Cancer is a tumor that forms from epithelial tissues - skin and mucous membranes. Therefore, the term “bone cancer” is not entirely accurate. Bone is a type of connective tissue, and tumors that arise from it are called sarcomas. The term “bone cancer” is still used in everyday life, meaning a malignant formation of bone tissue. It can appear as an independent disease or as a result of the development of bone metastases from cancer of other organs.
Types of bone cancer
Metastatic bone cancer is the most common type of malignant tumor. It consists in the spread of metastases in oncology of the lungs, breast, stomach or prostate. In this case, the disease is named after the site of the primary tumor, for example, breast cancer with metastases.
Osteosarcoma is a bone cancer that most often develops in patients aged 10-30 years. The disease develops directly from bone cells.
Chondrosarcoma is a bone cancer in which the tumor affects cartilage tissue. It is in second place in terms of prevalence after osteosarcoma.
Ewing's sarcoma is more common in children and young adults, but after 30 years it is extremely rare. In most cases, the shoulder blades, ribs, bones of the limbs and pelvis are affected.
Chordoma is a slowly progressing cancer that affects the base of the skull or spinal column. Most patients with this diagnosis are over 30 years of age.
Fibrosarcoma is a malignant lesion of soft tissue. Typical for middle-aged and elderly people.
Malignant fibrous hiscytoma is a tumor of soft tissues (muscles, ligaments, tendons, fatty tissue). When bones are affected, it is most often observed in the extremities. May be a cancer of the bones and joints.
Classification
Origin
According to its origin, chondrosarcoma is of two types:
- Primary;
- Secondary.
Primary
This type of chondrosarcoma is detected in 90% of cases and is divided into two more subtypes:
- Periosteal (this subtype of chondrosarcoma grows outside the bone surface);
- Central (this subtype of chondrosarcoma forms inside the bone).
Secondary
It is detected in 10% of cases and is formed from the following types of tumors:
- Chondroblastomas;
- Chondromas;
- Fibromas of chondromyxoid nature;
- Exostoses of an osteochondral nature;
- Tumors in Ollier-Maffucci disease.
Structural features
If you look at the structure of chondrosarcoma, the following subtypes are distinguished:
- Undifferentiated;
- Anaplastic;
- Clear cell;
- Typical.
Malignancy grade
Based on this criterion, the results of histological studies are taken into account, on the basis of which the degree of malignancy of chondrosarcoma is determined:
- I degree of malignancy: absence of mitotic figures, a small number of multinucleated cells, dense small-nucleated chondrocytes are present in the chondroid tissue;
- II degree of malignancy: there are cellular accumulations along the lobar periphery, an increase in nuclei is observed, there are zones of destruction and some mitotic figures, the intercellular substance is thus myxoid in nature;
- III degree of malignancy: also a myxoid intercellular substance with cells arranged in groups and cords, a large number of irregularly shaped cells, there are a large number of multinucleated and enlarged cells, there is mitosis and extensive areas of destruction.
Ewing's sarcoma
The degree of malignancy of this type of cancer directly determines how quickly metastases will form during the course of the disease, and whether relapse is possible if the pathological tumor is removed.
Stages
Based on the stage of bone cancer, doctors determine an effective treatment regimen. The prognosis for recovery depends on the severity of the disease. There are the following stages of bone cancer:
- first. The cancer has not yet spread beyond the bone tissue. At the initial stage, the size of the tumor is less than 8 cm, and later it either increases or it appears in different parts of the bone. The degree of malignancy is still low;
- second. At this stage of bone cancer, the tumor becomes more malignant, the cells lose their differentiation;
- third. The tumor appears in several areas of the bone, the cells are already dedifferentiated;
- fourth. Stage 4 bone cancer is characterized by tumor spread beyond the bone tissue. The lungs, regional lymph nodes and more distant organs are affected. Metastases in the bones of cancer appear precisely at the 4th stage.
Pathogenesis
Carcinogenesis is triggered under the influence of many factors, which include:
- radiation treatment for other cancers;
- suppression of tumor suppressor genes;
- prosthetics performed;
- hereditary diseases;
- complex chromosomal aberrations.
Frequent deletion, as well as loss of heterozygosity of 3q13, are specific aberrations for osteosarcomas. One of the tumor suppressor genes is localized in this region, which regulates cell proliferation and plays a major role in tumor pathogenesis. 3q12 deletion is associated with progression and poor prognosis.
An important morphological feature of bone tumors is the infiltrative nature of growth, or circular (encompasses the entire area of the bone around the circumference). The tumor spreads through the bone marrow spaces and replaces them, destroys and surrounds the bone beams. Neoplastic cells are characterized by severe cellular atypia. The architecture of the newly formed bone determines the tumor potential.
Symptoms and signs
Main symptoms of bone cancer:
- swelling in the affected area;
- fractures with sharp pain in the limb;
- weight loss;
- increased fatigue;
- nausea and abdominal pain.
How bone cancer manifests depends on the stage of the disease. At an early stage, only mild malaise is observed, the temperature rises, and then body weight decreases. Then, after 2-3 months, the lymph nodes enlarge and the soft tissues swell. Later, other symptoms of bone cancer appear. The tumor can already be felt by palpation.
With bone cancer, pain is the most common complaint of patients. They are observed in the area of affected bone tissue. At the initial stage, pain occurs only at night and during physical activity. As the disease progresses, the pain becomes constant.
Causes
The exact causes of bone cancer are unknown. There are only risk factors that increase the likelihood of its development. But their presence also does not necessarily imply the development of cancer. In some patients with this diagnosis, doctors did not detect any of the risk factors. These include:
- hereditary diseases;
- exposure to high ionizing radiation;
- mechanical bone injuries;
- Paget's disease;
- bone marrow transplantation.
Today, active research is underway to determine the causes of cancer. It was possible to establish that in most cases the disease is caused not by hereditary DNA mutations, but by acquired ones, which are associated with exposure to the listed risk factors.
Complications
Bone cancer can cause the following complications:
- constant pain in the affected area;
- erosive bleeding;
- infections;
- fractures due to minor injuries;
- relapse of the disease and spread of metastases;
- death in advanced forms of the disease or lack of treatment.
Causes
The causes of bone tumors are not well understood. To a certain extent, bone cancer is caused by:
- Chronic diseases of the skeletal system ( osteomyelitis , Paget's disease , benign tumors ).
- Smoking.
- Injuries.
- Foreign body in the bone (orthopedic implants). Tumors of the skeletal system are more often detected in patients who have had implants used for osteosynthesis or have undergone joint replacement. Dentures use hexavalent chromium, which is a carcinogen.
- Previous radiation therapy , which induces the development of osteosarcoma. Radiation-induced sarcomas develop 3 years after irradiation.
- State of immunodeficiency .
- Skeletal abnormalities ( Olier disease ).
- Mutations of the p53 gene and the retinoblastoma Rb1 gene.
- Hereditary diseases ( retinoblastoma , Li-Fraumeni syndrome , Rothmund-Thompson syndrome , Werner syndrome , absent thumb).
- Benign bone tumors that can become malignant.
- Taking the drug Natpara (a drug for the treatment of hypoparathyroidism ). This drug increases the risk of osteosarcoma.
There is evidence of an increased risk of osteosarcoma in children born weighing more than 4500 g and above average height. However, in most patients no specific factors are identified.
Diagnosis of bone cancer
The doctor may suspect bone cancer during a physical examination of the patient if he detects signs characteristic of this disease. To confirm or refute the diagnosis, instrumental and laboratory tests are prescribed. Diagnosis of bone cancer includes:
- positron emission tomography;
- computed tomography;
- magnetic resonance imaging;
- radionuclide osteoscintigraphy;
- microscopic examination of a sample of pathological bone tissue.
Diagnostics
Bone cancers are difficult to diagnose and the diagnosis process typically involves several different techniques.
- X-rays may reveal damage to the bone or significant abnormalities in its structure.
- Blood tests help check your overall health and find
- CT or MRI are tests that can visualize small bone abnormalities that are not visible with plain x-rays.
- PET scanning and SPECT - these methods allow you to identify very small tumors and find all traces of cancer pathology in the bones.
- A biopsy is the removal of tissue from the outside of a diseased bone for examination under a microscope. A biopsy can be done in one of two ways. In a core biopsy, a local anesthetic is used to numb the area, then a thin needle is inserted into the bone under CT guidance to take a sample. In an open or surgical biopsy, the surgeon cuts through the skin under general anesthesia to remove a piece of bone.
If Ewing's sarcoma is suspected, genetic testing is required before a biopsy to determine a specific marker for this disease. The diagnosis is then confirmed after a biopsy.
Treatment
Bone cancer may require consultation and monitoring of several specialists: an oncologist, a surgeon, a radiation therapist and a chemotherapy doctor. The treatment regimen is selected based on the stage of the disease and the clinical picture of the individual patient. There are 3 treatment methods in total:
- surgical;
- radiation therapy;
- chemotherapy.
Surgical intervention
The main and most radical method of treating bone cancer is surgery. Moreover, if previously they resorted to amputation, today doctors use organ-saving operations with transplantation or endoprosthetics. When part of the humerus or femur is removed, the underlying tissue can be preserved. The limb will become shorter, but will still be able to perform its functions. In some cases, other methods of removing a tumor in bone tissue are used:
- cryodestruction (exposure to low temperature);
- cementation with polymethyl methacrylate (due to heating, it destroys malignant cells);
- curettage (scraping with a special instrument).
Radiation therapy
The essence of radiation therapy is the targeted effect on the source of pathology with a beam of radiation. The method causes serious side effects, so its use is limited. Radiation therapy is used when the tumor is inoperable and as a symptomatic treatment for relapse of the disease. Radiation therapy is most effective for Ewing's sarcoma.
Chemotherapy
For Ewing's sarcoma and osteosarcomas, chemotherapy is often used. In this type of treatment, the patient is given intravenous cytotoxic drugs that destroy tumor cells. Chemotherapy may be used in addition to surgery to prepare for or after surgery to remove any remaining abnormal cells.
Diet
Dietary table No. 1a
- Efficacy: therapeutic effect after a week
- Terms: 3-10 days
- Cost of food: 900-1100 rubles per week
Diet table No. 5a
- Efficacy: therapeutic effect after 5-7 days
- Time frame: 2-6 weeks
- Cost of products: 1300 - 1400 rubles per week
Diet 11 table
- Efficacy: therapeutic effect after a month
- Terms: 2 months or more
- Cost of products: 1800-1900 rubles. in Week
of diarrhea while undergoing chemotherapy . In this regard, a diet excluding spicy, fatty foods containing fiber (vegetables, nuts, seeds, bran bread) is recommended.
Fried foods and simple carbohydrates, which increase intestinal motility, are also excluded. A balanced diet during this period should contain a sufficient amount of protein (boiled meat, fish, steamed cutlets, meat soufflé). Dishes must be pureed - soups, cereals, meat. During this period, you can use Diet No. 1B and No. 5P . When diarrhea disappears and the patient’s condition improves, the patient is transferred to Table No. 11 . The diet of this diet is suitable for the recovery period. The patient’s diet is complete, containing the necessary vitamins, nutrients and minerals. Daily calorie content is increased (3000 kcal). Food is taken in 5 divided doses. The goal of the diet is to normalize weight while reducing it and improve the function of all body systems.
All foods and cooking methods are allowed, but nevertheless, it is better to adhere to a healthy diet, in which preference is given to stewed, boiled or baked dishes, vegetable and cereal soups that are not fried. To replenish vitamins, the diet should contain fresh seasonal vegetables, fruits and berries. It is important to choose healthy and natural products that do not contain dyes, flavor enhancers or preservatives. The diet must contain dairy products: natural milk, kefir, cottage cheese, cheeses, yogurt. Dairy products are important for replenishing calcium, which is constantly lost from bones. The calorie content of the diet should not be increased by fatty foods, cakes, cream pies, semi-finished products, beef and lamb fat, fatty sausages, ready-made sauces, pastes, mayonnaise, and sweet carbonated water.
Bone cancer treatment prognosis
The prognosis for bone cancer directly depends on the stage of the disease, the location and size of the tumor, and the age of the patient. For adults with chondrosarcoma, the 5-year survival rate is as high as 80%. The question of how long people live with bone cancer cannot be answered accurately. Death in most cases is not due to the disease itself, but from tumors that have spread to neighboring organs.
The prognosis for bone cancer with metastases is somewhat worse, since this indicates stage 3-4 of the disease. In such a situation, life expectancy decreases. The prognosis depends on the therapy used and the aggressiveness of the primary tumor site.
Survival prognosis
The average five-year survival rate for all types of malignant bone tumors in children and adults is 70%. This is a pretty good indicator. We can say that bone tumors are often successfully treated. Of course, factors such as tumor type, stage, and degree of malignancy play an important role.
The Center for Integrated Medicine cooperates with the best oncology clinics in Moscow, we know where you can get the best treatment:
International Clinic MEDICA24 Clinical Hospital No. 1 Volyn Medical Scientific and Educational Center of Moscow State University named after M.V. Lomonosov Federal Scientific Center FMBA of Russia (Clinical Hospital No. 83) NCC JSC Russian Railways (1 territory) Yusupov Hospital Hospital of the Centrosoyuz NMHC named after. N.I. Pirogov
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Treatment of oncopathology under the compulsory medical insurance policy
You can receive FREE medical care at the Oncology Center under the State Guarantee Program of Compulsory Medical Insurance (Compulsory Medical Insurance) and High-Tech Medical Care.
The service is valid for all Russian citizens.
To find out more details, as well as for what nosologies and services this program works, please call +7, or you can read in more detail here.
As mentioned above, surgery, radiotherapy and chemotherapy are the main methods of treating bone cancer pathologies. Each of them has its own characteristics and advantages, but they have one common drawback - high cost. Unfortunately, treating cancer requires large financial investments. It is the financial component that is the main obstacle to recovery. Therefore, oncology provides the opportunity to receive free oncology treatment within the framework of the compulsory medical insurance policy. According to the quota, you can undergo the following procedures:
- PET/CT;
- radiation therapy;
- chemotherapy;
- IHC;
- surgery.
Treatment under compulsory medical insurance is available to all citizens of Russia, but first of all, patients with a very serious diagnosis that threatens their life can count on free medical care. The decision to grant a quota is made by three commissions - at the clinic, the health department and at the medical institution itself. To shorten this path, you can immediately contact our medical oncology center. The therapist or oncologist will prepare a statement with the diagnosis and the results of the tests and studies performed. The full list of documents for submission to the regional health authority includes:
- doctor's referral;
- application for treatment of cancer under the compulsory medical insurance policy;
- Russian passport and insurance policy;
- SNILS;
- consent to the processing of personal data;
- pension certificate (for pensioners).
Clinical picture of osteosarcoma
The disease manifests itself as a progressive increase in the volume of the affected part of the body. The main symptoms of osteogenic sarcoma of the pelvic bones:
- “Deep” increasing pain over several weeks or months.
- The skin over the tumor may become hyperemic and swollen. A pronounced venous pattern is often identified in this area.
- With a large volume of damage, movements in the hip joint may be limited; in some cases, effusion in the joint cavity is detected.
In the area of tumor growth, a painful, dense formation can be felt, which is fused to the bone. A local increase in skin temperature may also be observed.
Benefits of onco
In our work, we take into account every little detail so that patients’ difficult journey on the road to recovery is as comfortable and safe as possible. Over 30 years of existence in the medical market, I have helped many patients cope with their illness, providing high-quality diagnostics, therapy, and providing support at all stages of treatment. For our patients:
- Modern clinic in the city center. Two large buildings are located within walking distance of several metro stations. There is parking on site with plenty of space for your car. There will also be no problems finding the department or office you need - our employee will take you to where you say and help you find your way around the clinic.
- Favorable environment. All premises of the clinic are decorated in a stylish and beautiful interior. This has allowed us to move away from the depressing hospital environment, so patients feel comfortable. Also, patients and their accompanying persons can visit a cozy cafe and restaurant on the roof with panoramic views.
- High-tech equipment. All departments are equipped with the latest medical technology. The procedures are performed on the latest models of devices.
- High professionalism of doctors. Our employees are leaders of Russian medicine and competent international consultants. Many doctors completed internships in medical institutions in the USA, Europe and Israel. This exchange of experience and knowledge with foreign colleagues allows us to constantly improve the quality of work with patients.
- World standard. We conduct our activities in accordance with domestic and international protocols, which is confirmed by numerous certificates and awards.
How to make an appointment with an oncologist
To make an appointment with an oncologist, fill out the online form or call us at the contact number. Our clinic is located in the Central Administrative District, close to the Mayakovskaya, Belorusskaya, Chekhovskaya, Novoslobodskaya and Tverskaya metro stations. We can see you at any convenient time, including weekends and holidays.