Bone cancer – general

The bones

The human body is made up of over 200 bones of different shapes and sizes. Bones have living cells (called osteocytes) bound together by a hard, calcium-like material. This makes the bone strong and rigid. The bones are hollow and filled with a spongy material called marrow, which produces the blood cells.
The joints of the bones are covered in cartilage – a tough, flexible material, rather like gristle. As cartilage is more elastic than bone it allows the bones to move freely at the joints. It also cushions the bones at the joints to stop them rubbing against each other.

The bones have several important functions. The skeleton gives the body rigid support and the joints act as levers so that the body can move. The bones also protect organs in the body: for example, the ribcage protects the heart and lungs. They also store some of the body’s essential minerals, especially calcium.

What are the different types of primary bone cancer?

Bone cancer is a very rare type of cancer and fewer than 500 people are diagnosed with it in the UK each year. There are several different types of primary bone cancer and all of them are rare. If your cancer is not one of those described below, the nurses at CancerBACUP can give you information about it.

Osteosarcoma (also called osteogenic sarcoma)

This is the commonest type of primary bone cancer. Although it can occur at any age, osteosarcoma is most commonly found in teenagers and young adults, and is slightly more common in males. Any bone in the body can be affected but the commonest sites are the arms or the legs, particularly around the knee joint.

Ewing’s sarcoma

Ewing’s sarcoma is named after the surgeon who first described it. Again, this type of bone cancer is more common in young people than adults. Any bone can be affected but the pelvis, femur (thigh bone) and tibia (shin bone) are the commonest sites. Like osteosarcoma, Ewing’s sarcoma is slightly more common in males than females. For information on Ewing’s sarcoma in children, please see the section on Ewing’s sarcoma in the children’s cancers information centre.

Chondrosarcoma

This is a cancer that starts in cartilage cells although it can also grow within a bone or on its surface. It is most commonly found in middle-aged adults. Chondrosarcoma is usually a slow-growing tumour. The commonest sites are the pelvis, shoulder blade, ribs and the upper part of the arms and legs.

Spindle cell sarcoma

There are three types of spindle cell sarcoma: malignant fibrous histeocytoma, fibrosarcoma and leiomyosarcoma.

Malignant fibrous histiocytoma This is a very rare type of bone cancer that occurs in adults. It is usually found in the arms or legs, especially around the knee joint.

Fibrosarcoma  This type of bone cancer is also most often found in adults, particularly during middle age. The commonest site is the thigh bone (femur).

Leiomyosarcoma  Leiomyosarcoma of the bone is very rare. It can occur in people of any age, but is extremely rare in people under 20 years of age. It occurs slightly more often in men than women, and is more common in the long bones of the body, such as the thigh bone, shin bones and bone of the upper arm.

Chordoma

This is an extremely rare cancer which starts in the bones of the spine either in the neck or the sacrum (the bottom of the spine).

References

The information in the bone cancer section is based on the CancerBACUP booklet, Understanding primary bone cancer.

The references for this booklet are:

Bone cancer. Cancer Information section of Cancer Research UK website: www.cancerhelp.org.uk

Cancer Information section of US National Cancer Institute web site: www.nci.nih.gov

The Oxford Textbook of Oncology. Eds: Robert Souhami, Ian Tannock, Peter Hohenberger, & Jean-Claude Horiot. Oxford University Press, 2001.

NHS guidelines for suspected cancer. NHS Executive, 2000.

Radiotherapy uses a type of radiation, called ionising radiation, to destroy cancer cells. There are several types of ionising radiation including x-rays, gamma rays and beta rays.  Most radiotherapy treatment for cancer use x-rays.

Ionising radiation works by releasing chemicals in the nucleus of cells. These chemicals, called free radicals,  damage the DNA, the genetic material that is vital for the cell to multiply.  If the DNA is sufficiently damaged by the radiation then it will not be able to divide and will die off.

In order for the radiotherapy to release the free radicals that damage the DNA there needs to be a good supply of oxygen in the cells.   If the cells are starved of oxygen then this actually protects them against the effects of the x-rays and makes treatment less effective.

Oxygen is carried to the tissues and cells in our bodies by the haemoglobin in the red blood cells. If we are anaemic then the haemoglobin level in the blood is low, and so the amount of oxygen carried by the blood to our cells is reduced.

So in order to get the best results from a course of radiotherapy it is important to be sure that you are not very anaemic before you start treatment. 

If you are anaemic then your doctors may well suggest a blood transfusion before you start your treatment.  This will boost your haemoglobin level and will increase the oxygen in your blood, which will increase the chances of success from your radiotherapy treatment.

I am going to have a course of radiotherapy to treat my cancer. The doctors took a blood test today and when I asked about this they said it was important to make sure I wasn’t anaemic before I had the treatment? Why is this?

Very often when a cancer is treated the treatment will take away all evidence of that cancer: symptoms will disappear, physical examination and special tests (like blood tests and scans) will all go back to normal. All the appearances will suggest that the problem has been cured.


But sometimes there will be microscopic traces of the cancer left behind. Because they are so tiny these traces will not cause any symptoms and they will be too small to show up on even the most careful of examinations and most sensitive of special tests. These tiny clusters of cancer cells may lie dormant for months or years but may eventually grow and the cancer may come back.

Since these minute cells that might have been left behind cannot be detected in any way it is impossible to give an absolute guarantee that a cancer has been cured after treatment.

Having said this, very many people are cured of their cancer by modern day treatment. The chances of getting a cure depend on the type of cancer that someone has, how advanced (how large it was and how far it had spread) at the time it was first discovered (this is sometimes known as the ‘stage’ of the cancer) and how well that cancer responds to treatment.

There are now masses of statistics which doctors can use as a guide to predicting the chances of a cure for any particular cancer at any particular stage. These show that for some of the more curable types of cancer the chances of the cancer coming back after treatment are very small indeed, particularly if it was discovered at an early stage. Whereas for other types or  cancers diagnosed when they were more advanced, the outcome is likely to be poorer.

These figures are only ‘statistics’ which means they cannot absolutely predict what will happen to an individual but they do give a good idea of the ‘chances’ of whether, or not, someone will be cured. So doctors rely on these figures for deciding what the likely outcome is for each person at the end of their treatment.

These days many many people are cured of their cancers. So if your doctors have given you the ‘all clear’, although there is no absolute way of proving they are right and guaranteeing you are cured, they obviously think your chances of success are excellent and you should look forward to the future with confidence.

I have recently finished treatment for a cancer. My doctors have given me the all clear but how can I be sure I am cured and the cancer won’t come back?

Despite the advances that have been made in the treatment of cancer there are still many tumours that cannot be cured. In these situations it often possible for different treatments to stop the growth and spread of the cancer, or even to shrink  it for a period of time.

Depending on the type of cancer and treatment which has been given this period of time when the tumour is no longer growing may last from a few weeks to a number of years.During this time the tumour is said to be  under control or ‘stable’. 

Other phrases which are sometimes used to describe this situation are ‘static disease’ and ‘ISQ’ (in status quo). If the cancer has shrunk  by at least 50% before the period of ‘stabilisation’ this may be referred to as a ‘partial remission’ or ‘partial regression’ or ‘partial response’ (all three terms mean the same thing).

Small changes in tumour size, either recorded by direct measurement or by looking at images on x-rays or scans are difficult to assess precisely. Therefore there is general agreement among cancer specialists that in order for a cancer to show signs of progression, or a relapse, there must be a greater than 25% change in the measurements that have been used to assess it. So provided that any change is less then this level, and assuming there has been no other evidence to suggest the disease is becoming active again), then the condition will still recorded as being ‘stable’.

My mother is having treatment for a cancer. The doctors have said she cannot be cured but have told her that because of treatment her condition is now stable. What does this mean?

In the early days of radiotherapy treatment, skin burns during treatment and sometimes permanent damage or scarring of the skin, was common.

This changed during the late 1950s and 1960s as two new types of machine were introduced to give the radiotherapy treatment. These are called Linear Accelerators and Cobalt Units. These machines produce irradiating rays of a much greater energy than the previous machines. This higher energy of the rays give the treatments greater accuracy and greater penetration of the tissues (allowing treatment of cancers deep inside the body and also reduce skin damage. This is because the high energy rays pass through the first centimetre or two of the first tissue they meet, before they actually begin to give out any radiation.
 
Skin problems are uncommon with modern radiotherapy treatment. Occasionally skin problems can occur because of the location of the cancer and the area of the body treated. Usually this will cause no more than some temporary pinkness or redness of the skin for a week or two after treatment. If any soreness does develop it will only last a short time and can usually be eased with creams or lotions, which you will be given at the hospital. Severe or permanent skin damage is  rare indeed.

The fact that skin damage was common forty or fifty years ago means that people can remember friends or relatives who had bad experiences with their radiotherapy treatments which  probably account for the stories you have heard. Nowadays the situation is very different and things have improved enormously.

I have cancer and have been told I will need radiotherapy. I am so frightened that the radiotherapy will burn me. I have heard such a lot of stories about this. What can I do?

Radiotherapy is almost always a local treatment, limited to a particular part of the body. Only the skin in that area will be irradiated and the skin elsewhere will not be affected.

The doses of radiotherapy used can vary but even with quite high doses modern radiotherapy machines usually cause a little skin irritation. Even so this does mean that the skin which has been irradiated will be more sensitive to sunlight than your normal skin.

The degree of sensitivity will vary from person to person. The increased sensitivity also reduces gradually with time but probably never disappears completely.

Having had radiotherapy does not mean you must avoid the sun completely but you should take care over exposing the treated skin. It is very important to cover the treated area for at least the first year after radiotherapy. Wear clothing made of cotton or natural fibres which have a closer weave and offer more protection against the sun. Even after this time the area treated will be more delicate, so extra care should be given. You should also use a high factor sunscreen (of at least factor 15). Remember, too much sunbathing does carry the risk of leading to skin cancer and should be avoided.

Very occasionally radiotherapy is given to the whole body. In this situation the doses are normally quite low but you should still take precautions in exposure to strong sunlight. Seek advice  from your doctors if you are having this type of treatment.

I am about to have a course of radiotherapy following an operation for cancer. If I go on holiday in a few months from now, will I be able to go out in the sun?

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Bone cancer – general

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