Bone cancer refers to a malignant tumor that arises from the cells that make up the bones of the body. While bone tumors can be either benign (non-cancerous) or malignant (cancerous), the term “bone cancer” is generally used to describe cancers that begin in the bones. Bone cancers are relatively rare, accounting for less than 1% of all cancers. However, some types of bone cancer are particularly aggressive and deadly if not caught and treated early.
What are the most common types of bone cancer?
The most common types of bone cancer include:
- Osteosarcoma – The most common bone cancer, accounting for approximately 35% of cases. It develops in the osteoblast cells that form new bone tissue.
- Chondrosarcoma – The second most common bone cancer at approximately 26% of cases. It arises in cartilage cells.
- Ewing’s sarcoma – A rare cancer more common in children and young adults. It accounts for 16% of childhood bone cancers.
- Chordoma – A rare cancer that develops along the spine and base of the skull in adults. It accounts for 4% of bone cancers.
- Multiple myeloma – A blood cancer that forms in plasma cells in the bone marrow. It makes up approximately 13% of primary bone cancers.
Other rare bone cancers include fibrosarcoma, malignant fibrous histiocytoma, and adamantinoma among others.
Which bone cancer has the worst prognosis?
Of the main types of bone cancer, osteosarcoma and Ewing’s sarcoma generally have the worst prognosis and highest mortality rates.
Osteosarcoma is considered the most deadly bone cancer for several reasons:
- It has a high risk of spreading (metastasizing) to other parts of the body, most often the lungs.
- Even with treatment, approximately 30-40% of patients will have the cancer return.
- The 5 year survival rate is approximately 65% overall.
- Survival is worse if the cancer has already spread at diagnosis.
Ewing’s sarcoma also has relatively high mortality rates:
- At least 25% of patients will develop metastasis even after treatment.
- If the cancer has metastasized, the 5 year survival rate is about 15% to 30%.
- The overall 5 year survival rate is around 70%.
Both osteosarcoma and Ewing’s sarcoma often require intensive treatment with chemotherapy, radiation, and surgery. But outcomes tend to be worse if the cancer cannot be completely removed with surgery.
What factors affect bone cancer survival rates?
Some of the main factors that influence bone cancer prognosis and survival statistics include:
- Type of cancer – As mentioned, osteosarcoma and Ewing’s sarcoma generally have the highest mortality rates.
- Stage at diagnosis – Earlier stage bone cancers have better prognoses. At later stages, the cancer has often already spread to other body sites.
- Location of tumor – Tumors in difficult to treat locations, like the pelvis or spine, have worse outlooks.
- Size of tumor – Larger tumors are more difficult to treat effectively.
- Age of patient – Younger patients with bone cancers tend to have somewhat better survival rates.
- Response to treatment – Good responses to chemo and radiation prior to surgery predict better long-term outcomes.
In addition, factors like a patient’s overall health and treatment approach play a role. Multidisciplinary care at specialized cancer centers generally provides the best outcomes for bone cancer patients.
What are the survival rates for common bone cancers?
The 5-year relative survival rates for the most common bone cancers are:
- Osteosarcoma – Approximately 65% overall.
- Ewing’s sarcoma – Around 70% overall.
- Chondrosarcoma – 90% or higher for low to intermediate grade tumors.
- Chordoma – Around 70% for localized spine and skull base tumors.
- Multiple myeloma – 52% overall, but highly variable depending on other factors.
These survival statistics are based on large patient populations and act as general guidelines. Many factors at the individual level affect prognosis.
How is bone cancer treated?
The main treatment approaches for bone cancer include:
- Chemotherapy – Powerful cancer-killing drugs to try to eliminate any cancer cells that have spread beyond the main tumor. Often given before and after surgery.
- Radiation – High energy beams focused on the tumor to destroy cancer cells and reduce the risk of recurrence. Sometimes used before surgery.
- Surgery – Removal of the tumor and surrounding tissue. May involve limb salvage surgery or amputation depending on location.
These treatments may be used alone or in combination. For example, chemotherapy plus radiation followed by surgical removal of the tumor is a common osteosarcoma treatment approach.
Limb-sparing surgery
In the past, bone cancer surgery required amputation of the affected limb. Now limb-sparing procedures are often performed instead. These involve removing the tumor while preserving the limb using special surgical techniques.
With limb-sparing surgery, the tumor is removed and the bone rebuilt using:
- Bone grafting – Using bone from another part of the body or a donor.
- Metal implants – Inserting an internal prosthesis made of metal and other materials.
In some cases, amputation may still be needed if saving the limb is not possible. But most patients can have limb-sparing surgery. This greatly improves quality of life after bone cancer treatment.
Targeted therapy
Some types of targeted cancer drugs may be used in cases where chemotherapy is not effective. For example, the drug denosumab can help slow tumor growth and bone damage from cancer.
What are the symptoms of bone cancer?
Some common signs and symptoms of bone cancer include:
- Localized pain in the affected bone, often worsening over time
- Swelling or a lump over the painful area
- Fracture of the bone with minimal trauma
- Reduced joint motion if the tumor is near a joint
- Weakness or numbness if the tumor presses on nerves
- Fatigue from anemia due to bone marrow displacement
These symptoms may develop gradually or come on suddenly. They may be worse at night or with physical activities. Any unexplained bone pain that persists or worsens warrants medical attention.
Who is at risk for bone cancer?
While the causes of bone cancer are not fully understood, some factors are known to increase risk:
- Genetic syndromes like Li-Fraumeni syndrome
- Family history of bone cancer
- Previous radiation therapy
- Chemicals like benzene and arsenic
- Diamond Blackfan anemia
Factors that may slightly increase risk include past viral infections, Paget’s disease of bone, and metal implants. Bone cancer can occur at any age but is most common in children and older adults.
How is bone cancer diagnosed?
Diagnosing bone cancer typically involves:
- Medical history and physical exam – Looking for symptoms and assessing the site of reported pain or swelling.
- Imaging tests – X-rays, CT scans, MRI, bone scans, and PET scans to view the tumor, look for spread, and aid in biopsy.
- Biopsy – Removing a tissue sample from the tumor for microscopic analysis to confirm cancer.
- Lab tests – Checking blood cell counts, alkaline phosphatase, and other blood markers that may be abnormal with bone cancer.
These tests allow doctors to confirm a diagnosis, identify the type of bone cancer, and determine the stage to guide appropriate treatment.
What are the stages of bone cancer?
Bone cancer staging provides a measure of how far the cancer has progressed. While systems vary for different bone cancer types, general stages are:
- Stage 1 – The cancer is low grade and has not yet spread beyond the bone.
- Stage 2 – The cancer is high grade but contained within the bone.
- Stage 3 – The cancer has spread into surrounding tissue.
- Stage 4 – The cancer has metastasized, or spread to distant sites like the lungs.
Higher stage cancers tend to have poorer prognoses. Staging allows doctors to select appropriate treatments and predict outcomes.
Can bone cancer be prevented?
There are no definitive ways to prevent bone cancer. But the following steps may help reduce the risks:
- Avoiding tobacco use and excessive alcohol intake
- Limiting radiation exposure from imaging tests like X-rays when possible
- Reducing exposure to chemicals linked to bone cancer
- Eating a healthy diet with antioxidants from fruits and vegetables
- Exercising regularly
- Getting recommended cancer screenings
Early detection also improves outcomes. Anyone experiencing unexplained bone pain, fractures, or other symptoms should see their doctor promptly.
What is the outlook for bone cancer?
Bone cancer prognosis varies significantly depending on the specific type, location, stage, and more. With treatment, the overall 5-year relative survival rate for all bone cancers combined is approximately 70%. Survival is improving with new treatment techniques and specialized care teams.
Early diagnosis and treatment provide the best outcomes. Clinical trials evaluating combination therapies, targeted drugs, and limb salvage techniques also continue to improve outlooks for bone cancer.
While some bone cancers like osteosarcoma remain deadly if not promptly treated, long term survival and even cures are possible in many cases with modern medicine.
Conclusion
In summary, osteosarcoma and Ewing’s sarcoma are considered the deadliest major types of bone cancer. They have high risks of spreading and mortality even with intensive treatment. Chondrosarcoma and chordoma generally have better prognoses when detected early.
Survival rates for bone cancer depend heavily on the extent of tumor spread at diagnosis. Multidisciplinary treatment approaches including chemotherapy, radiation, surgery, and targeted drugs continue to improve outlooks for patients. Still, bone cancers like osteosarcoma remain difficult to treat once they metastasize to distant body sites.
Continuing research on combination treatments and early diagnosis will hopefully improve survival statistics and quality of life after bone cancer. But for now, prompt attention to symptoms and access to specialized cancer care gives patients the best chance of overcoming these aggressive tumors.