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Bone Cancer

Bone tumors are generally benign tumors. Most bone tumors arise as metastases of breast, lung, kidney, and prostate cancers. Orthopedic and Traumatology Department Specialists from Uniqacare Clinic provide information about bone cancer and tumors

What is bone cancer?

The most common type of bone cancer is called Osteosarcoma. Bone cancer primarily originates in bone cells. Bone cancer, most often occurring in the bones of the legs and arms, is frequently found in a portion of the thigh bone, the lower leg bone near the knee, or the upper part of the arm near the shoulder. In rare cases, bone cancer can also be found in different bones such as the hip bone (pelvis), shoulder, or jaw.

Bone density forms the basis of bone health. Bone density, which depends on the amount of calcium mineral in the bone, reaches its peak between the ages of 20-30. From this age range onward, it's important to pay attention to certain factors and maintain bone density levels. Among the most significant factors contributing to bone issues are sports injuries in young individuals, improper nutrition, and lack of physical activity. In later years, the incidence of systematic diseases increases with age. As a side effect of these diseases, there's a risk of developing bone tumors, which can lead to heavy burdens on the bones. Since bone tumors often progress without showing symptoms, it's crucial to consult a specialist doctor as soon as bone pain is noticed.

What are the symptoms of bone cancer?

The symptoms of Bone Cancer may not be noticeable initially. Often, ordinary but persistent bone pain is a common complaint, and Bone Cancer can particularly lead to swellings in bones located just below the skin, such as the shinbone or ribcage. In some cases, Bone Cancer makes itself apparent through spontaneous bone fractures. Benign bone tumors can be detected in X-rays taken for various reasons during childhood and adolescence.

When you notice the Bone Cancer symptoms listed below, make sure not to neglect consulting a specialist doctor:

  • If persistent bone pain doesn't subside even with painkillers,

  • If the intensity of the pain experienced for a long time is increasing,

  • If swelling and redness are noticed along with bone pain,

  • If there are findings such as a palpable lump and hardness at the site of pain,

  • If your pain is related to injuries like falls or impacts,

  • If your bone pain is accompanied by other symptoms such as loss of appetite, weakness, fatigue, fever, limping, and rash.

What are the types of bone cancer?

Understanding the progression and spread of bone cancer is crucial for determining the grade of the cancer. There are various subtypes of bone tumors. While some forms of bone cancer (Osteosarcoma) may have a milder course, others can exhibit aggressive progression. Bone cancer is categorized into three grades: low, intermediate, and high. In cases where the number of dividing cells in a bone tumor is low, the bone appears normal, resembling a regular bone. Tumors in this category, referred to as low-grade tumors, tend to progress slowly.

In high-grade bone cancer (osteosarcoma), the number of dividing cells is higher, leading to rapid growth. High-grade bone cancer tends to be more aggressive in nature and has a higher tendency to metastasize to other organs. The grade of bone cancer (tumor) and the stage of the tumor are crucial aspects of the treatment process. Upon identifying bone cancer symptoms, various diagnostic methods are used to determine the extent of the disease's spread and to assess the size of the tumor in its location, including pathology reports, PET-CT scans, and MRI results. It's also important to note that not all tumors observed in the bones are cancerous. There are many benign (non-cancerous) bone tumors that are not defined as cancer. Benign bone tumors do not spread to other parts of the body, can often be treated with surgical intervention, and pose no risk of loss of life.

What are the risk factors of bone cancer?

Although bone cancer (tumor) is not a very common type of cancer in our country, there are approximately 200 cases of bone cancer (osteosarcoma) diagnosed in young individuals each year. While the exact cause of bone tumors, particularly those commonly found in young people, is not known, certain risk factors can be discussed.

The following are potential risk factors for commonly encountered bone tumors (cancer):

  1. Bone cancer is more frequently seen in males.

  2. Bone cancer often occurs in tall adolescents and adults, and rapid bone growth is another risk factor.

  3. Osteosarcoma seen in older individuals can be associated with long-standing bone diseases.

  4. Bone tumors are more prevalent in individuals of African descent compared to Caucasians.

  5. Radiation therapy applied to the bone area to treat a different type of cancer in young patients can later lead to the development of bone cancer. It should also be noted that there is not yet clear information regarding X-rays, CT scans, and bone scans increasing the risk of osteosarcoma.

  6. Certain non-cancerous bone diseases carry the risk of causing bone cancer. For instance, Paget's disease of bone and multiple hereditary osteochondromas are considered such bone conditions.

  7. Genetic characteristics are also counted among the risk factors for bone cancer. Young individuals and adults with hereditary cancer indications like Li-Fraumeni syndrome and hereditary retinoblastoma are at an increased risk of osteosarcoma.

How is bone cancer diagnosed?

For distinguishing bone cancer (tumor), X-rays are often sufficient. Especially in children, X-rays taken during the investigation of long-lasting pain can be considered the sole diagnostic method for bone cancer. Benign bone tumors seen in children can spontaneously disappear over time. These tumors have the characteristic of gradually shrinking and disappearing on their own. In the case of benign bone tumors, regular monitoring and follow-up are much more important than resorting to surgical methods.

When deciding on a surgical approach for bone tumors:

  1. If the tumor causes enough damage to the body to result in bone fractures,

  2. If it negatively affects bone growth,

  3. If it causes shortening or curvature of the bone,

  4. If a sample needs to be taken from the area where the tumor is suspected for diagnosis,

Surgical methods are employed. In the case of bone tumors, the location and type of tumor are crucial, and the surgical approach and treatment will vary accordingly. Therefore, in some cases, X-rays may not be sufficient. In such instances, computed tomography (CT), MRI, bone scintigraphy, PET scans, and lung CT can also be utilized. CT is used to visualize all the details in the bone, while MRI is preferred to see soft tissue, the extension of the tumor within the bone, or the risk of spread to distant points. The presence of metastasis is determined using bone scintigraphy.

What are the treatment methods of bone cancer?

In the treatment of bone cancer, the most important goal is to save the patient's life. Therefore, sometimes during treatment, there might be cases of limb loss, such as arms or legs, but with new treatments, this rate has been reduced to as low as 10%. Preserving limbs like arms and legs and maintaining functionality takes second priority in treatment, as it aims to ensure continued normal functioning. Aesthetic appearance constitutes the final aspect of the treatment.

Bone cancer and limb loss

Bone cancers, benign tumors, and bone tumors that manifest as metastases from any organ in the body can occur anywhere in the skeletal system. In patients under 18 years old, bone cancers are more commonly found closer to joint areas like the knee, hip, or shoulder, which are referred to as "growth plates." The treatment for bone cancer patients twenty years ago involved amputating the affected limb. However, with modern treatments, such as limb-sparing surgeries, patients are now able to preserve their arms and legs in over 90% of cases.

Cryoablation in the treatment of bone cancer

Cryoablation can be used in the treatment of bone cancer. The cryoablation method is sometimes used on its own, but more commonly it is combined with chemotherapy and radiotherapy. There are also cases where cryoablation is not applicable. The freezing process can damage nerve tissue, so it is not used in areas where important nerves are located, such as the brain, spinal cord, or regions with critical nerves, unless special techniques are employed to preserve nerve tissue.

With the cryoablation method, the tumor-bearing bone is removed from the body, cleaned of the tumor, and frozen in a -180-degree liquid nitrogen bath. The freezing process aims to minimally affect the bone's durability while preserving its biological activity. The frozen bone is not reinserted as it is. The inside of the bone is filled with bone cement containing antibiotics to prevent infection, or a bone called the "fibula" from the opposite leg is buried within the frozen bone. This is connected to the main artery using microsurgery, providing vitality and support. The "frozen preservation" process allows the tumor-bearing bone to be returned to its original position, significantly reduces the risk of infection, and allows for eventual fusion over time. For this procedure to be applied, the tumor should not have severely damaged the bone's structure.

Cryoablation is mostly used for children and young patients

Cryoablation is predominantly applied to patients in their childhood and youth for the treatment of bone tumors. After cryoablation, patients can use protective devices or crutches. In older patients, prosthetics are preferred to enable them to return to their daily lives as soon as possible.

Healthy growth opportunity with reserve bone for children

In some cases of tumors in small children, the growth cartilage and the surface bone of the joint may need to be removed. For example, in a tumor affecting the hip joint, the part of the hip joint where growth occurs might need to be removed along with the tumor. Instead of amputating a child's leg from the hip at the age of 4 or 5, a bone called the "fibula" is used. This bone, along with the growth cartilage, is delicately transplanted under a microscope. This approach repairs the joint while preserving the ability to grow, resulting in a functional limb. This procedure, which is only performed in a few specialized centers worldwide, allows children to grow healthily without tumors. Consequently, children are able to lead normal lives. While they might not become professional tennis players, they can ride bicycles, swim, and engage in various physical activities.

Filling bone gaps with reserve bone

Some patients have tumors spanning from their knee to their hip. In such cases, the bone "fibula," which is also known as the reserve bone, can be utilized. There are two fibulas in the body, one in each leg, with a length of about 20-25 centimeters. By connecting these bones, a gap of 35-40 centimeters can be filled. The fibula is folded in half to achieve a normal bone thickness and is used alongside the frozen bone. After surgery, the expected outcome is for the transplanted bone to heal and fuse with the body within a year, essentially being accepted by the body as its own bone.

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