Bone Cancer

Groups

Group 1: Primary Cancer and Primary Bone Cancer

Group 2: Osteosarcoma Facts and Causes

Group 3: Osteosarcoma Symptoms, Treatment, and Diagnosis

Group 4: Ewing’s Sarcoma

Group 5: Chondrosarcoma

Group 6: Limb-Salvage Surgery

Group 7: Amputation

Primary Cancer• Remember that a Primary Cancer means a cancer

that originated in that organ– EX: primary brain cancer started in the brain; the cancer

did not travel to the brain• Metastatic Cancer means that the cancer

originated in one area and spread to another area– EX: metastatic brain cancer that began in the breast– What’s really cool about metastatic cancers is that the

cancers cells always look like the tissue they began in So cancer cells from a metastatic brain tumor that originated in the breast will look like breast cancer cells!

Primary Bone Cancer• Primary Bone Cancer is very rare

– Less that 2,500 people are diagnosed with primary bone cancer each year• More people diagnosed are children than adults

• The 3 most common types of primary bone cancer are:

1. Osteosarcoma2. Chrondrosarcoma3. Ewing’s Sarcoma

Osteosarcoma• Osteo = Bone• Sarcoma = cancer of

connective tissue• Most common type of bone

cancer• 6th most common type of cancer

in children• Develops from osteoblasts

(these are cells that create bones)• Because it comes from

osteoblasts, osteosarcomas are more common in teens experiencing a growth spurt

• More common in boys than girls• More common in boys who are

taller than average

Cause of Osteosarcoma• Cancer comes from random mutations in the DNA

that occur when bones are growing very quickly• Remember when you had that huge growth spurt in

middle school, or even at the beginning of high school?• During this growth spurt, your bones were growing very

very fast– When bones are growing this fast, it means those osteoblasts

are doing a ton of mitosis– Lots of mitosis means there is a lot of DNA synthesis, lots of

DNA synthesis means that there is a much greater chance of error occurring in the DNA

Symptoms of Osteosarcoma• Most common symptoms are pain and swelling

in arms and legs– Especially around the long bones in the appendicular

skeleton– The pain can get worse at night and during exercise

• Often the bones become weak so they break much easier than they should

• Also, osteosarcoma is more common in the knee, so an unexplained limp may develop

Treatment of Osteosarcoma• Usually treatment begins with chemotherapy to

shrink the tumor, surgery to remove the tumor, and then more chemotherapy to make sure no cancer cells remain

• In very serious cases where the cancer has begun to metastasize, amputation may be the only way to completely remove the cancer

• A newer treatment is a bone graft– Doctors will remove the cancerous bone and replace

it with a donated bone or a metal prosthetic

Diagnosis

• Patients with osteosarcomas in the knee area and long bones in the arms and legs have a much better chance of survival

• Tissue biopsy to determine cancer• Osteosarcoma in the areas that are difficult to do

surgery on and in areas like the pelvic bone, shoulder, and jaw are more deadly

Ewing’s Sarcoma• Bone tumor also common

in children• Peak ages are between

10 and 20• Can occur in any bone in

the body– More common in pelvis, legs,

upper arm, ribs, and femur• The tumor is actually

composed of small, round, blue cells

Ewing’s Sarcoma Symptoms• Pain around the site of the tumor• Swelling and redness around the site of the tumor • Fever • Weight loss and decreased appetite • Fatigue • Paralysis and incontinence if the tumor is in the

spinal region • Symptoms related to nerve compression from a

tumor such as numbness, tingling and paralysis

Ewing’s Sarcoma Treatment• Usually a mix of surgery and either chemotherapy and

radiation– Responds better to radiation than other bone cancers

• Treatment depends on the bone affected and whether the tumor has metastasized

• Newest therapy is called Myeloablative Therapy – This treatment utilizes stem cells– This treatment targets cells that divide quickly (such as fast

growing bone cells)– The biggest problem is that these cells also include hair, skin, and

bone cells

Chondrosarcoma• Chondro = cartilage• So this is a tumor in the

cartilage of bones• Accounts for 26% of all

primary bone cancers; 2nd most common type of bone cancer

• Usually occurs in legs, arms, and pelvis cartilage cells in people between 50-70

Symptoms of Chondrosarcoma• In the more aggressive and fast-spreadind

tumors, there is usually excruciating pain• The lower grade tumors usually produce

swelling and some pain• Chondrosarcomas in the pelvic region can affect

the bladder, so one symptom may be frequent urination

Treatment and Survival Rates• Because this is a tumor of cartilage cells,

radiation and chemotherapy are not very effective– It’s very difficult to target just those specific cells and

often they lie deeper in the bone matrix• Treatment is usually a wide excision of the

tumor and surrounding soft tissue and bone• Surgical excision of the lower grade tumors

usually leads to a relatively high survival rate• The higher grade tumors, which usually

metastasize early, have a much lower survival rate

Limb-Salvage Surgery• Limb-salvage surgery: It is sometime necessary to remove

all or part of a limb. In most cases, however, limb-salvage surgery, sometimes referred to as limb-sparing surgery, is used to avoid amputation. This however is considered only if the orthopaedic surgeon determines that it is possible that the tumor, and wide margins of healthy tissue surrounding the tumor, can be removed. Through limb-sparing surgery, all of the bone and cartilage involved with the tumor, including some degree of muscle surrounding it, is removed, while nearby tendons, nerves and vessels are saved. The bone that is removed is replaced with a bone graft or with a metal Prosthesis. Subsequent surgery may be needed to repair or replace rods, which can become loose or break. Patients who have undergone limb-sparing surgery need intensive rehabilitation. It may take as long as a year for a patient to regain full use of a limb following limb-sparing surgery. Rarely, patients who undergo limb sparing surgery may eventually have to have the limb amputated Because of a severe complication or tumor recurrence.

Amputation• Amputation - In certain cases, if your child's orthopaedic surgeon

determines that the tumor cannot be removed because, for example, it involves important nerves and blood vessels, amputation is the only surgical option. During the operation, doctors ensure that muscles and skin form a cuff around the amputated bone. A cast may be applied in the operating room that permits a temporary artificial leg (prosthesis) to be applied during the first few post-operative days for walking. Crutches are used for several weeks. As the swelling decreases, (10 to 14 days) the patient is fitted for a plastic, temporary socket and prosthesis, which is used for 2 to 4 months until the stump is healed sufficiently to accept a permanent artificial leg. The advantages of an amputation are that it is a simple operation with minimal chances of surgical complication and it definitively removes the local tumor. The functional outcome is good with the modern prostheses available today and with "immediate-fit" prostheses applied in the operating room. Although the patient will probably have a limp with above-the-knee amputations, the procedure is functional and stable. He/she will be able to walk, climb stairs, swim (with the prosthesis on or off) and participate in many sports such as skiing, basketball, baseball, and tennis although running will be limited. The functional limitations are left to the imagination and determination of the patient.