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Padua, Evangel O.

Bone Cancer
Bone cancer is a malignant (cancerous) tumor of the bone that destroys normal bone tissue. Not all bone
tumors are malignant. In fact, benign (noncancerous) bone tumors are more common than malignant ones.
Both malignant and benign bone tumors may grow and compress healthy bone tissue, but benign
tumors do not spread, do not destroy bone tissue, and are rarely a threat to life.
Malignant tumors that begin in bone tissue are called primary bone cancer. Cancer that metastasizes
(spreads) to the bones from other parts of the body, such as the breast, lung, or prostate, is
called metastatic cancer, and is named for the organ or tissue in which it began. Primary bone cancer is
far less common than cancer that spreads to the bones.
Types of primary bone cancer:
Cancer can begin in any type of bone tissue. Bones are made up of osteoid (hard or compact),
cartilaginous (tough, flexible), and fibrous (threadlike) tissue, as well as elements ofbone marrow (soft,
spongy tissue in the center of most bones).
Common types of primary bone cancer include the following:
Osteosarcoma, which arises from osteoid tissue in the bone. This tumor occurs most often in the knee
and upper arm (1).
Chondrosarcoma, which begins in cartilaginous tissue. Cartilage pads the ends of bones and lines the
joints. Chondrosarcoma occurs most often in the pelvis (located between the hip bones), upper leg, and
shoulder. Sometimes a chondrosarcoma contains cancerous bone cells. In that case, doctors classify the
tumor as an osteosarcoma.
The Ewing Sarcoma Family of Tumors (ESFTs), which usually occur in bone but may also arise in soft
tissue (muscle, fat, fibrous tissue, blood vessels, or other supporting tissue). Scientists think that ESFTs
arise from elements of primitive nerve tissue in the bone or soft tissue (2). ESFTs occur most commonly
along the backbone and pelvis and in the legs and arms (3).
Other types of cancer that arise in soft tissue are called soft tissue sarcomas. They are not bone cancer and
are not described in this resource.
Nobody knows in general what the causes of bone cancer are. Patients with chronic (long-term)
inflammatory diseases, such as Paget's disease are at a significantly higher risk of developing bone
cancer later on in life. However, nobody can explain why one person gets bone cancer while another one
doesn't. It is not contagious - you cannot catch it from someone else.

The following groups of people may be at a higher risk of developing bone cancer (risk factors):
Being a child or very young adult - most cases of bone cancer occurs in children or young adults aged
up to 20.
Patients who have received radiation therapy (radiotherapy).
Padua, Evangel O.
People with a history of Paget's disease.
People with a close relative (parent or sibling) who has/had bone cancer.
Individuals with hereditary renoblastoma - a type of eye cancer that most commonly affects very
young children.
People with Li-Fraumeni syndrome - a rare genetic condition.
Babies born with an umbilical hernia.

Signs and Symptoms of bone cancer:
A symptom is something the patient feels and reports, while a sign is something other people, such as the
doctor notice. For example, pain may be a symptom while a rash may be a sign.

The patient initially experiences pain in the affected area. Over time the pain gets worse and continuous.
In some cases the pain is subtle and the patient may not see a doctor for several months. The progression
of pain with Ewing sarcoma tends to be faster than in most other bone cancers. Typically, bone cancer
pain is deep, nagging and has a permanent character.
There may also be swelling in the affected area. Often the bone will weaken, resulting in a significantly
higher risk of fracture. The patient may find he/she loses weight unintentionally. A mass (lump) may be
felt in the affected area. Although much less common, the patient may also experience fever, chills
and/or night sweats.
A GP (general practitioner, primary care physician) may order a blood test to rule out other possible
causes for the patient's symptoms. The patient will then be referred to a bone specialist (orthopedic
surgeon). The following diagnostic tests may be ordered:
Bone scan: a liquid which contains radioactive material is injected into a vein. This material collects in
the bone, especially in abnormal areas, and is detected by a scanner. The image is recorded on a
special film.
Computerized tomography (CT): the CT scanner uses digital geometry processing to generate a 3-
dimensional (3-D) image of the inside of an object. The 3-D image is made after many 2-dimensional
(2-D) X-ray images are taken around a single axis of rotation - in other words, many pictures of the
same area are taken from many angles and then placed together to produce a 3-D image. It is a painless
procedure. CT scans are commonly used to see whether the bone cancer has spread and where it has
spread to.
Magnetic resonance imaging (MRI): the device uses a magnetic field and radio waves to create
detailed images of the body, which in this case would be a specific bone or part of a bone.
Most MRI machines look like a long tube, with a large magnet present in the circular area. When
beginning the process of taking an MRI, the patient is laid down on a table. Then depending on where
Padua, Evangel O.
the MRI needs to be taken, the technician slides a coil to the specific area being imaged. The coil is the
part of the machine that receives the MR signal.
Positron emission tomography (PET): a PET scan uses radiation, or nuclear medicine imaging, to
produce 3-dimensional, color images of the functional processes within the human body. The machine
detects pairs of gamma rays which are emitted indirectly by a tracer (positron-emitting radionuclide)
which is placed in the body on a biologically active molecule. The images are reconstructed by
computer analysis.
X-rays: this type of scan can detect damage the cancer may have caused to the bone. It may also detect
new (bone) cells that have started to form around the tumor. An x-ray does not provide enough data for
a definitive diagnosis, but can help the surgeon decide whether further tests are recommended.
Bone biopsy - a sample of bone tissue is extracted and examined for cancer cells. This is the most
reliable way to diagnose bone cancer. A core needle biopsy involves inserting a long, thin needle into
the bone and removing a sample, while an open biopsy involves making an incision in the target bone
area and surgically removing a sample of tissue.

Staging the bone cancer Bone cancer is has different stages which describe its level of advancement.
Stage I - the cancer has not spread out of the bone. The cancer is not an aggressive one.
Stage II - same as Stage I, but it is an aggressive cancer.
Stage III. Tumors exist in multiple places of the same bone (at least two).
Stage IV. The cancer has spread to other parts of the body.

Surgery - the aim is to remove the tumor, all of it if possible, and some of the bone tissue that surrounds
it. If some of the cancer is left behind after surgically removing the tumor it may continue to grow and
eventually spread. Limb sparing surgery, also known as limb salvage surgery means that surgical
intervention occurs without having to amputate the limb. The surgeon may take some bone from another
part of the body to replace lost bone (bone graft), or an artificial bone may be put in. In some cases,
however, amputation of a limb may be necessary.

Radiation therapy - also known as radiotherapy, radiation oncology and XRT. Approximately 40% of
patients of all types of cancer undergo some kind of radiotherapy. It involves the use of beams of high-
energy X-rays or particles (radiation) to destroy cancer cells. Radiotherapy works by damaging the DNA
inside the tumor cells, destroying their ability to reproduce. Radiotherapy can be used for different
Total Cure - to cure the patient by completely destroying the tumor.
To alleviate symptoms - radiotherapy is often used to relieve pain in more advanced cancers.
Padua, Evangel O.
Neo-adjuvant radiotherapy (before surgery) - if a tumor is large, radiotherapy can shrink it, making it
easier and less harmful to then surgically remove it.
Adjuvant radiotherapy - given after surgery. The aim is to eliminate the cancer cells that remained
Combination therapy (radiotherapy combined with another type of therapy) - in some cases,
chemoradiation - radiotherapy combined with chemotherapy - is more effective.
Chemotherapy - the use of chemicals (medication) to treat disease - more specifically, it usually refers to
the destruction of cancer cells. Cytotoxic medication prevents cancer cells from dividing and growing. In
general, chemotherapy has 5 possible goals:
Total remission - to cure the patient completely. In some cases chemotherapy alone can get rid of the
cancer completely.
Combination therapy - chemotherapy can help other therapies, such as radiotherapy or surgery have
more effective results.
Delay/Prevent recurrence - chemotherapy, when used to prevent the return of a cancer, is most often
used after a tumor is removed surgically.
Slow down cancer progression - used mainly when the cancer is in its advanced stages and a cure is
unlikely. Chemotherapy can slow down the advancement of the cancer.
To relieve symptoms - also more frequently used for patients with advanced cancer.
Cryosurgery is the use of liquid nitrogen to freeze and kill cancer cells. This technique can sometimes be
used instead of conventional surgery to destroy the tumor.

Nursing Management:
Emphasis is placed on preserving bone. When surgery is necessary, treatment is tailored to fit the nature
and location of the tumor. In some cases, chemotherapy and radiation therapy are administered.
Most often, limbs can be successfully saved with the use of bone allografts, which is bone tissue from a
human donor, and custom prosthetic implants. A rehabilitation program is developed with the assistance
of nursing staff, therapists, prosthetists and social workers. We then follow the patient's progress to ensure
long-term favorable outcomes.