Bone Tumours

Abnormal growths that form inside bones are called bone tumors. They may be malignant (cancerous) or benign (non-cancerous). Malignant bone tumors, particularly primary bone cancers, can be aggressive and need immediate treatment, whereas benign bone tumors are more prevalent and frequently less harmful.

Although they make up less than 1% of all cancers, bone cancers are more frequently found in children, adolescents, and young adults. To improve results and maintain function, early diagnosis and specialized treatment are essential.

What Are Bone Tumours?

Bone tumours are broadly classified as:

Benign bone tumours – Growths that are not cancerous and usually do not spread. Giant cell tumors, osteochondroma, and enchondroma are a few examples.
Malignant bone tumours (Bone cancers) – Malignant growths that have the ability to infiltrate adjacent tissue and travel to other organs.

Malignant bone tumours are either:

Primary bone cancers – Originate in the bone itself.
Secondary bone cancers (bone metastases) – Originate in other organs (like breast, lung, or prostate) and spread to the bone. These are more common in adults.

Common Types of Primary Bone Cancer

Osteosarcoma – Most common primary bone cancer, usually occurs in teenagers and young adults, often around the knee.
Ewing’s sarcoma – Affects children and adolescents, commonly in the pelvis, thigh, or chest wall.
Chondrosarcoma – Typically occurs in adults over 40 and arises from cartilage-producing cells.
Chordoma – A rare tumour found in the spine or skull base.

Each type behaves differently and requires a specific treatment approach.

Causes and Risk Factors

The exact cause of bone tumours is often unknown, but certain factors can increase risk:

Genetic conditions such as Li-Fraumeni syndrome, hereditary retinoblastoma, and Rothmund-Thomson syndrome.
Previous radiation therapy, especially during childhood or adolescence.
Paget’s disease of bone, which causes abnormal bone growth in older adults.
Bone injury or chronic inflammation – While not proven to directly cause cancer, areas of chronic irritation may be more susceptible.

Lifestyle factors like smoking and drinking alcohol are not strongly associated with bone tumors, in contrast to many other types of cancer.

Signs and Symptoms

Depending on the tumor's size, location, and whether it is benign or malignant, bone tumor symptoms can change. Typical indicators include:

Pain in the affected bone – initially mild and intermittent, but may become constant and severe, especially at night.
Swelling or a lump over a bone.
Limited movement if the tumour is near a joint.
Bone fractures due to weakening of the bone structure.
Fever, weight loss, or fatigue in advanced or aggressive cases.

Never write off chronic limb pain in kids and teenagers as "growing pains" if it doesn't go away.

Diagnosis and Evaluation

For the right treatment, an accurate diagnosis is essential. Evaluation usually consists of:

X-ray – Often the first step to detect bone abnormalities.
MRI – Provides detailed images of the tumour and its relation to surrounding tissue.
CT scan – Useful for assessing bone structure and detecting lung metastases.
Bone scan – To identify other areas of abnormal bone activity.
Biopsy – Essential for confirming the diagnosis and determining the exact type and grade of the tumour.
Blood tests – May include markers like alkaline phosphatase (ALP) or lactate dehydrogenase (LDH) in some cases.

Since the lungs are the most frequent site of metastasis for bone cancers, the tumor is staged after diagnosis to determine how far it has spread.

Treatment Options

A multidisciplinary approach is necessary for the management of malignant bone tumors, frequently involving radiation specialists, medical oncologists, surgical oncologists, and rehabilitation teams.

1. Surgery

The main treatment for localized bone cancers is typically surgical excision of the tumor. Instead of amputation, modern methods strive for limb-sparing surgery. Reconstruction with bone grafts or metal implants may be required in certain situations.

2. Chemotherapy

Osteosarcoma and Ewing's sarcoma require chemotherapy, particularly to reduce the tumor prior to surgery (neoadjuvant) and eradicate microscopic disease afterwards (adjuvant). Chondrosarcoma, which has a tendency to be resistant, is less frequently treated with it.

3. Radiation Therapy

Inoperable tumors or tumor types that respond better to radiation, such as Ewing's sarcoma, may be treated with radiation. In more severe cases, it also helps with pain relief.

4. Targeted Therapy and Immunotherapy

Targeted treatments and immunotherapy are being investigated in clinical trials and a few selected cases, but they are not yet common for the majority of bone cancers, particularly in cases where the disease is advanced or metastatic.

Rehabilitation and Recovery

Treatment for bone tumors can result in a lengthy recovery, particularly following surgery. Restoring function and quality of life requires rehabilitation.

Physical therapy helps regain strength, mobility, and independence.
Psychological supportis important, especially for young patients adjusting to changes in body image or physical ability.
Nutritional and general health support aids healing and strengthens the immune system.

Additionally, patients will need frequent follow-ups to check for metastases or recurrence, particularly in the lungs.

Prognosis and Survival

The tumor's size, location, stage, type, and response to treatment all affect the prognosis.

Osteosarcoma and Ewing’s sarcoma have a favorable prognosis when identified early and treated vigorously; in cases of localized disease, cure rates are between 60 and 70 percent.
Chondrosarcoma, has a better long-term result following total surgical removal because it grows more slowly.
Recurrent or metastatic disease is more difficult to treat but newer therapies continue to offer hope.

When to See a Specialist

It's critical to seek treatment at facilities that have experience managing sarcomas and bone cancers because of the intricacy and rarity of bone tumors. The best chance of recovery is provided by an early, precise diagnosis and professional treatment.

Medical oncologist Dr. Amit Badola is essential in the management of systemic therapies and chemotherapy for primary bone cancers. In order to provide comprehensive, multidisciplinary care that is customized to each patient's particular condition, he collaborates closely with the surgical and radiation teams.