Bone Cancer

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Questions to Ask Your Doctor About Your Cancer
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Treatment

Treatment for bone cancer depends on the stage and location of the disease, and on the patient's age and general health. Treatment may include surgery, chemotherapy, and radiation therapy, and in many cases, a combination of treatments is used.

Biologic therapy, also called biotherapy or immunotherapy, which may help to restore the body's natural defenses against cancer, is being studied as a possible treatment for localized primary bone cancer.

Surgery
Patients who have localized bone cancer are treated surgically whenever possible. In some cases, the surgeon is able to remove just the tumor and some surrounding healthy tissue (called limb-sparing surgery), but in other cases, the entire limb or part of the limb must be removed (called amputation). If bone cancer has spread to the lymph nodes, a lymph node dissection also is performed.

In some cases following surgery to treat bone cancer, an artificial device or a bone from another area of the body may be used to replace bone tissue that was removed. This procedure is called reconstructive surgery.

Chemotherapy
Chemotherapy is a systemic treatment (i.e., travels throughout the body via the bloodstream) that uses drugs to destroy cancer cells. Some chemotherapy drugs are administered orally (in pill form) and others are administered through a needle into a vein (intravenous) or injected into muscle. In many cases, more than one drug is used (called combination chemotherapy).

To treat bone cancer, chemotherapy is often used following surgery to destroy cancer cells that may remain after removal of the tumor (called adjuvant treatment). In some cases, chemotherapy is administered prior to surgery in order to shrink the tumor (called neoadjuvant treatment).

Chemotherapy drugs commonly used to treat bone cancer include the following:

• Actinomycin-D (e.g., Dactinomycin®, Cosmegen®)
• Cisplatin (e.g., Platinol®)
• Cyclophosphamide (e.g., Neosar®)
• Doxorubicin (e.g., Adriamycin®, Doxil®)
• Etoposide (e.g., VP-16, Toposar®, Vepesid®)
• Gemcitabine (e.g., Gemzar®)
• Ifosfamide (e.g., Ifex®)
• Methotrexate (e.g., Trexall®, Methotrex®)
• Vinblastine (e.g., Velban®)
• Vincristine (e.g., Oncovin®, Vincasar®)

For some types of bone cancer (e.g., Ewing's tumor) an intense regime of chemotherapy (called myeloablative treatment) with stem cell support may be used. In this treatment, chemotherapy drugs are used to destroy rapidly dividing cells throughout the body (e.g., cancer cells, certain blood cells) and the patient receives supplemental stem cells (cells found in bone marrow and lymphatic tissue that create other types of blood cells).

Chemotherapy may cause a number of serious side effects, including the following:

• Anemia (reduced red blood cell count)
• Fever
• Hair loss
• Infection
• Nausea and vomiting
• Reduced blood cell counts (e.g., leukopenia, thrombocytopenia)
• Sterility

Radiation Therapy
Radiation therapy uses high-energy x-rays to destroy cancer cells. To treat bone cancer, a machine outside the body is used to direct this energy to the treatment area (called external radiation). Side effects of radiation include fatigue and changes to the skin (e.g., redness, irritation).

Prognosis and Stages

The prognosis for patients who have primary bone cancer varies, depending on the type and stage of the cancer. The American Joint Commission on Cancer (AJCC) system is used to stage bone cancer.

Using the AJCC Staging System, T stands for the size of the tumor, N stands for lymph node involvement, M stands for spread (metastasis) to distant organs, and G stands for the tumor grade. The grade of the tumor (i.e., how abnormal the cells appear under microscopic evaluation) can be used to help determine how quickly the tumor is likely to grow and spread. This information is then combined and a stage (e.g., 1–4 or I–IV) is assigned to the cancer.

T Stages

• T0: No evidence of the tumor
• T1: Tumor is 8 cm (3 inches) or less
• T2: Tumor is larger than 8 cm
• T3: Tumor cells detected at another site(s) on the same bone

N Stages

• N0: No spread to nearby (regional) lymph nodes
• N1: Cancer detected in nearby lymph nodes

M Stages

• M0: No distant metastasis
• M1: Distant metastasis (cancer has spread to other tissues or organs)
  • M1a: Cancer has spread only to the lung
  • M1b: Cancer has spread to other sites

  Grades

  • G1-G2: Low grade
  • G3-G4: High grade

TNM Staging

Stage IA: T1, N0, M0, G1-G2: Tumor is confined to the bone, less than 8 cm in size, and is low grade.

Stage IB: T2, N0, M0, G1-G2: Tumor is confined to the bone, larger than 8 cm, and is low grade.

Stage IIA: T1, N0, M0, G3-G4: Tumor is confined to the bone, less than 8 cm, and is high grade.

Stage IIB: T2, N0, M0, G3-G4: Tumor is confined to the bone, larger than 8 cm, and is high grade.

Stage III: T3, N0, M0, Any G: Tumor is confined to the bone but tumor cells are detected at other sites on the bone.

Stage IVA: Any T, N0, M1a, Any G: Tumor has spread to the lung.

Stage IVB: Any T, N1, Any M, Any G: Tumor has spread to lymph nodes and distant sites, or Any T, Any N, M1b, Any G: Tumor has spread to distant sites other than the lung.

Stage 1 (I) tumors present the best prognosis and Stage 4 (IV) tumors present the worst prognosis.

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