Bone cancer: age, symptoms, treatment, life expectancy

We are talking about bone cancer to designate a tumor that starts in bone or cartilage cells (primary bone cancer) or a tumor in another organ that spreads to the bones (bone metastases). Primary bone cancers are rare diseases and represent 0.5 to 1% of new cancers each yearall locations combined, i.e. approximately 300 new cases per year, according to the Foundation for Medical Research. Bone metastases are more common. What are the first signs bone cancer? Symptoms such as pain? What are the causes ? Does bone cancer is serious ? Can bone cancer be cured? What life expectancy ?

What is the name of bone cancer?

So-called “primary” bone cancer is a quite serious cancer, one of the most common among children and adolescents, but rarer in adults. Depending on our age, we are more likely to have a type of cancer:

• Ewing’s tumor affects children more frequently,
• Chondrosarcoma, primary bone lymphoma And plasmacytomawhich are very rare, affect adults more.
• Osteosarcoma (most common)which accounts for 10% of sarcomas (but less than 0.5% of all cancers), can affect adults and children alike.

In practice, when we talk about bone cancer, usually refers to bone metastaseswhich affect 80% of bone cancers. “It is a migration of metastases from a primary cancer (mainly breast, lung, kidney, thyroid and prostate) who went to nest in the bones”, explains Dr. Audrey Monneur, medical oncologist at Institut Paoli Calmettes in Marseille. Metastases can thus affect all bones, even those of the skull, but localizations on the extremities of the limbs are rare.

What is the average age at diagnosis?

“For osteosarcoma, there are two frequency peaks: one around 20 years old, and another around 60 years old“, explains the oncologist. Primary bone tumors are common cancers in children. Finally, chondrosarcoma concerns people over 40 years old.

What are the chances of survival for bone cancer?

► For osteosarcoma, the 5-year survival for a localized cancer (that has not spread) is 70% without metastases. This means that 70% of patients are still alive 5 years after starting treatment. But if the cancer has developed metastases (stage 4 cancer), this figure drops to 30%.

► For Ewing’s sarcoma5-year survival is 50% when the tumor is still localized.

► Regarding metastasesit depends on the primary cancer: “We know that with metastatic breast cancer in the bones, we can live another 10 or 12 years with current progress, just like for prostate cancer, details the specialist. However, for lung cancer, this figure is lower”, she concludes.

What are the symptoms of bone cancer?

“Primary bone cancer mainly causes bone painbut can also cause pathological fractures on a bone damaged by the tumor and, sometimes, a painful swelling“, details the specialist. During bone metastases, the symptoms are also pain and sometimes pathological fractures, “but also hypercalcemia (i.e. an increase in calcium levels) or even metastatic spinal cord compression on an arterywhich may compress the spinal cord and lead to paralysis of the lower limbs , she explains. It is during a check-up carried out after the discovery of a primary cancer that it is detected before the appearance of bone pain.

What are the causes of bone cancer?

In most cases, the cause of bone cancer is not known. Some factors could increase the risk:In some people, exposure to radiation during treatment with radiotherapy For example”, says the specialist. The presence of an underlying bone pathology, such as Paget’s disease, or genetic factors, such as Li-Fraumeni syndrome (lack of a gene to fight against the development of cancer) could also play a role.

“To begin with, when there is bone pain, we make a radio to detect the problem. Then, some anomalies on the radio require to do MRI and CT scan. Then, when there are bone lesions, it is necessary to differentiate whether it is a metastasis or a primary tumor”, explains the oncologist. If it is metastases, then the specialists must seek where the original primary tumor comes from, via a scanner. “We also do bone scans to see if other bones are affected”, adds Audrey Monneur. If it is a primary bone tumor (in less than 20% of cases), “we do an MRI of the area and a CT scan as part of the extension workup, to see if there are no other tumors elsewhere. Sometimes, we also need a scintigraphy or biopsies (tissue removal) from the marrow, as the case may be”. In the case of sarcomas, the operation is delicate, and there are fairly strict rules.

For primary tumours, “we practice first chemotherapy neoadjuvant. It is used to reduce tumor volume and prevent the risk of metastases, explains the oncologist. Afterwards, an operation is performed to remove the tumour, and we check the response rate at chemotherapy – that is to say the number of viable cells or not”, she details. Depending on this rate, professionals will decide to practice post-operative chemotherapy more or less important. Radiation therapy may also be applied, depending on the type of sarcoma. It is generally used for Ewing’s sarcoma.

In the case of metastases, “Each treatment depends on the primary cancer. If there is bone pain, radiation therapy may be applied“. In addition to the initial treatment, there is often radiation therapy, combined with chemotherapy or hormone therapy. Interventional radiology can also be effective depending on the case, just like radiofrequency or cementoplasty : “This consists of injecting cement into the vertebra broken by the tumor, to fight against pain”, explains the oncologist. To prevent fractures, bisphosphonates can be useful: it is an anti-bone redemption treatment.

Thanks to Dr Audrey Monneur, medical oncologist at Institut Paoli Calmettes in Marseille.