The bones of the skeleton is a kind of bearing structure, the skeleton, the skeleton of the human body. But even this seemingly sturdy system may undergo neoplastic transformation and become a haven for malignant neoplasms, which can develop itself and become a result of the degeneration of benign tumors.
The content of the article
Symptoms and signs of bone cancer In most cases, if we are talking about bone cancer, this refers to the so-called metastatic cancer, when a tumor developed in some other organ (lungs, breast, prostate) and in advanced stages spread, including in the bone tissue. Sometimes bone cancer called cancer that develops from blood-forming cells of the bone marrow, but again, not from the bones themselves. It could be multiple myeloma or leukemia. But a true bone cancer originates in the bones and is generally called sarcoma (so-called malignant tumor, a “grown up” of bone, muscle, fibrous or adipose tissue, and blood vessels). Depending on their localization and types opujolevidnami cells of the following types of bone cancer.
Types of bone cancer
- Osteosarcoma. This is the most common form of bone cancer which is common mostly for young patients aged 10 to 30 years. Osteosarcoma originates directly from bone cells;
- Chondrosarcoma. It is a cancer of the cartilage, the second frequency of occurrence among all types of bone cancer. Can develop anywhere where there is cartilage;
- Diffuse endothelioma or Ewing’s sarcoma. Can develop anywhere, not just in the bones. Most often the place of its dislocation is the pelvis, ribs, scapula and bones of the extremities;
- Malignant fibrous histiocytoma. Often develops in the soft tissues (muscles, adipose tissue, ligaments, tendons), rather than in the bones. If the tumor affects the bones, it is often the bones of the extremities;
- Fibrosarcoma. Also more common for soft tissues but is found in the bones of the limbs and jaws;
- Giant cell tumor. Has benign and malignant forms. Most often affects the bones in the legs (especially the knees) and hands. Occurs in young and middle-aged persons. Does not tend to metastasize but often recurs, appearing in the same place.
The main risk factors, causes bone cancer Studying this section of the article, it is necessary to realize that the presence of any one or even several risk factors does not automatically mean cancer development by default. And some patients with bone cancer was not one of the known risk factors. That’s basically these reasons that increase the probability of incidence of bone cancer:
- A hereditary disease. It could be Li-Fraumeni syndrome, syndrome Rothmund—Thomson or retinoblastoma gene called RB1, which increases the risk including and bone cancer;
- Paget’s disease, which is considered a precancerous condition causing abnormal growth of bone tissue in people over the age of 50 years;
- Exposure to high doses of ionizing radiation. By the way, non-ionizing radiation (microwave radiation, electromagnetic fields from high-voltage lines, mobile phones and household appliances) in any way increases the risk of cancer;
- Bone marrow transplant;
- Mechanical injuries of the bones. Many patients with bone cancer later recalled about previous traumatic impact on the bone site, where “settled” tumor.
Do we know the exact causes of bone cancer? Unfortunately, no. However, scientists are in continuous search and have already made significant progress towards understanding how certain changes in DNA can start the process of malignization of the cells. In most cases, bone cancer is not hereditary DNA mutations and acquired in the course of the life cycle, including and under the influence of the above factors.
The symptoms and manifestations of bone cancer
Here are the main signs of bone cancer.
- Pain. Pain in the affected bone are the most common complaint of patients with bone cancer. At first the pain is present constantly. As a rule, at night or during loading on bone (walking or running) condition worsens. The growth of the tumor, the pain becomes constant, can develop a limp.
- Swelling of the affected area.
- Fractures. Cancer weakens the bone in which it develops. Patients with bone cancer describe their feelings, as a sharp severe pain in the limbs, aching in front of it for a few months.
- Other symptoms. Cancer often causes weight loss, fatigue. If the tumor has penetrated into other parts of the body, for example, in the lungs, there are various respiratory disorders.
Diagnosis of bone cancer
Bone biopsy is the main method diagnosis of bone cancer Despite the fact that a complex set of symptoms, physical examination, results of laboratory and instrumental tests can give all grounds to assume the existence of bone cancer in most cases requires microscopic examination of a sample of cells of the patient, known as a biopsy. Some other diseases such as bone infections, can cause the same symptoms and give the same results instrumental studies, and bone cancer. Accurate diagnosis depends on how it will be interpreted and analyzed information about the location of the tumor, how it looks on the radiograph and under the microscope. As isolated bone metastases have the same signs and symptoms as a true bone cancer, many oncologists use a biopsy along with instrumental methods including:
- computed tomography;
- magnetic resonance imaging;
- radionuclide bone scan;
- positron-emisionnaya tomography.
Stage of bone cancer
Staging cancer is an important process, giving the doctor information on the extent of tumor spread in the body. Forecast result for the treatment of bone cancer depends on the stage of the disease established in the result of diagnosis.
Stage I: tumor at this stage has a low degree of malignancy and does not extend beyond the bone. In stage IA the tumor is less than 8 cm, stage IB or greater than this size, either localized in more than one area of bone.
Stage II: the tumor is still not beyond the bone, but becomes more malignizaciei (cells lose differentiation).
Stage III: the tumor appears in more than one area of bone. Tumor cells dedifferentiate.
Stage IV: the cancer has spread beyond the bone. In the first place, as the rule is a light, and then regional lymph nodes and distant organs besides the lungs.
The survival rate for bone cancer
In Oncology, as a rule, 5-year survival rate, i.e. calculated the percentage of patients who live 5 years or more since diagnosis. Naturally, many of them live much more than 5 years. For bone cancer, the figure is an average of 70% (taking into account both children and adults). Adult patients usually suffer from chondrosarcoma, for which 5-year survival rate is 80%.
Cancer treatment kostadinovska intervention
This treatment is essential for most types of bone cancer. At the same time with surgery is usually taken and a biopsy. Ideally, both one and the other procedure should be the same surgeon. The importance of biopsy is difficult to underestimate: wrong location for biopsy can lead to further problems during the surgical intervention and even limb amputation.
Surgical intervention is the main way to treat bone cancer the Main aim of surgery is to remove all of the tumor entirely. If the body remains even a small amount of cancer cells they can give rise to new tumors. Therefore, it is necessary to remove and part of the surrounding healthy tissue. This process is called a wide excision (wide excision). After this procedure a pathologist checks the removed tissue under a microscope to detect cancer cells in the periphery. If they are not, this phenomenon is called “negative edge” (histologically clean margins after resection of the tumor). Reverse the situation — “positive edge” means that doesn’t remove all the cancer cells.
If to speak about the loss of the bones of the limbs, sometimes conditions are such that wide excision requires complete removal of the limb, i.e., amputation. But, in most cases, operations are performed with preservation of the limb. When planning the treatment process is very important to weigh the potential advantages and disadvantages to choose the method of surgical intervention. For many people, for obvious reasons operation with preservation of the limb seems to be more acceptable than amputation. However, it is much more complicated and entails the risk of postoperative complications.
In cancer of the pelvic bones, when possible, use a wide excision. If necessary for recovery of bone tissue can be used in bone grafts.
For tumors in the lower jaw is sometimes required its complete removal and subsequent transplant of bone taken from other parts of the body.
For tumors in the spine and the skull is wide excision is not suitable, in such cases, use techniques such as curettage, cryosurgery and radiation. Curettage — is a scraping of the tumor from the bone without removal of the diseased segment. At the end of the procedure remains in the bone cavity. In some cases, after removal of the greater part of the tumor, in order to clear the adjacent areas of bone tissue from cancer cells, used cryosurgery and radiation. So the procedure of cryosurgery is the introduction into the cavity left by the tumor, liquid nitrogen, and the subsequent freezing of tumor cells. Subsequently, this cavity is filled with bone cement (polymethylmethacrylate).
Bone cancer is very resistant to radiation, so its destruction need fairly high doses that can lead to a defeat nearby nerve endings. That is why this type of treatment for bone cancer is not a major (with the exception, perhaps, of Ewing’s sarcoma). Also, radiation therapy may be used in embodiments of inoperable bone cancer. Another field of activity for radiation therapy — destruction of cancer cells remaining in the body after surgery (“positive edges”).
Radiation therapy for bone cancer, the Most advanced variant of external beam radiation therapy (the radiation source is outside the body) is radiation therapy with intensity modulated (IMRT). This method involves computer simulation of the projection of the emitted rays in the form of a tumor with the ability to adjust the power of irradiation. The tumor is exposed to mixed beams (this is done in order to reduce the dose of radiation passing through any one portion of healthy tissue).
Another innovative method of radiation therapy — proton beam therapy. The proton is positively charged particles included in the composition of the atom. They practically do not harm healthy tissue, but copes with the destruction of cancer cells at the end of his journey. This ensures a high dose of radiation with minimum side effects. However, it should be noted that this method is very demanding in terms of necessary equipment and in the average health centres is not yet used.
Chemotherapy for bone cancer As you probably know, chemotherapy is a systematic treatment method in which medication is injected into the bloodstream and, one way or another, affects the whole body. This has both pros (the destruction of metastases in remote organs and tissues) and cons (a lush bouquet of side effects). To chemotherapy exhibit a particular sensitivity of Ewing’s sarcoma and osteosarcoma, chondrosarcoma but little amenable to its influence.
In the framework of chemotherapy bone cancer commonly used the following drugs:
Usually used not a single drug but a combination of 2-3. The most common combination of chemotherapy drugs is cisplatin + doxorubicin.
Among the side effects of chemotherapy include nausea and vomiting, loss of appetite, stomatitis, alopecia.
As soon as the scientists learned about the molecular and genetic changes in cells that become cancerous because of their rebirth, they were able to create new drugs specifically “under” these changes. These drugs (called “targeted”, from the English word “target” — the target) work in a completely different way than traditional chemotherapeutic agents, which has a plume of unwanted side effects because they act solely on cancer cells. Targeted drugs have proven to be extremely effective in chordoma and other bone cancers, where chemotherapy is powerless.
What happens after treatment of bone cancer
Patients who are fortunate enough to get rid of cancer, however, experience great emotional stress, bordering on a phobia. Such experiences caused by the fear of cancer’s return. Take some time to the mental condition of the patient returned to normal.
For other patients, whose cancer was resistant to treatment, life becomes a constant struggle. They regularly undergo chemotherapy, radiotherapy or any other treatment to keep the cancer in check.