What is Bone Cancer?
How much does a bone cancer treatment cost in Iran?
The cost of bone cancer treatment in Iran starts from $1600.
Bone cancer occurs when a tumor, or abnormal mass of tissue, forms in a bone. A tumor may be malignant, which means it’s growing aggressively and spreading to other parts of the body. A malignant tumor is often referred to as cancerous. Bone cancer is rare, making up less than 1 percent of all cancers. In fact, noncancerous bone tumors are much more common than cancerous ones.
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Before Bone Cancer Treatment
Symptoms of Bone cancer
What are the symptoms of Bone Cancer?
The symptoms of bone cancer are:
. Pain and swelling in the affected bones
. Palpable hard mass in the long bones of the limbs
. Feeling tired or fatigued
Less common symptoms include:
. Easily broken bones
. Weight loss
When to see a doctor
Make an appointment with your doctor if you or your child develops bone pain that:
. Comes and goes
. Becomes worse at night
. Isn't helped by over-the-counter pain relievers
What Causes Bone Cancer?
The cause of bone cancer isn’t exactly known, but there are certain factors that may contribute to or increase a person’s chances of forming abnormal growths in the bone. These include:
. Abnormal Cellular Growth
Healthy cells continually divide and replace older cells. After completing this process they die. Abnormal cells, however, continue living. They start forming masses of tissue that turn into tumors.
. Radiation Therapy
Radiation therapy, which kills dangerous cancer cells, can be used to treat bone cancer. However, osteosarcoma may form in some people who receive the treatment. The use of high dosages of radiation may be a factor in this development.
Who is at risk for Bone Cancer?
The following may be risk factors for bone cancer:
. Having a family history of cancer, especially bone cancer
. Having received radiation treatment or therapy in the past
. Having Paget’s disease, which is a condition that causes the bones to break down and then grow back abnormally.
. Currently or previously having had multiple tumors in the cartilage, which is the connective tissue in the bone.
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Imaging tests can help determine the location and size of bone tumors, and whether the tumors have spread to other parts of the body. The types of imaging tests recommended depend on your individual signs and symptoms. Tests may include:
. Bone scan
. Computerized tomography (CT)
. Magnetic resonance imaging (MRI)
. Positron emission tomography (PET)
Needle or surgical biopsies
Your doctor may recommend a procedure to remove a sample of tissue (biopsy) from the tumor for laboratory testing. Testing can tell your doctor whether the tissue is cancerous and, if so, what type of cancer you have. It can also reveal whether the tumor cells are growing quickly or slowly.
Types of biopsy procedures used to diagnose bone cancer include:
. Inserting a needle through your skin and into a tumor. During a needle biopsy, your doctor inserts a thin needle through your skin and guides it into the tumor. Your doctor uses the needle to remove small pieces of tissue from the tumor.
. Surgery to remove a tissue sample for testing. During a surgical biopsy, your doctor makes an incision through your skin and removes either the entire tumor or a portion of it.
Determining the type of biopsy you need and the particulars of how it should be performed requires careful planning by your medical team. Doctors need to perform the biopsy in a way that won't interfere with future surgery to remove bone cancer. For this reason, ask your doctor for a referral to a team of doctors with extensive experience in treating bone tumors before your biopsy.
How to prepare
Appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared. Try to:
. Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
. Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
. Write down key personal information, including any major stresses or recent life changes.
. Make a list of all medications, vitamins or supplements that you're taking.
. Consider taking a family member or friend along. Sometimes it can be difficult to remember all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
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During Bone Cancer Treatment
Staging and grading
Staging and grading a bone tumor allows doctors to decide on the best course of treatment and the most likely outlook.
Grading involves looking at the cells of the tumor under a microscope and assessing how they differ from healthy bone tissue.
A grade 1 tumor has cells that resemble bone tissue, while a grade 3 tumor has more abnormal cells that suggest a more aggressive cancer.
Staging a tumor indicates its size and spread. Several different characteristics can constitute the different stages, so each stage has two substages apart from stage 3.
. Stage I
The tumor measures either less or more than 8 centimeters (cm) across and has not spread from its original site. It is low grade, or the doctor has not been able to determine the grade through testing.
Stage 1 is the most treatable stage of bone cancer.
. Stage 2
A stage 2 tumor can be the same size as a stage I tumor, but the cancer is a higher grade. This means that it is more aggressive.
. Stage 3
Tumors have developed in at least two places in the same bone have not yet spread to the lungs or lymph nodes. A stage 3 bone tumor would have a high grade.
. Stage 4
This is the most advanced form of bone cancer.
A stage 4 tumor will appear in more than one location and will have spread to either the lungs, lymph nodes, or other organs.
The stage of the cancer will dictate the method of treatment and the overall outlook.
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Types of bone cancer
There are several types of bone cancer.
Primary bone cancers
Tumors in the bone are either benign (noncancerous) or malignant (cancerous). Benign tumors do not spread beyond their original site. Malignant tumors are more aggressive and have a higher risk of growing and spreading.
Examples of benign bone tumors include:
. Osteoid osteoma
. Aneurysmal bone cyst
. Fibrous dysplasia of the bone
Osteoblastoma and giant cell tumor of bone may become malignant after starting as benign. They will usually become aggressive without spreading to distant sites and cause damage to the bone near the tumor.
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Examples of malignant primary bone tumors include:
. Ewing’s sarcoma
. Malignant fibrous histiocytoma
. Other sarcomas
Common types of primary bone cancers include:
. Multiple Myeloma (MM)
Multiple myeloma is the most common type of bone cancer. It occurs when cancer cells grow in the bone marrow and cause tumors in various bones. MM usually affects older adults. Among bone cancers, MM has one of the best prognoses, and many people who have it don’t require treatment.
. Osteosarcoma (Osteogenic Sarcoma)
This type of cancer develops in osteoblasts, which are the cells that form bones.
Osteosarcoma is the most common type of bone cancer. Children and adolescents aged 10–19 years have the highest risk of osteosarcoma.
Having Paget’s disease of the bone, which is a disease that causes excessive bone growth, also increases the risk of osteosarcoma.
. Ewing sarcoma
Ewing sarcoma usually develops in the pelvis, chest wall, shinbone, or thighbone. However, it might also develop in supporting soft tissue, such as fat, muscle, or blood vessels.
This is a rapidly growing tumor that often spreads to distant sites in the body, such as the lungs. It is most common in adolescents between 10–19 years of age. Although it is the second most common type of bone cancer in children and teenagers, it is very rare.
Chondrosarcoma usually develops in adults. It starts in cartilage, a type of connective tissue that lines the joints, and then spreads to the bone.
Most commonly, it develops in the upper leg, pelvis, and shoulders. Chondrosarcoma usually grows slowly.
This is most common in adults over the age of 40 years.
This is a very rare cancer of the spine. It usually develops at the bases of the spine and skull in older adults.
Children and adolescents can also develop chordoma. When this occurs, chordoma usually begins to grow at the base of the neck and skull.
Secondary bone cancers
These are the most common bone cancers in adults.
They develop when a cancer spreads to the bone from elsewhere in the body. Most cancers can spread to the bones. However, people with breast and prostate cancer have a particularly high risk of developing secondary bone cancer. Doctors know this as bone metastases.
This type of cancer can cause pain, fractures, and hypercalcemia, which is an excess of calcium in the blood.
The type of treatment for bone cancer depends on several factors, including:
. The type of bone cancer
. Its location in the body
. How aggressive it is
. Whether it has spread
There are several approaches to treating bone cancer.
Medications that treat bone cancer include:
. Chemotherapy drugs for multiple myeloma
. Pain medications to relieve inflammation and discomfort
. Bisphosphonates to help prevent bone loss and protect bone structure
. Cytotoxic drugs to prohibit or stop the growth of cancerous cells
Surgery aims to remove the tumor and some of the bone tissue that surrounds it. It is the most common treatment for bone cancer.
If a surgeon leaves some of the cancer, it may continue to grow and eventually spread.
Limb sparing surgery, or limb salvage surgery, means that surgical intervention occurs without having to amputate the limb. However, for a person to use the limb again, they may need reconstructive surgery.
The surgeon may take bone from another part of the body to replace lost bone, or they may fit an artificial bone.
In some cases, however, a doctor may need to amputate a limb to remove the presence of cancer altogether. This is becoming increasingly rare as surgical methods improve.
. Radiation therapy
Radiation therapy is common in the treatment of many cancers.
A specialist targets cancer cells with high-energy X-rays to destroy them.
A person may receive radiation therapy alongside surgery. People who do not need surgery for bone cancer might also be candidates for radiation therapy.
It is a standard treatment for Ewing sarcoma and a regular part of combination treatment for other bone cancers.
Combination therapy is radiation therapy combined with another type of treatment. This may be more effective in some cases.
Chemotherapy involves using medications to destroy cancer cells.
People with Ewing sarcoma or a new diagnosis of osteosarcoma usually receive chemotherapy.
A doctor may also recommend a combination of chemotherapy and radiation therapy.
This technique sometimes replaces surgery to remove tumors from bone tissue. A surgeon targets cancer cells with liquid nitrogen to freeze and destroy them.
. Targeted therapy
This treatment uses a drug that scientists have designed to interact specifically with a molecule that causes cancer cells to grow.
Denosumab (Xgeva) is a monoclonal antibody that doctors use in targeted therapy. The U.S. Food and Drug Administration (FDA) have approved it for use in adults and adolescents with fully developed skeletons.
Denosumab prevents osteoclasts, which are a type of blood cell, from destroying bone tissue.
. Alternative Therapy
Your doctor may add alternative therapies that include herbal treatments to your care plan. However, this must be done with careful consideration as some alternative treatments may interfere with chemotherapy and radiation treatments.
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After Bone Cancer Treatment
When treatment ends, your doctors will still want to watch you closely. It's very important to go to all of your follow-up appointments. During these visits, your doctors will ask about any problems you might be having. Exams, lab tests, x-rays, and scans will be needed to look for signs that the cancer has come back. These may be done every 3 to 6 months for a few years. You'll see your doctor and have imaging scans quite often at first, but as time goes on there will be more time between scans and visits. Because primary bone tumors tend to come back, you may need to have imaging scans every year for many, many years.
Your doctor will also look for treatment side effects. Almost every cancer treatment has side effects. Some may last for a few weeks to months, but others can last the rest of your life. Now is the time for you to talk to your cancer care team about any changes or problems you notice and any questions or concerns you have.
After bone surgery, fitting for a prosthetic limb, rehabilitation, and/or physical therapy might be important to help you regain as much of your mobility and independence as possible.
The outlook for a person with malignant bone cancer depends mainly on whether it has spread to other parts of the body.
The 5-year survival rate is the percentage of people with bone cancer (reported by stage) who are likely to survive to at least 5 years after diagnosis.
For example, a person with chondrosarcoma that has not spread has a 91% chance of surviving for 5 years after diagnosis.
However, if the cancer spreads to distant sites, such as the lungs, the 5-year survival rate reduces to 33%. Taking all stages into account, the American Cancer Society puts the 5-year survival rate at 80%.
Early detection and treatment is key to improving the outlook.
Can I lower my risk of the bone cancer progressing or coming back?
If you have (or have had) primary bone cancer, you probably want to know if there are things you can do that might lower your risk of the cancer growing or coming back, such as exercising, eating a certain type of diet, or taking nutritional supplements. Unfortunately, it’s not yet clear if there are things you can do that will help.
Adopting healthy behaviors such as not smoking, eating well, getting regular physical activity, and staying at a healthy weight might help, but no one knows for sure. Still, we do know that these types of changes can have positive effects on your overall health beyond your risk of bone cancer or other cancers.