Bone Cancers Explained by Dr Satish Reddy

Dr G Satish Reddy is Head of Ortho-oncology, Aster Prime Hospital, Hyderabad.

We requested Dr Satish to answer FAQs on bone cancer to help caregivers and cancer patients understand their condition better. 

Q1: What is the difference between bone cancer and bone metastasis?

Bone cancer originates in the bones, while metastasis signifies that the cancer has spread from another organ. In the advanced stages, cancer tends to spread from the original site to other organs in the body. 

For example, if cancer that originated in the bones, spreads to the lungs, it is called lung metastasis. 

Q2: What are the most common symptoms of bone cancer?

There are two age groups among whom bone cancer is common. First is between the ages 10 – 20 years of age, and the second is between the ages 55 -60 years. 

Common symptoms include pain, swelling and a fracture from a trivial trauma. For example, a child might fracture his hand while throwing a ball. That is trivial trauma. On investigation, we find that the child had been experiencing pain in that bone even prior to the fracture, the fracture merely draws his attention to a pre-existing pain. 

Q3: How are bone cancers diagnosed and treated?

An x-ray gives us a good idea of the situation we are dealing with. We then ask for a technetium 99 bone scan, to check other parts of the skeleton and the chest. An MRI scan can show us if there is soft tissue spread and if there are multiple lesions on the same bone. Nowadays, a PET scan gives us 95 -96% idea of what we are dealing with. 

A biopsy is the most important part of the diagnosis. It needs to be conducted by the same surgeon who will conduct the final treatment. This is because we need to plan the incision for the final treatment and it needs to be in line with the biopsy. 

A tissue diagnosis from the biopsy gives us a clear idea of the problem at hand. This helps us decide the treatment to be followed. 

The commonest treatment protocols available for us are chemotherapy, radiation therapy and surgery. Most often we give chemotherapy for a period of time, conduct a surgery to remove the tumour and then continue with chemotherapy after that. 

Q4. What does ‘limb saving surgery’ mean? 

Today, we are able to remove a tumour without any spillage of cells. We then reconstruct the gap which is left behind. If the gap is in the muscle, we perform a muscle transfer. If it is in a bone, we use artificial prosthetics.

In the past, the limb would be amputated. We don’t have to do that now. We are able to remove the tumour and then replace or reconstruct the limb in the original manner. This is called limb sparing or limb saving surgery.

Q5. Can someone who has gone through bone cancer treatment continue to have normal limb functions?

We cannot say it is completely normal as there are limitations with an artificial joint. But the person will be able to perform all daily activities like walking, working etc. Most people would not be able to notice that there is anything unusual with this person. 

Q6. Ewing’s tumour is a rare type of cancer among adults. Tell us a bit about it. 

Ewing’s sarcoma is a rare type of cancer among Asian and African population. It is more common among caucasian population. 

The cause of Ewing’s sarcoma is not known, but there are indications that it is due to genetic mutations. 

It is treated with chemotherapy, followed by limb sparing surgery and then further chemotherapy.

Q7. What does a patient who has bone cancer need to know about life after treatment?

The rehabilitation period for bone tumours is a little longer when compared to other surgeries. Usually, we rest the limb for the first ten to twelve days after surgery as there will be risk of bleeding.

Once the trauma settles, we begin exercises to improve the mobility of the limb. It might take about three months before the patient can walk comfortably. 

Q8. Is there any way to prevent bone cancer?

No, because we don’t know the exact cause of bone cancers. This is being researched and in the future we will have a better understanding of the causes.