Bone Cancer Treatment in Delhi, India

Bone tumours develop when cells within the bone multiply uncontrollably, forming a lump or mass of abnormal tissue. Most bone tumours are benign and not life-threatening and, in most cases, do not spread to other parts of the body. Depending on the type of tumour, treatment options range from simple observation to surgery to remove the tumour.

Some bone tumours are malignant (cancerous). Malignant bone tumours can metastasize or cause cancer cells to spread throughout the body. In almost all cases, treatment for malignant tumours can involve a combination of chemotherapy, radiation, and surgery.

Symptoms of Bone Tumour

Bone tumours are usually asymptomatic unless they obstruct functioning. Sometimes, patients may experience dull pain in the tumour area, which worsens with activity. Other symptoms related to bone tumours include:

• Fevers
• Night sweats
• Swelling around a bone
• Limping
• Fatigue
• Weight loss

Types of Benign Bone Tumours

Osteochondromas

Osteochondroma is one of the most common types of benign bone tumour. It accounts for 30-40% of all benign bone tumours. Osteochondromas develop in adolescents and teenagers. These tumours form near the actively growing ends of long bones, such as the thigh bone, lower leg bone, and upper arm bone. These tumours are made of bone and cartilage. A child may develop single or multiple osteochondromas.

Non-ossifying fibroma unicameral

Non-ossifying fibroma unicameral is a solitary bone cyst and is the only true cyst of bone. It develops in the legs and most often affects adolescents and children.

Giant Cell Tumours

These tumours rarely occur and tend to grow aggressively. It commonly occurs in adults. They develop at the rounded ends of the bone and not in the growth plate. 

Enchondroma

Enchondroma is a cartilage cyst that grows inside the bone marrow. It begins in childhood and may persist even into adulthood.

Fibrous dysplasia

Fibrous dysplasia results from the mutation of a gene. It makes bones fibrous and vulnerable to fracture.

Aneurysmal bone cyst

It is an abnormality of blood vessels in the bone marrow. It can multiply rapidly and be particularly destructive because it affects growth plates.

Types of Malignant Bone Tumours

Osteosarcoma

Osteosarcoma usually develops around the shoulder, hip, or knee. It is the second most common type of bone cancer. This tumour multiplies and tends to spread to other parts of the body.

Ewing sarcoma family of tumours (ESFTs)

Ewing sarcoma family of tumours (ESFTs) strikes adolescents and young adults, but these tumours can also develop in children.

Chondrosarcoma

It commonly affects middle-aged and older adults. This type of bone cancer usually develops in the shoulders, hips, and pelvis.

Secondary bone cancer

The term "secondary bone cancer" means that cancer starts somewhere else in the body and then spreads to the bone—for example, multiple myeloma.

Causes of Bone Tumour

The cause of bone tumours is not known. They occur in areas of the bone that proliferate. Possible causes are:

• Genetic defects passed down through families
• Radiation
• Injury

In most cases, no specific cause is associated.

Diagnosis of Bone Tumour

Doctors start by inquiring about symptoms and medical history, after which a physical exam is performed. Various tests may be advised, and can include:

• X-rays: Bone cancers are best detected on X-rays as they appear as abnormal outgrowths of irregular shape and size.
• CT scans: A CT scan provides clear images of the tumours' size, shape, and position. It also helps identify the enlarged lymph nodes that may be cancerous.
• MRI scans: MRI scans help examine bone cancer by giving a detailed view of the structures and determining whether or not the cancer has metastasized.
• PET scans: This scan helps assess metastasis of throat cancer to lymph nodes. A technician injects radioactive glucose into the vein. A scanner then spots cancer cells, as they use more glucose than normal cells.
• Bone scans: A technician injects a radioactive material into the vein, where it collects in the bones, and the scanner can see it.
• Biopsy: Different types of biopsy methods can be employed to diagnose the presence of cancer cells. Some of them include:
• Endoscopic biopsy: An endoscope instrument is pushed into the nostrils or mouth. The endoscope consists of light and a video camera on one end, allowing the surgeon to see the biopsied area. It is hollow to allow the surgeon to pass instruments through it that helps remove a sample from an abnormal-looking site.
• Incisional biopsy: A small piece of suspected tissue and a part of normal tissue is taken from the suspected tissue in this procedure. Removing samples involves a complex process because the larynx is deep inside the neck. Biopsies of the larynx are performed in the operating room under general anaesthesia to prevent pain. 
• Fine Needle Aspiration Cytology (FNA): A very thin needle (attached to a syringe) is used to extract (aspirate) cells from a suspected tumour.
• Blood tests may be advised to look for two enzymes that may be signs of blood cancer.

Treatment of Bone Tumour

Firstly, the doctors assess all the symptoms and medical history and perform a physical check-up to diagnose tumours. After that, an appropriate treatment plan is formulated depending on the individual case. Bone tumours can be managed with both non-surgical and surgical treatment modalities. 

Non-surgical treatment

Benign Tumours

Benign tumours require close monitoring to see if they change in size, shape or colour. Regular follow-ups with the oncologist during this time are advised. Some tumours disappear with time, while others require medication. 

Malignant Tumours

Treatment of bone cancer requires a team of different medical specialities to provide care. The team of doctors would include a medical oncologist, orthopaedic oncologist, radiation oncologist and a pathologist. The treatment aims to cure cancer while maintaining the body's function affected by the tumour. 

The treatment of malignant tumours depends on numerous factors such as the stage of cancer, its size, and type. Cancer cells are confined to a specific area if the tumour is localized. But cancer can get more challenging to cure and recover from when it has metastasized.

Doctors prefer the use of combination therapy to treat malignant bone tumours, such as:

• Radiation therapy: High-dose X-rays kill tumour cells and shrink them. This only treats cancer in the area where the beam of X-rays falls and does not show any effect on other parts of the body.
• Chemotherapy: It is a systemic treatment employed to kill tumour cells that have metastasized to the bloodstream but have not been detected on tests and scans. It is generally used when cancerous tumours have a very high risk of metastasis. chemotherapy is usually administered intravenously or in a swallowed pill or capsule.
• Most commonly, malignant tumours are removed with surgery. Often, a combination of radiation therapy, surgery and chemotherapy is employed to cure cancer.

Surgical Treatment

Benign Tumours

Doctors often advise excision of the tumour or other surgical modalities to prevent the risk of fractures and disability. Tumours tend to recur repeatedly despite multiple surgeries. Rarely do certain benign tumours of the bone metastasize or become malignant.

Malignant Tumours

• Limb salvage surgery: This surgery removes the malignant part of the bone, leaving the surrounding blood vessels, muscles, tendons, and nerves intact where possible. The surgeon removes the tumour and a part of the healthy tissue around it. The removed bone is replaced with a metallic implant or prosthesis, an autologous bone (bone from other parts of the patient's body), or bone is taken from a donor.
• Amputation: Amputation is done to remove all or part of an arm or leg. It is usually used when a large tumour involves nerves and blood vessels. 

Complications of Bone Tumour

Problems that may arise from bone tumour or treatment of the bone tumour include:

• Pain
• Reduced function- depending on the location of the tumour
• Side effects of chemotherapy and radiation therapy
• Spread of cancer to other nearby tissues (metastasis)

Risk Factors of Bone Tumour

Risk factors that may cause the development of bone cancer are:

• History of cancer treatment: Bone tumours happen more often in people who have a history of radiation therapy, stem cell transplant, or have been on chemotherapy drugs for other forms of cancer.
• Inherited conditions: Patients suffering from diseases passed down through genes, such as Li-Fraumeni syndrome retinoblastoma, are more likely to develop bone cancer.
• Paget's disease of bone: This benign bone condition may also increase the odds of developing bone cancer.

Prognosis of Bone Tumour

How well the body responds to treatment depends on the bone tumour type. The treatment outcome is usually good in people with noncancerous or benign tumours. But some benign bone tumours can turn into cancer. People with cancerous bone tumours that have not metastasized have a better prognosis. The rate of recovery depends on the location of the tumour, type of cancer, size, and others. 

Review

Reviewed by Dr. Vivek Verma, Associate Director – Surgical Oncology (Musculoskeletal, Paediatrics)