Bone Cancer

The most common types of primary bone cancer (sarcoma) are:

• Osteosarcoma: The most common primary bone cancer in young adults but can occur at any age. While osteosarcoma can start in any bone in the body, it most often forms in the long bones around the knee - femur (end of thigh bone) or tibia (top of shin bone); and upper arm (humerus). In older adults it is also found in the hips and jaw.
• Chondrosarcoma: The second most common type of primary bone cancer and is most common in adults. This type of tumour arises in the cartilage, which is the tissue that lines the joints. It is most often found in the upper arm bone (humerus), thigh bone (femur) and pelvic bones. Surgical removal of the tumor is the main treatment for chondrosarcoma. Radiation and chemotherapy are rarely helpful in treating chondrosarcoma.
• Ewing sarcoma family of tumours: Unique in that it can occur in bone and the soft tissue. It can develop in the pelvis, the long bones of the arms and legs, the chest (ribs and shoulder blades) and spine. It is most common in adolescents and young adults, but can occur at any age.

The cause of primary bone cancer is still largely unknown, although the following factors can increase a person’s risk of developing bone cancer:

• Genetics: Research is discovering that genes that are passed between generations such as familial retinoblastoma or Li-Fraumeni syndrome can increase the risk of developing osteosarcoma.
• Previous radiation therapy: People may have a higher risk of developing bone cancer in an area that has been previously radiated.
• Previous chemotherapy: Medicine like alkylating agents and anthracyclines can increase the risk of secondary cancer, usually osteosarcoma.
• Bone conditions: Paget’s disease of bone, for instance, may lead to osteosarcoma.

Mount Sinai Hospital and the Lunenfeld-Tanenbaum Research Institute are dedicated to clinical and translational research and our scientists are working to learn more about sarcoma, how to best treat it, and how to provide the best care.

• There may be no symptoms or signs at first
• Bone or joint pain, gets worse with movement
• Swelling, tenderness or stiffness
• An unexplained bone fracture
• Common cancer symptoms such as fatigue, sweating, fever and weight loss are usually rare with bone cancer

Material adapted from Canadian Cancer Society

The following imaging studies may be used in conjunction with clinical examination by your doctor to investigate a probable diagnosis of sarcoma:

• Blood tests
• X-ray
• CT
• MRI
• Bone scans
• PET scans

A biopsy is performed whenever possible to confirm the diagnosis. A biopsy is a sample of tissue that is removed and examined microscopically by a pathologist.

A bone biopsy requires careful planning and is important that it is performed by sarcoma specialists with extensive expertise in diagnosing and treating bone cancers.

Your health care team will offer you treatment options and recommendations based on several factors, including the type, stage, and grade of sarcoma, possible side effects, your preferences and overall health. Your care plan may also include treatment for symptoms and side effects which is an important part of cancer care.

Doctors may use a combination of treatments when treating primary bone tumours. These include surgery, systemic treatment, and radiation therapy.

Surgery

The goal of Surgery is to remove the tumour and a margin of healthy bone or tissue around the tumour to remove all the cancer cells during an operation. Orthopaedic oncologists are doctors who specialize in treating bone cancer with surgical techniques.

Common surgical options:

• Wide excision removes the tumour with a margin of healthy bone or tissue around the tumour to ensure all cancer cells have been removed.
• Limb sparing surgeries remove the tumour from an arm or a leg (limb) without removing the whole arm or leg and preserving nearby vessels and nerves.
• Reconstructive surgery uses prostheses such as metal plates, bone grafts or modular implants to replace bone that has been removed and they provide strength to the remaining bone. Muscle flaps and skin grafts can be used over areas of reconstruction to help with healing and reduce the risk of infection.
• Amputation, in some cases, may be the best option for the treatment depending on the size and/or location of the tumour, and involvement of nearby vessels, muscles or nerves. These include cases when the tumour cannot be completely removed with surgery, when reconstruction is not possible or if cancer comes back in the same area after limb-sparing surgery.

Chemotherapy

Chemotherapy is prescribed by a medical oncologist, a doctor who specializes in treating cancer with medication. It may be given alone or in combination with surgery, radiation therapy, or both.

It can be more effective in the treatment of some bone cancers than others. Chemotherapy is an important part of the treatment plan for osteosarcoma and Ewing sarcoma, but is rarely effective in the treatment of chondrosarcoma.

Our medical oncologists specialize in the treatment of sarcoma using medication. All bone cancers are unique and require different treatment strategies and may include the use of two or three different chemotherapy drugs.

For fast-growing tumours, chemotherapy may be given before surgery to help shrink the tumour to make it easier to remove. This is often called neoadjuvant chemotherapy.

After the patient has recovered from surgery, chemotherapy may be given to help destroy any remaining cancer cells. This is often called adjuvant chemotherapy.

The side effects of chemotherapy depend on the individual, the drug used and the dose, and can include fatigue, low blood counts, risk of infection, nausea and vomiting, hair loss, loss of appetite and diarrhea. These side effects usually go away after treatment is finished. Your doctor will monitor you for potential long-term side effects.

For most chemotherapy regimens to treat primary bone cancer, treatment protocols can range from two to five days and will require you to be admitted to the hospital to receive your chemotherapy – inpatient chemotherapy.

Radiation

Radiation treatment is prescribed by a radiation oncologist. Radiation is generally given over consecutive treatments for days.

Targeted Therapy

Targeted therapy is treatment with medicine that targets and interferes with the tumour’s specific proteins, genes or other factors that promote cancer growth and survival. It will block the growth and spread of cancer cells and limits damage to healthy cells. Your doctor may have your cancer cells tested to see if they may respond to targeted therapy drugs.

Immunotherapy

Immunotherapy, also called biologic therapy, is a treatment with medicine that uses your immune system to fight the cancer. Your cancer cells may produce proteins that prevent the immune system from attacking them. Immunotherapy drugs interfere with that process to target, improve or restore immune system function.