1 Farrer Park Station Road #13-18 Farrer Park Medical Centre Singapore 217562

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Bone Cancer

Recognising the Potential Signs of Bone Tumours

Bone tumours occur when the cells within the bone divide uncontrollably and form a mass of abnormal tissue or lump. Most bone tumours are benign (not cancerous). Benign tumours are not life-threatening and will not spread to other parts of the body. Depending on the type, treatment interventions for benign bone tumours can range from simple observation to surgical removal.

Unfortunately, not all bone tumours are benign. Some bone tumours can be malignant or cancerous. Malignant bone tumours can cause the cancer cells to spread to other parts of the body (metastasise). Typically, the treatment approach for malignant bone tumours include a combination of radiation, chemotherapy, and surgery.

Bone tumours can develop in any part of the bone (from the surface to the bone marrow) and can affect any bone in the body. A growing bone tumour, even a benign one can weaken the bone and destroy healthy tissues, making it more prone to fractures. Malignant bone tumours are either primary or secondary bone cancer. Primary bone cancers originally begin in the bone while secondary bone cancers began somewhere else in the body and spread to the bone.

Cancer types that begin elsewhere that often spreads to the bone include:

  • Renal
  • Prostate
  • Lung
  • Breast
  • Thyroid

Benign Bone Tumors

While there are many types of benign bone tumours, there are also conditions and diseases that may resemble bone tumours. Although some of these conditions are not really classified as tumour of the bone, in most cases, they will require the same treatment. Some of the most common benign bone tumors and the conditions that resemble them include:

  • Giant cell tumour
  • Enchondroma
  • Non-ossifying fibroma
  • Unicameral (simple) bone cyst
  • Chondroblastoma
  • Fibrous dysplasia
  • Osteoid osteoma
  • Aneurysmal bone cyst
  • Osteoid osteoma

 

Symptoms

Oftentimes, people with bone tumour will experience pain in the affected area. In most cases, the pain is described as dull and aching. It also has the tendency to worsen at night and during activity. Other typical indicators include night sweats and fever.

While bone tumours are not attributed to trauma, an injury may cause a tumour to become painful. Injury may also cause a bone already weakened by the tumour to break. In some cases, benign tumours are discovered incidentally, when an X-ray is taken for another reason like knee injury or a sprained ankle.

Diagnosis

Stress fractures, infections, and other non-tumour conditions can closely resemble bone tumours. To ensure the diagnosis is accurate, a thorough evaluation and a number of tests may be ordered.

Medical History – patients will be asked about their current symptoms, their general health, and their complete medical history. Oftentimes, the doctor would also check if the patient or any member of the family has had a history of tumours or cancer.

Physical Examination – when conducting a thorough physical examination, the doctor will look for the following signs:

  • Tenderness or swelling (in the tumour area)
  • Changes in the overlying skin
  • Presence of mass
  • Effects the tumour might have on the joints that are nearby

Tests – X-rays are used to provide images of dense structures like the bone. In most cases, an X-ray will be ordered to help confirm the diagnosis. When further evaluation is necessary, the doctor may also order magnetic resonance imaging (MRI) or computed tomography (CT) scan.

Treatment

Nonsurgical Options

  • Benign Tumours – If benign, the doctor may just recommend a close monitoring of the tumour to check for any changes. In line with this, periodic X-rays, tests, and follow-ups may be required. Fortunately, some benign tumours will respond well to medication. Others may disappear over time as the case of osteoid osteoma.
  • Malignant Tumors – In the case of bone cancers, treatment is often provided by a team of doctors from different medical specialties (i.e. orthopaedic oncologist, radiologist, pathologist, medical oncologist, etc.). Generally, malignant tumours are treated using a combination of radiation therapy, chemotherapy, and surgery.

Surgical Treatment

  • Malignant Tumors – Limb salvage surgery – This procedure involves removal of the cancerous section of the bone while keeping the nearby tendons, nerves, blood vessels, and muscles intact where possible. However, the surgeon will remove the tumour as well as a portion of the healthy surrounding tissues. The bone excised will be replaced with a prosthesis (metallic implant) or bone taken from the patient’s own body or from a donor.
  • Benign Tumours – In some cases, excision (removal of the tumour) or other surgical techniques may be recommended to help minimize disability and fracture risk. However, some tumours may return, even with appropriate treatment. Fortunately, it is very rare that they become cancerous or metastasize.
  • Amputation – This procedure involves removal of all or a part of the affected extremity. It is considered the ideal treatment option when the tumour is large or when the blood vessels or nerves are involved. A prosthetic limb may be used to aid function after the procedure.

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