with your doctor since they may indicate other health problems.
Diagnosis
Blood tests, imaging exams and even surgical procedures are used to check for cancer.
Accurate diagnosis is essential to the successful treatment of bone cancer. The wrong kind of biopsy may make it more difficult later for the surgeon to remove all of the cancer without having to also remove all or part of the arm or leg. A biopsy that is not done correctly may cause the cancer to spread.
If your doctor thinks you may have bone cancer, it’s important to go to a cancer center with a specialized bone cancer program. You should look for a program that does as many diagnostic procedures as possible.
If you have symptoms that may signal bone cancer, your doctor will examine you and ask you questions about your health and your family history. One or more of the following tests may be used to find out if you have cancer and if it has spread. These tests also may be used to find out if treatment is working.
Biopsy
A biopsy, which removes a tiny piece of bone, is used to confirm the presence of cancer cells. This is the only way to find out for certain if the tumor is cancer or another bone disease. It is very important for the biopsy procedure to be done by a surgeon with experience in diagnosing and treating bone tumors.
There are two types of bone biopsy:
Needle biopsy: A long, hollow needle is inserted through the skin to the area of bone to be tested. The needle removes a cylindrical sample of bone to look at under a microscope.
Open or surgical biopsy: An incision (cut) is made, and the surgeon removes a tiny piece of bone for examination under a microscope.
Your doctor will decide which type of biopsy is best for you based on several factors, including the type and location of the tumor. If possible, the surgeon who performs the biopsy should also do the surgery to remove the cancer.
Treatment
Common cancer treatments include chemotherapy, radiation treatment and surgery. Doctors select the treatment for bone cancer based on your diagnosis and disease stage, as well as your general health.
Your treatment for bone cancer will be customized to your particular needs. One or more of the following therapies may be recommended to treat bone cancer or help relieve symptoms.
Surgery
If at all possible, the same surgeon should perform both the biopsy and surgery. The biopsy will help the surgeon locate the tumor more precisely. The goal of surgery is to remove as much of the cancer as possible. If any cancer cells remain, they may grow and spread. To get as much of the cancer as possible, the surgeon performs a wide-excision surgery. This involves removing the cancer, as well as a margin of healthy tissue around it.
If the tumor is in an arm or leg, the surgeon almost always is able to perform limb-sparing surgery, which removes the cancer cells but allows you to keep full use of your leg or arm. To replace bone that is removed during surgery, a bone graft may be done or an internal device called an endoprosthesis may be implanted.
If this is not possible, an amputation, or removal of the limb, may be performed. Reconstructive surgery and/or a prosthesis will be needed. Rehabilitation is necessary after either procedure.
Chemotherapy
Chemotherapy may be recommended to treat osteosarcoma or Ewing’s sarcoma. In osteosarcoma, it is often given before surgery to shrink the tumor and make it easier to remove, and after surgery to destroy remaining cancer cells. Chemotherapy is also used for bone cancer that has metastasized (spread) to the lungs or other organs.
Radiation Therapy
Bone cancer is not highly sensitive to radiation, so radiation usually is not a treatment. It sometimes may be given if the tumor cannot be operated on or if cancer cells remain after surgery. Radiation may help relieve symptoms if bone cancer returns.
New radiation therapy techniques and remarkable skill allow our doctors to target tumors more precisely, delivering the maximum amount of radiation with the least damage to healthy cells.
Proton Therapy
Proton therapy delivers high radiation doses directly into the tumor, sparing nearby healthy tissue and vital organs.
Targeted Therapy
These newer agents are used to help fight some types of bone cancer, including chordoma. Targeted therapies attack cancer cells by using small molecules to block pathways that cells use to survive and multiply.
