Bone Cancer
(Ewing's and other sarcomas)
Bone cancer is a relatively rare malignancy that can occur at any age, but more often it seems to strike during childhood or adolescence.
There are several different types: Osteogenic sarcoma and Ewing's sarcoma are the most common in children. Parosteal sarcoma, a slow-growing tumor, affects adults. Chondrosarcoma, also an adult disease, develops in cartilage, most often in the knee, trunk, shoulders, or upper thighs, where it may cause tender masses. Giant cell tumors of the bone often begin in the knee and affect women more often than men. Adamantinoma of the long bones usually involves the shinbone. Chordoma arises in the vertebrae of the lower back, and can also involve the skull and affect vision.
Most childhood bone cancers develop during periods of rapid growth, but the cause is unknown. Excessive radiation exposure through repeated X-rays is linked to some cancers. Paget's disease, which causes bone overgrowth, is sometimes implicated.
A hallmark of bone cancer is increasing pain that cannot be relieved with painkillers. Other symptoms include unexplained fractures, fatigue, loss of appetite and weight, and a persistent low-grade fever. Depending on the tumor site, there may also be swelling.
Diagnostic Studies and Procedures
Characteristic symptoms usually alert a doctor to the possibility of bone cancer. After a physical examination, he will probably order X-rays of the affected bones and perhaps scans of the entire skeleton and the lungs.
Special bone scans to show where new bone is forming may be ordered. One imaging technique, called scintigraphy, involves injecting a radioactive substance into a vein and then scanning the skeleton with a special camera, which will reveal areas of increased blood flow characteristic of a tumor.
A definitive diagnosis requires a biopsy of tissue removed from the tumor. Blood studies can help determine whether the tumor originated in the bone or has metastasized from a cancer elsewhere in the body.
Medical Treatments
Treatment should be carried out by a team of specialists at a comprehensive cancer center, because these cancers are uncommon and therapy is constantly being refined. Surgery is usually called for, but not necessarily amputation. Sometimes the tumor can be removed along with a margin of healthy tissue, followed by radiation treatments and chemotherapy to eradicate any remaining cancer cells.
When amputation is necessary, surgeons can sometimes replace the diseased bone with either a metal substitute or with bone from some other part of the persons body.
A few bone cancers, especially Ewing's sarcoma, are sometimes cured with radiation and chemotherapy, either alone or following surgery.
Alternative Therapies
Potentially useful adjuncts to conventional treatments include:
Acupuncture. This technique is helpful in alleviating the pain, which can be severe with bone cancer.
Herbal Medicine. Some traditional Chinese herbal combinations may help to reduce the nausea and other side effects of radiation and chemotherapy.
T'ai Chi and Other Movement Therapies. Gentle exercise is instrumental in regeneration of healthy bone after radiation treatments, which destroy both healthy and cancerous bone tissue. Before embarking on any exercise regimen, check with your doctor. Too much weight placed on the weakened bones can result I in fractures.
Self-Treatment
Maintaining a healthy diet can be very difficult for bone cancer patients. Both the disease and its treatments suppress appetite. Emphasize foods that are high in protein, calcium, and the nutrients needed to boost the immune system -- zinc and vitamins A, B„, and C. Fruit milkshakes and creamed vegetable soups are examples. (Talk to your doctor about supplements and enriched foods.) Frequent, nutritious snacks may be easier to cope with than three regular meals. Foods served cold or at room temperature are less likely to provoke nausea than hot dishes.
Recovery often demands extensive physical therapy and rehabilitation, especially after an amputation. The rehabilitation should be part of the overall treatment plan, and some aspects may begin before or during the active treatment phase.
Consider joining a support group of patients with similar problems. New bioengineering technology has produced truly amazing artificial limbs, but learning to use them often requires determination, patience, and support.
Other Causes of Bone Tumors
Cancers that arise elsewhere and spread to the bones are actually much more common than primary bone cancer. Malignancies of the breast, lung, thyroid, prostate, and kidneys are most likely to spread to the skeleton.