[National Cancer Prevention and Treatment Week] Can bones also develop cancer? Learn about the "low-key" bone tumor

What? Bones can also develop cancer! Yes, you heard it right! Many people habitually think that bones are very hard, like stones, and that they must be barren and cancer-free. In fact, this is not true. "Bone cancer" should be strictly called "bone tumor". In fact, it is not uncommon, but it is not as familiar as lung cancer and intestinal cancer. Therefore, bone tumors are truly "strange but common" and "relatively low-key" tumors.

Definition and classification of bone tumors

Bone tumors are tumors that originate from various bone tissue components, or are tumors that are metastatic to bones from malignant tumors in other parts of the body. Therefore, bone tumors can be divided into two categories: primary and secondary. The former originates from bones and their accessory tissues, while the latter is caused by malignant tumors in other parts of the body metastasized to bones through the bloodstream.

Primary bone tumors account for about 2%-3% of all tumors, and most of them are benign. We call them "tumors", such as osteoid osteoma, osteochondroma, enchondroma, etc. True primary bone malignancies are rare, such as osteosarcoma and Ewing's sarcoma, especially in adolescents. The incidence rate is slightly higher in males than in females. They often occur in the epiphysis of long bones such as the distal femur, proximal tibia and humerus. They are common tumors that cause disability and death in adolescents (Figure 1: Osteosarcoma at the upper end of the left tibia). The cause of primary bone tumors is still not very clear. It may be related to ionizing radiation, trauma, genetic factors, etc., and further research is needed.

Secondary bone tumors, also called metastatic bone tumors or bone metastases, are bone metastases of other malignant tumors, and almost all of them are malignant. About half of cancer patients will have bone metastases, especially common tumors such as breast cancer, lung cancer, prostate cancer, kidney cancer, liver cancer, and thyroid cancer. Therefore, metastatic bone tumors are far more common than primary bone tumors in clinical practice. Some cancer patients even seek medical treatment with bone metastasis as the first symptom (Figure 2: Pathological fracture of left femoral shaft metastasis due to breast cancer). In this case, the patient is in the late stage and the prognosis is very poor. Therefore, the harm of bone tumors is still very serious.

Early diagnosis and treatment of bone tumors

So how can we achieve early diagnosis and treatment of bone tumors?

Here is a special reminder: if you find the following signs of bone tumors, you should go to the hospital in time and seek help from professional doctors:

① Children or adolescents develop lumps in bones or bone joints accompanied by swelling and pain. The lumps do not subside at rest and gradually grow larger, accompanied by fever, weight loss, increased skin temperature at the swollen site, and distended superficial veins. The pain worsens at night, and the severity of the pain is unrelated to activity;

② Unexplained persistent back pain or pain in the spinal region that cannot be relieved by rest and is difficult to explain with common cervical spondylosis or lumbar spondylosis;

③ Limited joint movement and dysfunction, numbness or intractable radiating pain in the distal limbs, limb weakness, or accompanied by convulsions, muscle spasms, etc.;

④ Pathological fractures or limb deformities, or even spontaneous fractures without obvious causes;

⑤ When middle-aged and elderly people experience unexplained back pain and limb pain that progressively worsens, they should be alert to the possibility of metastatic bone tumors, especially those with a history of malignant tumors.

Regarding the treatment of bone tumors, it is necessary to distinguish between primary and secondary. Secondary bone tumors need to refer to the treatment plan of their primary tumors for targeted systemic treatment, combined with local radiotherapy and bone regulator therapy to relieve pain, reduce the risk of bone-related events, and improve the quality of life. The treatment of primary bone tumors relies more on surgery-based comprehensive treatment, especially the comprehensive treatment model based on preoperative neoadjuvant chemotherapy-surgery-postoperative adjuvant chemotherapy. About 70% of osteosarcoma patients can achieve limb preservation, and 60%-70% of patients can survive for a long time.

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Author: Wang Xi, Tumor Diagnosis and Treatment Center, 903 Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army

Source: Zhejiang Anti-Cancer Association