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Bone Metastasis & Bone Cancer

  • What is bone metastasis and bone cancer?

    Bone cancer

    Bone metastasis refers to cancer in a different organ that has spread to the bone. Also known as secondary bone cancer, it occurs when cancer cells break away and spread from the original (primary) tumour to the bone. This is different from a primary bone tumour, which starts in the bone. While all types of cancer have the possibility to spread to the bones, there are cancers that are more likely to lead to bone metastasis, including:

    Bone cancer is cancer that develops from the bone itself. Also known as primary bone cancer, it can affect people of all ages. Cancer occurs when abnormal cells divide out of control. While it can begin in any bone of the body, cancer of the bone usually affects the pelvis or the bones in the arms and legs.

    Types of bone cancer

    The most common types of bone cancer include:

    • Osteosarcoma – This is the most common form of bone cancer and it begins in the cells that form bones. Osteosarcoma can start in any bone but is most often found in the legs or arms. Most people diagnosed with osteosarcoma are under the age of 25, and it is thought to occur more often in males than females.

    • Chondrosarcoma – A malignant type of bone cancer that primarily affects the cartilage cells of the femur, arm, pelvis, knee, and spine. Common in middle-aged adults, it is the second most common primary malignancy of the bone. It is also resistant to chemotherapy and radiotherapy, making it one of the most difficult bone tumours to diagnose and treat.

    • Ewing’s sarcoma – This is a rare type of cancerous tumour that grows in the bones or the soft tissue around the bones. It mainly affects children and young adults between the ages of 5 – 25.

    Stages of bone cancer

    Once you are diagnosed with bone cancer, your doctor will need to determine the extent of your cancer. The stage of bone cancer will serve as a guide in choosing the right treatment for your condition. In determining the stage of cancer, factors to be considered include the size of the tumour, growth rate of the cancer, the number of affected bones, and presence of metastasis.

    The stages of bone cancer have a designated Roman numeral from 0 to IV. A lower number means smaller tumour. Stage IV indicates that the bone cancer has already spread to other body parts.

  • Cancer cells are different from normal cells in various ways. Unlike normal cells, cancer cells keep growing and doubling, forming a tumour that grows in size. It is still not clear what causes these cells to divide out of control.

    Risk factors for bone cancer

    There are only certain factors that are associated with an increased risk of developing bone cancer, including:

    • Inherited genetic syndromes – Certain rare genetic syndromes such as Li-Fraumeni syndrome and hereditary retinoblastoma can increase the risk of bone cancer.

    • Radiation therapy – Those who have had exposure to radiation, like patients receiving radiation therapy for cancer, are at a higher risk as well.

    • Chemotherapy – Some drugs involved in chemotherapy may increase one’s risk for developing a secondary cancer like bone cancer.

    • Other bone conditions – Benign tumours in the bone and other non-cancerous bone disease may increase one’s risk for bone cancer. Rarely, people with Paget's disease of the bone, which disrupts the body’s process of gradually replacing old bone tissue with new ones, can develop bone cancer.

    • Secondary cancer – When a cancer starts in one place in the body and spreads elsewhere, this is a secondary cancer or a metastasis. Some cancer types are particularly likely to spread to the bone, including breast cancer and prostate cancer.

    Preventing bone cancer

    As there are many possible factors that cause different types of cancer, prevention of this disease is still unknown.

    The best way to fight the disease is through early detection. The earlier bone cancer is detected, the higher the chance for a successful treatment. Thus, regular check-up is recommended for people who are at high risk of developing bone cancer, especially if you have health conditions such as Li-Fraumeni syndrome, retinoblastoma, or other conditions in which the risk of sarcoma is inherited. Talk with your health care team for more information about your personal risk of bone cancer.

  • It is important to pay attention to the changes in your body and potential symptoms to detect bone cancer early. Bone cancer symptoms include:

    Symptoms of bone cancer

    • Feeling a lump or swelling around a joint or bone
    • Fever
    • Bone or joint pain
    • Redness on the skin
    • Fatigue
    • Sudden weight loss
  • Your doctor may require certain tests to check for bone cancer and determine how far the cancer has spread. These tests include:

    X-ray

    If you have bone pain and other bone symptoms, X-ray can often be one of the first tests you will go for. An x-ray can help reveal signs that there is cancer of the bones.

    Bone scan

    A bone scan can show the entire skeleton. It can usually detect bone cancer earlier than regular x-rays. It is also used to monitor how much the cancer has spread.

    Computerised tomography (CT scan)

    A CT scan may be necessary in checking for cancer, which sometimes won't be detected by a bone scan. CT scan is also ideal for checking the size and shape of a tumour in the bone.

    Magnetic resonance imaging (MRI)

    Like the CT scan, MRI produces detailed cross-sectional images of the body. It is the standard test that doctors require if spinal cord compression is suspected. It is also useful in evaluating the extent of soft tissue involvement.

    Positron emission tomography (PET)

    PET scan can provide detailed information on the function of an organ or system in your body such as the chemical and physiological changes related to metabolism. This is important because these functional changes often occur before structural changes in tissues can be seen and PET images are able to show abnormalities long before they would be revealed by X-ray, CT or MRI.

    Biopsy

    A biopsy is needed to determine whether the lesion is cancerous or not. It also reveals whether the lesion is a primary bone cancer or a bone metastasis.

  • The treatment of bone cancer depends on several factors such as the stage of bone cancer, history of past treatment, age, and general health. Bone cancer may be treated with a combination of treatment options.

    The goal of treatment is to remove the whole cancerous lesion if possible. If the cancer is already very advanced, treatment may aim to ease the cancer-related symptoms and to control further growth of the cancer.

    Treatment of bone cancer

    • Chemotherapy – This treatment makes use of strong chemicals to get rid of fast-growing cells in the body. It is one of the treatments that may be given if cancer has spread to multiple bones already. Chemotherapy can be taken as a pill or administered through the vein or both.

    • Radiation therapy – Using high-powered energy beams like x-rays and protons to destroy cancer cells, radiation therapy is one of the treatment options if bone cancer is causing pain that can't be relieved by medications or if the pain is confined to a small number of areas.

    • Surgery – Surgery may be recommended by your doctor to remove the entire cancerous tumour. If your cancer is in an arm, leg, shoulder or hip, your surgeon may want to do a limb sparing surgery. This means removing the cancer, but not the whole arm or leg. In some cases, amputation or removal of the entire limb or part of it may be necessary if the bone cancer is very large or if it extends into the nerves and/or the blood vessels, making it impossible to salvage the limb.

  • Bone cancer can compromise bone health and put you at risk of complications including:

    • Bone pain

      Bone cancer pain is usually dull and continuous. As cancer grows, the pain can intensify.

    • Hypercalcaemia

      Bone cancer can lead to hypercalcaemia, a condition in which you have too high a concentration of calcium in the blood. Symptoms of hypercalcemia include and abdominal pain, nausea, vomiting, and anorexia.

    • Pathologic fractures

      Cancerous bones become weak and can lead to broken bones.

    • Spinal cord compression

      This condition causes severe pain, motor weakness, sensory deficits, and gait problems. It can also disturb functions of the bowels, bladder, and sexual organs.

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