Primary bone cancer, sarcoma, is cancer that starts in the bone, rather than starting in another part of the body and then spreading to the bone. The latter is known as secondary bone cancer. Unlike primary bone cancer, secondary bone cancer is common in cases of advanced cancer.

Bone pain is the most common symptom of primary bone cancer.

Primary bone cancer is a rare type of cancer that accounts for just one in every 500 cases of cancer in the UK each year. There are an estimated 500 cases every year. The cause of most cases of bone cancer is unknown. The four most common types of primary bone cancer are osteosarcoma, Ewing sarcoma, chondrosarcoma, and spindle cell sarcoma. These are explained below:

1.      Osteosarcoma

Osteosarcoma is the most common type of bone cancer, with an estimated 150 cases a year in the UK. Most cases of osteosarcoma develop in children and young people who are between 5-20 years of age, making it the third most common cancer in young people (after leukaemia and brain tumours).

Osteosarcoma usually develops in the larger bones, such as the thigh bone (femur) or the shin bone (tibia).

2.      Ewing sarcoma

Each year, in the UK, there are an estimated 100 cases of Ewing sarcoma. As with osteosarcoma, Ewing sarcoma usually develops in children and young people who are between 10-20 years of age, although 10% of cases develop in people who are over 20 years of age.

Ewing sarcoma usually develops in the pelvis, thigh bone, or shin bone.

3.      Chondrosarcoma

This type of bone cancer usually develops in adults who are between 40-50 years of age. Chondrosarcoma begins in the cartilage cells before spreading to the bone. Cartilage is a tough, flexible tissue that lines the surface of many bones and joints. The most common areas for chondrosarcoma to develop are:

1. pelvis,
2. thigh bone,
3. upper arm bone (humerus),
4. shoulder blade (scapula), and
5. ribs.

4.      Spindle cell sarcoma

There are an estimated 80 cases of spindle cell sarcoma every year. Spindle cell sarcoma is very similar to osterosarcoma in terms of its symptoms and treatment, except that it affects older adults who are aged 40 or over.

Other types of bone cancer

Rarer types of bone cancer include:

1. chordoma – which is a type of cancer that starts in the base of the spine and usually affects men between 40-50 years of age, and
2. angiosarcomas – which is a type of cancer than can start anywhere in the skeleton (sometimes in multiple sites at once) and usually affects adults who are 20 years of age or over.

The most important factor in determining the likely outlook for cases of bone cancer is whether the cancer has spread from the bone to other parts of the body (metastasis).

The most common places in the body for the cancer to spread to are the lungs, and secondary lung cancer can be challenging to treat.

If bone cancer is diagnosed before it spreads out of the bone(s), the outlook is moderate to good because a cure is often achievable. This type of cancer is known as localised bone cancer.

Health professionals use a general measurement of a five-year survival rate when describing cancer statistics. However, it should be stressed that the five-year measurement is, in many senses, an arbitrary measurement and it does not mean that people with bone cancer only have a five year life expectancy.

For cases of localised bone cancer:

1. between 55-70% of people with osteosarcoma will live for at least five years after receiving the diagnosis,
2. about 70% of people with Ewing sarcoma will live for at least five years after receiving the diagnosis,
3. about 80% of people with chondrosarcoma will live for at least five years after receiving the diagnosis, and
4. about 60% of people with spindle cell sarcoma will live for at least five years after receiving the diagnosis.

If the bone cancer has spread to other parts of the body, the outlook is not as favourable because a cure is often not possible. This type of bone cancer is known as metastatic bone cancer.

For cases of metastatic bone cancer:

1. about 30% of people with osteosarcoma will live for at least five years after receiving a diagnosis,
2. about 30% of people with Ewing sarcoma will live for at least five years after receiving a diagnosis,
3. between 10-30% of people with chondrosarcoma will live for at least five years after receiving a diagnosis, and
4. about 25% of people with spindle cell sarcoma will live for at least fiver years after receiving a diagnosis.

Bone cancer is usually treated with a combination of chemotherapy, radiotherapy, and surgery.

Symptoms of bone cancer

Bone pain is the most common symptom of bone cancer. It usually begins with a feeling of tenderness in the affected bone, and then gradually progresses to a persistent ache that often feels worse during the night and when using the affected bone.

In cases of Ewing sarcoma, bone pain is a symptom that usually increases in severity over a short space of time.

Bone pain that is caused by bone cancer is sometimes wrongly mistaken for arthritis in adults and growing pains in children and teenagers.

If you have bone cancer, you may also experience inflammation (swelling) or detect a noticeable lump on or around the affected bone. If the bone is near a joint, the swelling may make using the joint difficult.

Less common symptoms of bone cancer include:

1. high temperature (fever) of 38C (100.4F) or above,
2. unexplained weight loss, and
3. sweating.

If your child is experiencing persistent bone pain that lasts for more than three days, you should visit your doctor. Bone pain is unlikely to be the result of growing pains if it lasts longer than three days.

You should also visit your doctor if you are an adult and you experience persistent bone pain. While the majority of cases of bone pain are caused by arthritis, such a symptom requires a medical diagnosis. If you have arthritis, you will also benefit from having an early diagnosis.

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