Advances in bone cancer treatment

When a patient is diagnosed with bone cancer, it is common for them to feel fear and uncertainty. Currently, there are specific treatments for each type of cancer, which will ensure that the patient has a good quality of life and a longer life expectancy.

What is bone cancer and what are its causes?

Bone cancer is cancer that develops in bone cells. These begin to spread without control. Usually, it presents as a secondary cancer, that is, as a metastasis of another cancer existing in the same patient.

The causes of bone cancer are sometimes related to hereditary genetic alterations. In addition, there are certain hereditary diseases, whose patients are prone to developing bone cancer over time, for example, Rothmund-Thomson Syndrome.

Prolonged exposure to ionizing radiation or pathologies such as Paget's Disease are also factors that could trigger bone cancer.

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In some cases, the development of a benign bone tumor could also be related to the development of bone cancer.

Primary bone cancer vs bone metastases: what's the difference

When discussing bone cancer, it is common to talk about bone metastases, that is, a cancer that started in another organ and ended up spreading to the bone.

Primary bone cancer originates within the bone tissue itself, such as osteosarcoma, Ewing sarcoma, or chondrosarcoma. Differentiating between them is crucial, as the treatment approach and follow-up will vary depending on the case.

• Primary: originates in the bone and is classified by the type of tumor.
• Metastasis: the tumor started in another part of the body and affects the bone as an extension phase.

The treatment plan may vary depending on whether it involves local control, such as surgery, or systemic treatment of the primary tumor. The goal is to maintain function, reduce pain, and prevent complications.

What are the types of bone cancer

In cases of primary bone cancer, the most common types are three:

• Osteosarcoma, it is a malignant bone tumor, is the most common and usually appears in the bones of the arms and legs. It originates in the cells responsible for the generation of new bone. It is common in young people.
• ChondrosarcomaIn this case the tumor originates in the cartilage of the bone, and is usually located in the pelvis or ribs. It usually occurs in people over 40 years of age.
• Ewing sarcoma, is caused by the fusion of two gene zones and its cells are round. Patients are usually under 20 years old.

Symptoms of bone cancer

Bone cancer can be very limiting for the patient, as it causes acute pain and limited mobility. One of the symptoms is the existence of intense localized pain, which may appear accompanied by inflammation or a lump.

In addition, the patient usually feels general fatigue constantly and, in some cases, may experience weight loss for no apparent reason.

Warning signs: when to seek medical advice as soon as possible

Bone pain can have many causes, but there are situations that are warning signs that you shouldn't wait. If the pain is persistent, worsens over several days, or appears alongside other symptoms, the wisest course of action is to seek medical attention to determine the cause and act as soon as possible if necessary.
The warning signs are:

• Persistent bone pain that worsens and does not improve with rest or usual painkillers.
• Nighttime pain that causes waking up or persists even at rest.
• Lump, swelling or increase in volume in a specific area of the body.
• Fracture following a minimal blow or sudden intense pain that causes functional disability.

If the pain is in the spine and weakness, tingling or loss of strength appears, a priority assessment is necessary and urgent.

How bone cancer is diagnosed

The most effective test for detecting bone cancer is MRI., since it provides images with detailed information. This test is usually done after a physical examination and x-ray.

Usually, once the tumor has been detected, a biopsy of the tumor tissue is performed, which provides more precise information.

To determine the degree of spread of bone cancer, two main tests are performed: bone gramgraphy, which allows us to determine the existence of metastases throughout the body, and CT, which detects lung metastases.

It is essential to carry out a study of the patient's general condition to provide the most appropriate treatment.

Tests to diagnose and assess the extent: what each one contributes

The diagnosis of bone cancer combines various imaging tests with clinical evaluation. No single test can determine the origin of all the variables, but several studies can be performed to confirm the tumor, define its size, and check for spread to other areas.
The tests that can be performed for diagnosis are:

• X-ray: This is generally the first study and can show typical changes in the bone.
• Magnetic resonance imaging: This is the test that best defines the tumor and its relationship to nearby tissues.
• CT scan: A study that complements and provides detailed information, helping to detect the extent of the disease in specific locations.
• Bone scintigraphy or PET-CT: These are used to assess the involvement of other bones or the extent of the disease, depending on the case.

Biopsy: A technique that confirms the diagnosis and precisely defines the type of tumor.

Treatments for bone cancer

Treatment for bone cancer must be multidisciplinary, that is, professionals from different specialties must participate in its preparation, such as: traumatologists, orthopedic surgeons, hematologists and oncologists.

Depending on the characteristics of the tumor, the treatment will vary, since not all of them have the same characteristics, nor do they have the same resistance to certain treatments.

Treatment goals: to relieve symptoms and prevent complications

In addition to treating the tumor, it is crucial to work on reducing its impact on daily life. In bone tumors, treatment focuses on controlling pain, preserving the patient's mobility, and preventing complications such as fractures or other related problems.
The goals of treatment are:

• Preserve the patient's functionality and autonomy during treatment.
• Reduce pain by controlling inflammation or limiting movement.
• Prevent fractures when the bone is weakened.
• If it involves the spine, watch for signs of compression or neurological involvement.

Adjust the monitoring to detect possible responses to treatment or possible relapses.

Osteosarcoma Treatment

To treat osteosarcoma, the most appropriate treatment is chemotherapy: neoadjuvant, which will be applied before surgery and will allow knowing the percentage of tumor necrosis, and adjuvant, after the intervention.

In this case, surgery can be performed to completely remove the tumor. To do this, certain factors must be taken into account. Firstly, the location of the tumor and its relationship with nerves and blood vessels. The age of the patient is also important, since in young patients cancer cells can continue to grow after the intervention.

In this type of tumors, radiotherapy is not effective, since they are resistant to it. Only palliative radiotherapy is applied to dry tumors located in the head or spine.

Therefore, in osteosarcoma patients, the most effective treatment with the best long-term results is chemotherapy.

Ewing sarcoma treatment

Ewing sarcoma requires multidisciplinary treatment, that is, approached from different disciplines.

First, adjuvant chemotherapy is usually applied, with the aim of reducing the size of the tumor and destroying cancer cells that may have spread.

In this type of tumors, radiotherapy is also applied, since they are radiosensitive. It is usually applied in combination with surgery. The risk that this treatment presents in young patients is that it can affect bone growth.

Tumor removal surgery can also be performed, which will be combined with neoadjuvant or adjuvant treatments.

Chondrosarcoma Treatment

In the case of chondrosarcoma, surgery is the most effective treatment today. Sometimes, it requires amputation of the affected area, although currently, surgeries with bone grafts are being performed, which have good results.

This tumor is very resistant to chemotherapy and radiotherapy treatments. The latter is only applied in cases where a very high dose is needed, because the tumor could not be controlled during surgery.

In the treatment of chondrosarcoma, new treatments are being used. One of them is proton therapy, which is a proton beam radiotherapy that, thanks to its precision, protects healthy tissue without exposing it to radiation.

What to expect after surgery, chemotherapy, or radiation therapy

After bone cancer treatment, recovery is usually gradual and requires close monitoring by the medical team. Following surgery, it is normal to experience pain, swelling, and limited movement, which may improve with specific physical therapy. Patients undergoing chemotherapy may experience significant fatigue, nausea, and even hair loss—all common side effects that are typically managed with medication and complementary care. In cases of cancer treated with radiation therapy, it is normal to experience tenderness or redness in the irradiated area. Most patients regain their functionality after a period of time and can resume their activities, but they should be aware that they need regular checkups to detect any potential relapses.

What increases the risk of developing bone cancer

There are several factors that can increase the risk of developing bone cancer, starting with hereditary genetic factors, a family history of syndromes that alter bone formation, or cell mutations that incite uncontrolled growth.

Prolonged exposure to ionizing radiation, prior radiotherapy treatments, or bone pathologies such as Paget's disease are additional factors that could affect bone health, as they alter bone structure. It is also possible for certain benign bone tumors to progress and become malignant over time, especially if they are not properly monitored. Understanding these factors is crucial for the specialist in charge to establish regular checkups and thus be able to act early on any symptoms.

How can the prognosis be determined in bone cancer?

The prognosis for bone cancer is determined by several factors, including the size of the tumor, its location, the type of malignant cells present, and the presence of metastasis in other organs.

The patient's age and overall health also play a role, as they modify the response to chemotherapy or surgery. Furthermore, tumor aggressiveness can be assessed through histological studies and imaging tests. The tumor's initial response to treatment is also important because it provides key information about its expected progression. By compiling all this data, the medical team can estimate survival and adjust treatment to plan a therapeutic strategy that yields the best possible results.

Tips for dealing with bone cancer

After the diagnosis of bone cancer, the patient feels fear and uncertainty about the near future. Furthermore, misinformation is common. That's why, It is important to keep certain guidelines in mind to make this complicated situation more bearable:

• It is important to seek a second opinion after the initial diagnosis. In this way, you will be able to have another point of view and have more information about the pathology.
• Consult with a traumatologist all doubts and concerns about bone tumors. It is common for the patient to have no information about the disease they suffer from and need to resolve their doubts. In this way, you will also gain greater confidence in yourself and in the professional handling your case.
• Inform the specialist of any changes, pain or side effects experienced.
• Request psychological help if symptoms of anxiety or depression arise. The patient's good mood is essential in their recovery.
• Contact people who have suffered from the same disease. Knowing other testimonies will help the patient gain confidence. As well as, seek support from patient associations.

In the case of bone cancer, early detection is important for the application of appropriate treatment that has fewer side effects on the patient's quality of life. Therefore, it is essential to follow certain guidelines when symptoms appear.