One of the more obvious symptoms of bone cancer is unexpected fractures, especially those occurring without any significant trauma or injury. — Freepik
Bones are the pillars of strength and stability for the soft tissues in our bodies, carrying us through every step and enabling every movement.
Yet, what happens when this fundamental strength is compromised?
Despite their resilience, bones can conceal a hidden vulnerability: bone cancer.
Although bone cancer is less common compared to other forms of cancer, its impact on individuals and their families can be just as devastating.
This often-overlooked disease lurks in the shadows of more prevalent conditions, quietly eroding the very foundation of our physical stability.
Types of bone cancer
There are various classifications of bone cancer, each presenting unique characteristics in terms of disease aggressiveness and origin.
“Bone cancer often spreads, or metastasises, to other areas of the body.
“It metastasises to the lungs through the bloodstream, occasionally spreading to nearby soft tissues in the process,” explains consultant orthopaedic oncology surgeon Dr Choong Chee Leong.
He notes that bone cancers can be categorised into primary and secondary types.
Primary bone cancers originate in the bone itself, while secondary bone cancers – also known as metastatic bone cancers – occur when cancer from another part of the body spreads to the bones.
Within primary bone cancers, there exists a spectrum of aggressiveness.
For instance, osteosarcoma and Ewing sarcoma are notably aggressive forms of primary bone cancer, often exhibiting rapid growth and metastasis potential.
These cancers often manifest in younger individuals, primarily affecting those aged 10 to 20 years old.
“There are primary bone cancers that tend to be less aggressive, such as chordomas and chondrosarcomas.
“They typically progress at a slower rate and are less likely to metastasise, compared to osteosarcoma and Ewing sarcoma,” says Dr Choong.
“However, despite being comparatively less aggressive, they still require careful monitoring and appropriate medical intervention to manage effectively.
“They are also more prevalent in individuals above the age of 40.”
Bone cancer can be caused by genetic factors, previous exposure to high doses of radiation from cancer treatments, rapid bone growth during adolescence, and certain chronic bone diseases like Paget’s disease.
In Malaysia, bone cancer is relatively rare, as it is worldwide.
The most common type of primary bone cancer in Malaysia is osteosarcoma, followed by Ewing sarcoma and chondrosarcoma.
Recognising the symptoms
According to Dr Choong, some of the symptoms associated with bone cancer include:
In the early stages, this pain is typically mild and intermittent, which means it comes and goes.
It often feels like a dull ache or discomfort in the affected bone and can be easily dismissed as a minor issue, such as a minor injury, growing pains or overuse.
However, as the cancer progresses, the pain tends to become more consistent and severe, prompting further medical evaluation.
A distinctive sign of bone cancer is swelling around the affected joint(s) that does not diminish over time.
Unlike typical joint inflammation or swelling from injury, this swelling persists and may gradually worsen as the cancer progresses.
One of the most obvious symptoms of bone cancer is the occurrence of unexpected fractures or breaks in the affected bone(s).
These fractures can happen without any significant trauma or injury, often occurring spontaneously or with minimal impact.
“Diagnosing bone cancer typically begins with clinical suspicion, prompting the use of imaging procedures such as X-rays and MRI (magnetic resonance imaging) scans.
“Then, it is followed by confirmation through histopathological examination,” Dr Choong shares.
While there is no standard test to screen for bone cancer in people with average risk, most cases are found early because of symptoms like bone pain or swelling.
For those at higher risk due to bone conditions or family history, doctors may suggest keeping a close eye on their health to catch any signs of bone cancer early.
Genetic predisposition plays a significant role in the development of bone cancer.
Several rare genetic syndromes are considered potential contributors to the onset of this disease, including:
- Li Fraumeni syndrome
- Hereditary retinoblastoma
- Rothmund-Thomson syndrome
- Multiple exostoses syndrome
- Tuberous sclerosis.
Paget’s disease, although not directly hereditary, is another condition associated with an increased risk of bone cancer.
This chronic bone disorder disrupts the normal bone-remodelling process, potentially creating an environment conducive to the development of cancerous growths.
While not all cases of Paget’s disease lead to bone cancer, its presence warrants careful monitoring and management to mitigate any associated risks.
A combination of treatments
Treatment options for bone cancer often include a combination of chemotherapy administered before surgery, with further chemotherapy post-operation.
Surgery remains fundamental in the treatment approach, playing a pivotal role in managing bone cancer effectively.
“Surviving bone cancer is a significant achievement, but it often comes with its own set of long-term complications and side effects that survivors may face after treatment.
“For example, survivors of bone cancer may encounter weakened heart function as a consequence of chemotherapy’s side effects.
“The potent medications used in chemotherapy can impact cardiac health over the long term, necessitating careful monitoring and management,” explains Dr Choong.
Other than that, complications may arise from surgical procedures, including infections in reconstructive implants or fractures in the bones adjacent to the implants.
These issues can pose ongoing difficulties for survivors even after the initial treatment phase has concluded.
He adds: “The general health and fitness level significantly impact patients’ ability to withstand treatments and recover from surgery.
“Factors such as age, pre-existing medical conditions and overall physical resilience are vital in determining prognosis.”
In addition, the feasibility of safely cutting out the affected bone(s) and completely removing the cancerous cells is crucial for prognosis (i.e. the patient’s outcome).
Successful surgical removal of the tumour significantly improves the chances of long-term survival and reduces the risk of recurrence.
“The effectiveness of chemotherapy in combating the cancer cells also influences prognosis.
“A favourable response to chemotherapy can aid in shrinking tumours, reducing the risk of metastasis, and improving overall survival rates,” adds Dr Choong.
“But then, individual responses to chemotherapy can vary.
“Factors such as tumour type and genetic markers may impact treatment efficacy.”
Minimising risk
While there are no definitive studies pinpointing specific preventive measures for bone cancer, adopting certain lifestyle modifications can potentially lower the risk, particularly for younger individuals who are more prone to this condition.
Here are some recommended strategies:
- Avoid smoking and vaping
- Maintain a healthy weight
- Exercise regularly
- Limit alcohol consumption
- Eat a healthy diet.
