FAQ

The patient with bone cancer usually has pain in the affected area, the knee being the most common site. The pain may be severe, may cause the patient to limp, and may even be there when the patient is not walking, e.g. at night. There may also be a swelling of the bone or even a fracture that happens without any significant injury. Because these symptoms are not exclusive to bone cancer, it may be mistakenly diagnosed as injury/ infection or some other disease of bone. Hence a high index of suspicion is needed to pick up a cancer of bone early enough.

The diagnosis of bone cancer is considered when the suspicion of any such possibility leads the physician or orthopaedic surgeon to ask for an X ray. Further tests like MRI and CT scan may help in obtaining further detailed information. However, the definitive diagnosis of cancer and the type of cancer is done only by performing a biopsy.

A biopsy is a procedure where some tissue is taken out from a suspicious area of an organ (bone in this case) to determine the presence of a disease and to make further detailed studies. It is extremely important that the biopsy of a bone tumour is performed only at a centre where there are specialised teams dealing exclusively in bone and muscle cancer, and where the final surgical procedure for these tumours is going to be performed.

In a specialised centre as ours, the vast majority of biopsies, known as core needle biopsy, are done as an OPD procedure, by using a hollow needle and is used to take out small pieces of tissue under local anaesthesia. A small percentage, however, may require an incisional biopsy (a short surgical procedure under general anaesthesia).

The treatment and chances of cure depend on the type and stage of the cancer (and here we are talking of “primary” bone cancers, namely osteosarcoma, Ewing sarcomas and Chondrosarcoma). The cure rates of early stage primary bone cancers are in the range of 60–80 percent. For a successful outcome, it is most important to start and complete the investigations (including biopsy) and treatment at a specialised sarcoma centre.

Treatment of bone cancer depends on the type of bone cancer. Every patient is evaluated in detail by a multidisciplinary team consisting of musculoskeletal/ orthopaedic oncologist, paediatric/ adult medical oncologist, radiation oncologist, radiologist, pathologist, and other specialities. A treatment plan is thus made on day one, and started as soon as possible after the initial evaluation. The patient will be offered surgical removal (which in > 90 percent of cases will be a limb sparing option) with chemotherapy for Ostoesarcoma and Ewing sarcoma, and without chemotherapy for chondrosaercoma.

No. Nowadays, at centres where these patients are routinely treated, up to 90% of patients undergo “limb salvage surgery”, where the tumour is completely removed while at the same time saving the form and function of the limb. Amputation is required in only a small percentage of patients.

Cancer that starts in other organs and then spreads to bones is called secondary bone cancer or metastatic bone disease. Some common cancers spreading to bones are prostate, breast, lung, kidney and thyroid. This means that the cancer is at an advanced stage. However, with the advancements in medical sciences, there are now many treatments available which enable the patients to live meaningful lives, sometimes much, much longer than one would expect. The bone affected by secondary bone cancer is diseased and often a source of severe pain. The bone may also get weakened and fractured without any injury , which is known as a pathological fracture. The treatment of secondary bone cancer is treatment of the primary cancer according to the organ affected, medicines for pain relief and to prevent born weakening, and often radiation therapy to the affected bone. Your orthopaedic oncologist may sometimes recommend surgery to prevent or treat a pathological fracture.

COsteosarcoma is the commonest primary bone cancer (cancer originating in bone itself), and the most common location is the knee. It most commonly affects adolescents (at the time of growth spurt), though no age is immune. Like all cancers, it is essentially an unregulated growth of bone, that leads to one or more of the symptoms of pain, swelling and sometimes fractures. As a result, the patient finds it increasingly difficult use the affected limb. If not treated in time, it may spread to the lungs (causing breatlessness/ cough/ chest pain) or other parts of the skeleton (leading to pain/swelling). The exact cause of osteosarcoma is largely unknown but it is more common around the time of growth spurt and has been shown to have height as a risk factor. A small minority of patients may have it secondary to other pre existing conditions (eg Paget’s Disease), certain genetic disorders (eg. retinoblastoma gene) or external causes (e.g Radiation exposure). Thankfully, if detected in time, it is curable with chemotherapy and surgery. Most of these patients (>90%) undergo “Limb Salvage Surgery” , where the limb is saved by removing the affected bone with a layer of normal tissue , and is replaced by a prosthesis, a bone graft, or recycled tumor bone.