Bone CancerLast Updated: December 14, 2011 This section has been reviewed and approved by the Cancer.Net Editorial Board, 10/11 Overview
About bones The human skeletal system is made up of more than 200 bones that protect the internal organs, allow people to stand upright, and attach to muscles that allow movement. Bones are connected to other bones by ligaments, which are bands of tough, fibrous tissue. Cartilage is the tough, fibrous material that covers and protects the joints where bones come together. The cortex is the hard, outer portion of the bone. Bones are hollow and filled with bone marrow, which is the spongy, red tissue that produces blood cells. Bone is a tissue that consists of collagen (a soft, fibrous tissue) and calcium phosphate (a mineral that helps harden and strengthen the bone). There are three types of bone cells:
About bone cancer Cancer can occur in any part of the bone. Cancer begins when normal cells in the bone change and grow uncontrollably, forming a mass called a tumor. A bone tumor can be benign (noncancerous) or malignant (cancerous, meaning it can spread to other parts of the body). Even though a benign tumor does not spread outside the bone, it can grow large enough to press on surrounding tissue and weaken the bone. A malignant tumor can destroy the cortex and spread to nearby tissue. If bone tumor cells get into the bloodstream, they can spread to other parts of the body, especially the lungs. There are different types of bone cancer, including:
Rarely, soft tissue sarcomas begin in the bone, including:
This section contains information about primary bone cancer (cancer that begins in the bone). It is much more common for bones to be the site of metastasis (spread) from other cancers, such as breast, lung, or prostate cancer. For information about cancer that has started in another part of the body and spread to the bone, please see the information for that type of cancer or read a fact sheet on bone metastasis. Find out more about basic cancer terms used in this section. Statistics
This year, an estimated 2,810 adults (1,620 men and 1,190 women) in the United States will be diagnosed with bone cancer. It is estimated that 1,490 deaths (850 men and 640 women) from this disease will occur this year. Primary bone cancer accounts for less than 0.2% of all cancers. In adults, chondrosarcoma makes up more than 40% of primary bone cancers, followed osteosarcoma (28%), chordoma (10%), Ewing family of tumors (8%), and MFH/fibrosarcoma (4%). The remaining bone cancers are other, rare types. In teens and children, osteosarcoma and Ewing family of tumors are more common. Cancer statistics should be interpreted with caution. These estimates are based on data from thousands of people with this type of cancer, but the actual risk for a particular individual may differ. It is not possible to tell a person how long he or she will live with bone cancer. Learn more about understanding statistics. Statistics adapted from the American Cancer Society's publication, Cancer Facts and Figures 2011. Medical Illustrations
Risk Factors
A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors can influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices. The following factors may raise a person’s risk of developing bone cancer: Genetics. Children with familial retinoblastoma (an eye cancer) have an increased risk of developing osteosarcoma. Previous radiation therapy. People who have had radiation treatment for other conditions have a higher risk of developing bone cancer at the site of the radiation therapy. The majority of radiation therapy-caused bone cancers are osteosarcomas, but other types may occur. Chemotherapy. Some drugs, including alkylating agents and anthracyclines, used to treat cancer may increase the risk of developing a secondary cancer, usually osteosarcoma. Benign tumors or other bone conditions. Paget’s disease may cause osteosarcoma. Other noncancerous bone diseases, such as fibrous dysplasia, may increase the risk of osteosarcoma. Currently, there is no known way of preventing bone cancer. Early detection offers the best hope for successful treatment, so people with risk factors are encouraged to visit the doctor regularly. Still, most bone cancer occurs in people with no known risk factors. Symptoms and Signs
People with bone cancer may experience the following symptoms or signs. Sometimes, people with bone cancer do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not cancer. If you are concerned about a symptom or sign described below, please talk with your doctor. When a bone tumor grows, it presses on the normal tissue and destroys bone tissue, which can cause symptoms. The earliest symptoms of bone cancer are pain and swelling in the area of the tumor. The pain may come and go at first, then become more severe and steady later. The pain may worsen with movement, and there may be swelling in the soft tissue nearby. A tumor that occurs near or in joints may cause the joint to swell and become tender or stiff, which means a person may have a limited and painful range of movement. A pronounced limp (if the leg is affected) or a fracture (break) in the bone with the tumor are symptoms of more advanced bone cancer. Rarely, people with bone cancer may have symptoms such as fever, generally feeling unwell, weight loss, and anemia (low red blood cell level). Your doctor will ask you questions about the symptoms you are experiencing to help find out the cause of the problem, called a diagnosis. This may include how long you’ve been experiencing the symptom(s) and how often. If cancer is diagnosed, relieving symptoms and side effects remains an important part of cancer care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your health care team about symptoms you experience, including any new symptoms or a change in symptoms. Diagnosis
Doctors use many tests to diagnose cancer and find out if it has metastasized. Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests, such as an x-ray, may be used to find out whether the cancer has metastasized. Benign and cancerous tumors usually look different on imaging tests (see below). A benign tumor has round, smooth, well-defined borders. A cancerous tumor has irregular, poorly defined border because of aggressive growth. There may also be evidence of bone destruction on an image of a cancerous tumor. Imaging tests may suggest a diagnosis of bone cancer, but a biopsy will be performed whenever possible to confirm the diagnosis and find out the subtype. It is extremely important for a patient to be seen by a sarcoma specialist before any surgery or a biopsy is performed. Your doctor may consider these factors when choosing a diagnostic test:
In addition to a physical examination, the following tests may be used to diagnose bone cancer: Blood tests. Some laboratory tests may help detect bone cancer. Alkaline phosphatase and lactate dehydrogenase levels in the blood may be higher in patients with osteosarcoma or Ewing’s sarcoma. However, it is important to note that alkaline phosphatase is normally high when cells that form bone tissue are very active (for example, when children are growing or a broken bone is mending), so high levels do not always mean cancer. Abnormal glucose tolerance may be found in people with chondrosarcoma. X-ray. An x-ray is a way to create a picture of the structures inside of your body using a small amount of radiation. Bone scan. A bone scan uses a radioactive tracer to look at the inside of the bones. The tracer is injected into a patient’s vein. It collects in areas of the bone and is detected by a special camera. Healthy bone appears gray to the camera, and areas of injury, such as those caused by cancerous cells, appear dark. Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, a contrast medium (a special dye) is injected into a vein to provide better detail. Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. A contrast medium may be injected into a patient’s vein to create a clearer picture. MRI scans are used to check for tumors in nearby soft tissue. Positron emission tomography (PET) scan. A PET scan is a way to create picture of organs and tissues inside the body. A small amount of a radioactive substance is injected into a patient’s body. This substance is absorbed mainly by organs and tissues that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body. Integrated PET-CT scan. This scanning method collects images from both CT and PET scans at the same time, and then combines the images. This technique helps the doctor look at both the structure and how energy is used by the tumor and normal tissue. This information can help doctors plan treatment and determine the benefits of different treatments. Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. The sample removed from the biopsy is analyzed by a pathologist (a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease). The type of biopsy (needle or incisional, see below) performed depends on where the cancer is located. However, sometimes a biopsy may not be able to be performed. For a needle biopsy, a small hole is made in the bone, and a tissue sample is removed from the tumor with a needle-like instrument. In an incisional biopsy, the tissue sample is removed after a small cut is made in the tumor. Learn more about what to expect when having common tests, procedures, and scans. After these diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer; this is called staging. Learn more about the first steps to take after a diagnosis of cancer. Staging
Staging is a way of describing a cancer, such as where it is located, if and where it has spread, and whether it is affecting the functions of other organs in the body. Doctors use diagnostic tests to determine the cancer's stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis (chance of recovery). There are different stage descriptions for different types of cancer. One tool that doctors use to describe the stage is the TNM system. This system judges three factors: the tumor itself, the lymph nodes around the tumor, and if the tumor has spread to the rest of the body. The results are combined to determine the stage of cancer for each person. There are five stages: stage 0 (zero) and stages I through IV (one through four). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments. TNM is an abbreviation for tumor (T), node (N), and metastasis (M). Doctors look at these three factors to determine the stage of cancer:
Tumor. Using the TNM system, the “T” plus a letter or number (0 to 4) is used to describe the size and location of the tumor. Some stages are also divided into smaller groups that help describe the tumor in even more detail. Specific tumor stage information for bone cancer is listed below. TX: The primary tumor cannot be evaluated. T0: There is no evidence of a primary tumor. T1: The tumor is 8 centimeters (cm) or smaller. T2: The tumor is larger than 8 cm. T3: There is more than one separate tumor in the primary bone site. Node. The “N” in the TNM staging system stands for lymph nodes, the tiny, bean-shaped organs that help fight infection. Lymph nodes near the site of the cancer are called regional lymph nodes. Lymph nodes in other parts of the body are called distant lymph nodes. Spread to the regional lymph nodes is rare for primary bone cancer. NX: The regional lymph nodes cannot be evaluated. N0: The cancer has not spread to the regional lymph nodes. N1: The cancer has spread to the regional lymph nodes. Distant metastasis. The “M” in the TNM system indicates whether the cancer has spread to other parts of the body. MX: Metastasis cannot be evaluated. M0: The cancer has not metastasized. M1: There is metastasis to another part of the body. M1a: There is metastasis to the lung. M1b: There is metastasis to another organ. Grade. A cancer may also be graded. The grade describes how much cancer cells look like healthy cells under a microscope. If they look like healthy cells, called well differentiated, the cancer is a low-grade tumor. If they look very little like healthy cells, called poorly differentiated, the cancer is a high-grade tumor. A tumor’s grade is described using the letter “G” and a number. The grade of cancer can help the doctor predict how quickly the cancer will spread, with lower grade tumors having a generally better prognosis. GX: The tumor grade cannot be identified. G1: The cancer cells are well differentiated. G2: The cancer cells are moderately differentiated. G3: The cancer cells are poorly differentiated. G4: The cancer cells are undifferentiated. Cancer stage grouping Doctors assign the stage of the cancer by combining the T, N, M, and G classifications. In general, patients with the best prognosis have:
Stage IA: The tumor is low grade (G1 or G2) and 8 cm or smaller (T1). It has not spread to lymph nodes or other parts of the body (N0, M0). Stage IB: The tumor is low grade (G1 or G2) and larger than 8 cm (T2). It has not spread to lymph nodes or other parts of the body (N0, M0). Stage IIA: The tumor is high grade (G3 or G4) and 8 cm or smaller (T1). It has not spread to lymph nodes or other parts of the body (N0, M0). Stage IIB: The tumor is high grade (G3 or G4) and larger than 8 cm (T2). It has not spread to lymph nodes or other parts of the body (N0, M0). Stage III: There are multiple high grade (G3 or G4) tumors in the primary bone site (T3), but they have not spread to lymph nodes or other parts of the body (N0, M0). Stage IVA: The tumor is of any size or grade and has spread to the lung(s) (any G, any T, N0, and M1a). Stage IVB: The tumor is of any size or grade and has spread to the lymph nodes (any G, any T, N1, and any M), or the tumor is of any size or grade and has spread to another organ (any G, any T, any N, and M1b). Recurrent: Recurrent cancer is cancer that comes back after treatment. If there is a recurrence, the cancer may need to be staged again (re-staging) using the system above. Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Seventh Edition (2010) published by Springer-Verlag New York, www.cancerstaging.net. Treatment
This section outlines treatments that are the standard of care (the best proven treatments available) for this specific type of cancer. When making treatment plan decisions, patients are also encouraged to consider clinical trials as an option. A clinical trial is a research study to test a new treatment to evaluate whether it is safe, effective, and possibly better than standard treatment. Your doctor can help you review all treatment options. For more information, see the Clinical Trials section and Current Research sections. Treatment overview In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. Descriptions of the most common treatment options for bone cancer are listed below. Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. Learn more about making treatment decisions. For a low-grade tumor, the primary treatment is surgery. The goal of surgery is to remove the tumor and a margin of healthy bone or tissue around the tumor to make sure all the cancer cells are gone. For a high-grade tumor, oncologists (doctord who specializes in the care and treatment of people with cancer) often use a combination of treatments, including surgery, chemotherapy, and radiation therapy. Surgery Surgery is the removal of the tumor and surrounding tissue during an operation. A surgical oncologist is a doctor who specializes in treating cancer using surgery. Surgery for bone cancer often involves a wide excision of the tumor. A wide excision means that the tumor is removed along with a margin of normal tissue around it in all directions. Limb-sparing techniques are used whenever possible. However, amputation (removal) of the arm or leg with the tumor may be needed depending on the tumor’s size or location. Wide excision surgical techniques have reduced the number of amputations performed for patients with bone cancer. About 75% to 80% of patients can be treated with conservative (limb-sparing) surgery compared with amputation. These surgeries often require prostheses, such as metal plates or bone from other parts of the body, to replace the missing bone and provide strength to the remaining bone. Learn more about cancer surgery. For some patients, amputation may offer the best option. These include patients whose cancer is located where it cannot be completely removed by surgery, patients who cannot undergo reconstruction, or when the surgical area cannot be fully covered with soft tissue. Surgeons use soft tissue, such as muscle, to cover the reconstruction area. The tissue helps in healing and reduces the risk of infection. Children with bone cancer may require amputation more often than adults since their bones grow more. To avoid amputation, some children can be fitted for expandable joint prostheses that adjust as the skeleton grows. These prostheses require multiple operations to adjust bone length as the child grows. It’s important to remember that the operation that results in the most useful and strongest limb may be different from the one that gives the most normal appearance. If amputation is needed, rehabilitation that includes physical therapy can help maximize the patient’s physical functioning. Rehabilitation can also help a person cope with the social and emotional effects of losing a limb. Chemotherapy Chemotherapy is the use of drugs to kill cancer cells, usually by stopping the cancer cells’ ability to grow and divide. Systemic chemotherapy is delivered through the bloodstream to reach cancer cells throughout the body. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication. A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a set period of time. A patient may receive one drug at a time or combinations of different drugs at the same time. Chemotherapy for bone cancer can usually be given as an outpatient treatment, which is treatment that can be given at a clinic or doctor’s office instead of being admitted to a hospital. Surgery alone is not usually enough treatment for patients with some bone cancers, particularly osteosarcoma. These cancers sometimes recur as distant metastases (most often in the lungs) that were most likely very small (only able to be seen with a microscope) when the person was diagnosed. The use of chemotherapy has increased survival rates for some types of bone cancer. In addition, chemotherapy is often useful for treating cancer that has visibly spread at the time of diagnosis. Fast-growing bone cancer may be treated first with chemotherapy before surgery. This often reduces the size of the primary tumor and may destroy tiny areas of metastasis if some of the cancer cells have spread to other areas. Chemotherapy that is given before surgery is called preoperative chemotherapy, neoadjuvant chemotherapy, or induction chemotherapy. For most high-grade tumors, the oncologist gives chemotherapy for three to four cycles before surgery to shrink the primary tumor and make it easier to remove. Chemotherapy before surgery may also improve survival, since it can kill cancer cells that have spread from the original tumor. The tumor’s response to chemotherapy, evaluated with a microscope after the primary tumor has been removed, can be used to better determine the prognosis. After the patient has recovered from surgery, the patient may receive additional chemotherapy to kill any remaining tumor cells. This is called postoperative or adjuvant chemotherapy. The use of chemotherapy to shrink the tumor before surgery combined with chemotherapy after surgery has saved many lives and many patients’ limbs. Some common chemotherapy drugs given to patients with bone cancer are ifosfamide (Cyfos, Ifex, Ifosfamidum), methotrexate (multiple brand names), cyclophosphamide (Cytoxan, Clafen, Neosar), etoposide (Toposar, VePesid), cisplatin (Platinol), doxorubicin (Adriamycin), and dactinomycin (Cosmegen, Lyovac Cosmegen). In particular, chemotherapy is very effective for Ewing sarcoma. Some drugs used to treat Ewing sarcoma are vincristine (Vincasar), dactinomycin, cyclophosphamide, doxorubicin, ifosfamide, and etoposide. The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished. Learn more about chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases. Radiation therapy Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is a radiation oncologist. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time. For bone cancer, radiation therapy is most often used for patients with a tumor that cannot be removed by surgery or that may have cancer cells remaining after surgery. Radiation therapy may be done before surgery to shrink the tumor, or it may be done after surgery to kill any cancer cells remaining after surgery. Radiation therapy makes it possible to do less extensive surgery, often preserving the arm or leg. Radiation therapy may also be used to relieve pain for people as part of palliative care. For patients with Ewing sarcoma, radiation therapy may be combined with chemotherapy and surgery. However, oncologists have had good results in recent years using surgery for Ewing sarcoma, with or without radiation therapy. Ewing sarcoma that starts in bones that cannot be surgically removed is treated with chemotherapy and radiation therapy. Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Most side effects go away soon after treatment is finished. Learn more about radiation therapy. Recurrent bone cancer Once your treatment is complete and there is a remission (absence of cancer symptoms; also called “no evidence of disease” or NED), talk with your doctor about the possibility of the cancer returning. Many survivors feel worried or anxious that the cancer will come back. Learn more about coping with this fear. If the cancer does return after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence). When this occurs, a cycle of testing will begin again to learn as much as possible about the recurrence. After testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the therapies described above (such as surgery, chemotherapy, and radiation therapy) but may be used in a different combination or given at a different pace. Your doctor may also suggest clinical trials that are studying new ways to treat this type of recurrent cancer. People with recurrent cancer often experience emotions such as disbelief or fear. Patients are encouraged to talk with their health care team about these feelings and ask about support services to help them cope. Learn more about dealing with cancer recurrence. Metastatic bone cancer If cancer has spread to another location in the body, it is called metastatic cancer. Patients with this diagnosis are encouraged to talk with doctors who are experienced in treating this stage of cancer, because there can be different opinions about the best treatment plan. Learn more about seeking a second opinion before starting treatment, so you are comfortable with the treatment plan chosen. This discussion may include clinical trials. In addition to treatment to slow, stop, or eliminate the cancer (also called disease-directed treatment), an important part of cancer care is relieving a person’s symptoms and side effects. It includes supporting the patient with his or her physical, emotional, and social needs, an approach called palliative or supportive care. People often receive disease-directed therapy and treatment to ease symptoms at the same time. If disease-directed treatment is not successful, this may also be called advanced cancer. This diagnosis is stressful, and it may be difficult to discuss. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team is there to help, and many team members have special skills, experience, and knowledge to support patients and their families. Learn more about advanced cancer care planning. Find out more about common terms used during cancer treatment. About Clinical Trials
Doctors and scientists are always looking for better ways to treat patients with bone cancer. To make scientific advances, doctors create research studies involving people, called clinical trials. Many clinical trials are focused on new treatments, evaluating whether a new treatment is safe, effective, and possibly better than the current (standard) treatment. These types of studies evaluate new drugs, different combinations of existing treatments, new approaches to radiation therapy or surgery, and new methods of treatment. Patients who participate in clinical trials are often among the first to receive new treatments before they are widely available. However, there is no guarantee that the new treatment will be safe, effective, or better than a standard treatment. There are also clinical trials that study new ways to ease symptoms and side effects during treatment and manage the late effects that may occur after treatment. Talk with your doctor about clinical trials regarding side effects. In addition, there are ongoing studies about ways to prevent the disease. Patients decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other patients volunteer for clinical trials because they know that these studies are the only way to make progress in treating bone cancer. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with bone cancer. Sometimes people have concerns that, by participating in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” The use of placebos in cancer clinical trials is rare. When a placebo is used in a study, it is done with the full knowledge of the participants. Find out more about placebos in cancer clinical trials. To join a clinical trial, patients must participate in a process known as informed consent. During informed consent, the doctor should list all of the patient’s options so that the person understands how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different than the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment. Learn more about clinical trials, including patient safety, phases of a clinical trial, deciding to participate in a clinical trial, questions to ask the research team, and links to find clinical trials. For specific topics being studied for bone cancer, learn more in the Current Research section. Patients who participate in a clinical trial may stop participating at any time for any personal or medical reason. This may include that the new treatment is not working or there are serious side effects. It is important that patients participating in a clinical trial talk with their doctor and researchers about who will be providing their treatment and care during the clinical trial, after the clinical trials ends, and/or if the patient chooses to leave the clinical trial before it ends. Side Effects
Cancer and its treatment can cause a variety of side effects. However, doctors have made major strides in recent years in reducing pain, nausea and vomiting, and other physical side effects of cancer treatments. Many treatments used today are less intensive but as effective as treatments used in the past. Doctors also have many ways to provide relief to patients when such side effects occur. Fear of treatment side effects is common after a diagnosis of cancer, but it may be helpful to know that preventing and controlling side effects is a major focus of your health care team. Before treatment begins, talk with your doctor about possible side effects of the specific treatments you will be receiving. The specific side effects that can occur depend on a variety of factors, including the type of cancer, its location, the individual treatment plan (including the length and dosage of treatment), and your overall health. Common side effects for each treatment option are described in detail within the Treatment section. Ask your doctor which side effects are most likely to happen (and which are not), when side effects are likely to occur, and how they will be addressed by the health care team. Also, be sure to communicate with your doctor about side effects you experience during and after treatment. Care of a patient’s symptoms and side effects is an important part of a person’s overall treatment plan; this is called palliative or supportive care. It helps people with cancer at any stage of illness be as comfortable as possible. Learn more about the most common side effects of cancer and different treatments, along with ways to prevent or control them. Be sure to talk with your doctor about the level of caregiving you may need during treatment and recovery, as family members and friends often play an important role in the care of a person with bone cancer. Learn more about caregiving. In addition to physical side effects, there may be psychosocial (emotional and social) effects as well. For many patients, a diagnosis of bone cancer is stressful and can bring difficult emotions. Patients and their families are encouraged to share their feelings with a member of their health care team who can help with coping strategies. Learn more about the importance of addressing such needs, including concerns about managing the cost of your medical care. A side effect that occurs months or years after treatment is called a late effect. Treatment of late effects is an important part of survivorship care. Learn more about late effects or long-term side effects by reading the After Treatment section or talking with your doctor. After Treatment
After treatment for bone cancer ends, talk with your doctor about developing a follow-up care plan. This plan may include regular physical examinations and/or medical tests to monitor your recovery for the coming months and years. For bone cancer, follow-up care typically includes general physical examinations, blood tests, and imaging studies (such as a bone scan, CT scan, or x-rays) to check for signs that the cancer has come back. Tell your doctor about any new symptoms, such as swelling or bone pain, because they may be signs that the cancer has come back or signs of another medical condition. ASCO offers cancer treatment summary forms to help keep track of the cancer treatment you received and develop a survivorship care plan once treatment is completed. Patients who have surgery for bone cancer, particularly amputation, often need physical therapy and other types of rehabilitative therapies. Follow-up care should also address the patient’s quality of life, including social and emotional concerns, especially if amputation was necessary. Learn more about cancer rehabilitation. People recovering from bone cancer are encouraged to follow established guidelines for good health, such as maintaining a healthy weight, not smoking, eating a balanced diet, and having recommended cancer screening tests. Talk with your doctor to develop a plan that is best for your needs. For bone cancer survivors who smoke, quitting smoking may help recovery and reduce the risk of cancer recurrence. Learn more about tobacco. Moderate exercise can help you rebuild your strength and energy level. Talk with your doctor about helping you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about the next steps to take in survivorship, including making positive lifestyle changes. Find out more about common terms used after cancer treatment is complete. Current Research
Doctors are working to learn more about bone cancer, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the diagnostic and treatment options best for you. Intraoperative radiation therapy. Clinical trials are evaluating the usefulness of radiation therapy given inside the body during surgery for some Ewing tumors. This is called intraoperative radiation therapy or internal radiation therapy. Myeloablative therapy. A supplement to the treatment options for Ewing tumors is myeloablative therapy with stem cell support. Myeloablative therapy, an intense regimen of chemotherapy, destroys all cells that are dividing rapidly. This includes cancer cells but also some normal cells. Stem cells are cells that create all other types of cells in the body. They may be given to the patient after myeloablative therapy to boost the patient’s recovery. Targeted therapy. Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to normal cells, usually leading to fewer side effects than other cancer medications. A type of targeted therapy being looked at for bone cancers, as well as other types of sarcoma, is called insulin-like growth factor receptor (IGFR) inhibitors. The IGFR is an important growth protein for sarcomas. Inhibiting its activity may be an important new way to improve sarcoma treatment. Early results look promising, but the clinical trials are still ongoing. Some research suggests that combining an IGFR inhibitor with other targeted therapies, as an example, an mTOR inhibitor, may be a more effective treatment. An mTOR inhibitor blocks the protein mTOR, which is another growth protein for sarcomas. Learn more about targeted treatments. Supportive care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current bone cancer treatments in order to improve patients’ comfort and quality of life. To find clinical trials specific to your diagnosis, talk with your doctor or search online clinical trial databases now. Questions to Ask the Doctor
Talking often with the doctor is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you.
Patient Information Resources
In addition to Cancer.Net, there are other sources of information about this type of cancer available online. Cancer.Net maintains a list of national, not-for-profit organizations that may be helpful in finding additional information, services, and support. As always, be sure to talk with your doctor about questions you may have about information you find about this disease. View organizations that offer information on this specific type of cancer. |
