At Home with Dr Christian Jessen - 392

| ORTHOPAEDICS|

WORDS: CATHERINE FRANCIS | PHOTOGRAPH: GETTY IMAGES

'IF ANYTHING ABNORMAL
SHOWS UP ON THE X-RAY,
YOU'LL BE REFERRED TO AN
ORTHOPAEDIC SPECIALIST'

What are the causes
of bone cancer?
The causes of primary bone cancer are still somewhat
unclear. There's a very small raised risk for people
who've been exposed to a lot of radiation,
including radiotherapy, and those with a condition
called Paget's disease of bone, where the cycle
of bone growth is disrupted.
Some rare inherited conditions can increase
the risk, as can previously having a benign
(non-cancerous) bone tumour, or a history of
retinoblastoma (a rare childhood eye cancer).
It's more common in teenagers and young adults,
whose bones are growing rapidly.
However, the vast majority of bone cancers are
secondary, having spread from elsewhere in the
body. Therefore the risk factors that can cause
it are the same as those for primary cancers.

This is sometimes mistaken for
arthritis in adults and 'growing
pains' in children and teenagers.
The bones also become weakened
and may break very easily. There
may be a swelling around the bone,
but this may not show up until the
tumour is quite large. If it's near a
joint, it may make movement difﬁcult.
Damaged bones often release
calcium, so patients may have raised
levels in their blood, known as
hypercalcaemia. This can lead
to dehydration, mental confusion,
abdominal pain, vomiting and
constipation. Anaemia (low levels
of red blood cells) can also occur,
as blood cells are made in the bone
marrow and can be 'crowded out'
by cancer cells. This increases the
risk of infection, bruising and bleeding.
Cancer in the spine can put pressure
on the spinal cord, leading to weakness,
numbness or paralysis in the legs, and
loss of bladder and bowel control.
Secondary bone cancers are
sometimes identiﬁed during tests
for the primary cancer before they
cause any symptoms. But often, the
ﬁrst symptoms people become aware
of are from the secondary bone
tumour, and then the primary
cancer is identiﬁed as a result.

HOW IS IT
D IAG N OSED ?

If your GP is concerned about your
symptoms, he will arrange for you to
have an X-ray. If anything abnormal
shows up, you'll be referred to an
orthopaedic specialist or oncologist
for further investigations.
This may include a bone scan,
where a small amount of radioactive
dye is injected into your vein and
monitored on a scan - abnormal
areas of bone show up as 'hot spots'.
MRI and CT scans are also used.
Your specialist may decide to take
a biopsy (a small tissue sample) from
the bone under local or general
anaesthetic. With a core needle
biopsy, a needle is inserted into
the bone to take the sample. Less
commonly, an open biopsy,
requiring an incision to remove
some bone tissue, may be needed.
The sample is sent to a lab to
determine the exact cells present.
Some bone cancers cause
abnormalities in the blood. For
example, osteosarcoma can lead to
an increase in the enzyme alkaline
phosphatase. A bone-marrow test is
sometimes needed to assess whether
blood-cell production is affected.

What about
surgery?
If you require surgery, your
orthopaedic surgeon will aim
to remove part or all of the
affected bone along with
a surrounding area of tissue.
If the cancer is in an arm
or leg, amputation may be
the only way to get rid of
it (this is the case for one in
seven patients). A prosthetic
limb may be fitted.
However, if possible, the
surgeon will try to save the
limb by removing only the
section of bone affected
and replacing it with a
metal implant or a piece
of healthy bone grafted
from elsewhere in the body.
Advances in surgical
techniques mean this 'limbsparing surgery' is becoming
more common. If the cancer
is in a joint, the surgeon
may be able to replace
it with an artificial one.
If cancer has caused the
spinal bones to collapse and
is causing pain, a special
'bone cement' can be
injected to fill areas that have
been destroyed to support
the bone and ease pain.

HOW IS IT TREATED?

Treatment depends on the type of
bone cancer, how far it's spread, the
patient's age and general health. Your
specialist will discuss with you what's
best for you and your quality of life.
The treatment for secondary bone
cancer depends on its primary
source. But treatment usually aims
to slow down its development and
control symptoms. This may include
hormone treatment, radiotherapy,
chemotherapy, biological therapy
(acting on processes in cells) and
surgery to strengthen bones (for
instance, inserting pins and rods).
Painkillers and blood transfusions
may also be involved.
Primary bone cancer treatments
include radiotherapy, chemotherapy
and surgery (see What About Surgery?
above). Survival rates vary, but many
people make a full recovery.

www.athomemagazine.co.uk MARCH 2015 | 81

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