Treating bone sarcomas

Not all bone cancers are sarcomas. Where a cancer has spread from another primary location (eg breast or prostate cancer) this is a secondary cancer. The primary bone cancers are sarcomas.

The most common bone sarcoma is osteosarcoma. The highest incidence is among the young and the very old. Children, teenagers and young adults are more likely to be diagnosed as a result of a strange pain or a bony lump, while with more elderly people it can be a result of Paget's disease or other complications of age and only diagnosed following a fall or fracture.

The next most common primary bone cancer is Ewing's sarcoma - a family of tumours named after the doctor who first identified them as a separate cancer. The majority of Ewing's patients are in their teens.

Among adults two further bone cancers are occasionally found. Malignant fibrous histiocytoma (MFH) is a cancer of fibrous tissue. Chondrosarcoma is a cancer with its origin in cartilage.

As with most solid tumour cancers the initial aim is to remove the tumour completely and to ensure that the patient is disease free. The approach with all these cancers differs. Ewings tumours respond to radiotherapy and the treatment may consist of a combination of surgery, radio and chemotherapy according to the extent and location of the disease. Osteosarcoma and MFH will usually be treated with a course of high dose chemotherapy prior to surgery, followed by further chemotherapy after surgery.  Chondrosarcoma does not respond well to chemotherapy so surgery will usually be the principle option.

Most bone sarcomas in younger people affect the leg while in adults there are more varied sites. Because of the difficulty of removing or replacing diseased bones surgery can be quite radical and disabling.

Although not as common as some years ago amputation of a diseased limb is an option which the consultant may discuss with the patient and their family. There is a lot to consider and the specialist orthopaedic surgeons who treat bone cancer are very experienced in discussing the issues and the options. Limb salvage surgery with the insertion of a replacement artificial bone is sometimes a practical option and there are also other techniques.