BONE CANCER TREATMENT INFORMATION

General Information About Normal Bone

The bone is actually an organ system, meaning that it is made up of various tissues,
which are in turn made up of specific cells. The bone system functions at two levels,
one for structural support of the body (so we don't collapse) and one for the
manufacture of blood cells within the "marrow space of the bone. There are specific
cells that contribute to each of these two functions. In childhood the outer bone, called
the "cortex," is made up of soft cartilage, which in turn is laid down by cartilage-forming
cells called "chondroblasts." Gradually, as we mature, the cartilage is calcified into hard
bone by cells called gosteoblasts."

Initially, the calcium is laid down in a rather haphazard pattern, so the bone does not
have it's optimal strength. A secondary "restructuring" of bone occurs through puberty
and young adulthood, where the initial calcified bone is re-absoted cells called
"osteoclasts." The restructured bone is then laid down by osteoblasts in "Haversian
Canals" which are cylindrical, run along the long axis of the bone, and resemble cement
rods. These "canals" have a central blood vessel (bone is living tissue that needs blood
for survival).

There are two basic types of bone in the body: flat bone and long long. Flat bones
include those in the skull, vertebrae and ribs, while long bones are found in the
extremities. The central skeleton contains the flat bones, and is called the 'axial"
skeleton; the limbs contain the long bones which are called the "appendicular" skeleton.

While the outer shell, or "Otable" of each bone is the hard cortex, the inside of both flat
and long bones is made of up the soft "marrow." The marrow is basically little spicules of
bone with blood forming cells clinging to them, so it is very rich in blood. The marrow
contains "stem cells," which are the 'precursor (first) blood cells from which all others
arise. The cortex of the bone has nerves traveling through it, accounting for bone pain
when the bone is injured. When a bone fractures, it forms a hard "callous" around the
break, and amazingly this is even stronger than the bone before breakage!

A balance is kept between the free calcium in the blood and the calcium in bone by
hormones. If the blood calcium is too low, then some is reabsorbed from bone through
the action of "parathyroid hormone" (PTH), produced by small glands in the thyroid. If
the blood calcium is too high, it is deposited into bone by the hormone "Ocalcitonin,"
also from the thyroid. The laying down of calcium in bone also requires active vitamin D,
and a shortage of this during childhood results in "rickets." Vitamin D is converted from
its dietary to active form by sunlight, but only requires a very brief exposure. There is a
balance between phosphorus and calcium in the blood: when one goes up the other
goes down. People with kidney failure, on dialysis, have a difficult time clearing their
blood of phosphorus, and this results in calcium being leached out of bone. Too much
phosphoric acid in the diet, from soda-pop, can also weaken bone. In women, the
deposition of calcium into bone requires estrogen. calcium and exercise. and if lacking
these women tend to get "osteoporesis" (brittle bones) after menopause.

What is Bone Cancer?

Normally, the cells informing the bone cortex divide very rapidly from womb life through
puberty, and then slow down dramatically during adult life. The major growth occurs at
the ends of the long bones, called the "epiphysis": where initially new cartilage grows:
this is gradually calcified by osteoblasts into hard bone. If the "epiphyseal plate" is
damaged in childhood, by injury or medication, this will stunt that bone's growth. The
long shaft of a bone is called the "diaphysis', and the area between the epiphysis and
diaphysis is called the "metaphysis." These areas are important to know since particular
bone tumors have a predilection to arise in particular areas of the bone, as will be seen.
The cells inside the bone marrow, which form the blood cells, must continue to divide
very rapidly throughout life, since white blood cells may normally live as little as 10
hours. The types of cancer that arise from these are lymphomas, leukemias, and
myelomas, are are NOT considered primary bone cancer; they are different topics.

The control of new bone formation is by the "genes," sequences of DNA which are
themselves packed into larger chromosomes in each cell. If there is damage to the
genes. a given cell may start dividing out of control. Bone cancer starts in just one cell.
This cell starts dividing in a haphazard manner, eventually forming a clump called a
"tumor." A tumor simply means a swelling; it can be caused by infection or cancer or
injury.

If a tumor only grows in it's local area, and does not have the capacity to spread
distantly, it is called "benign" and is not cancer. If, however, a tumor has the capability to
spread distantly to other organs, it is called "malignant" and this is cancer. The actual
process of cancer spread is called "metastasis," and may occur to any place in the
body. Sometimes, a tumor in bone may start as benign, but further DNA damage can
cause it to become malignant; this process is called "malignant degeneration."

Cancer kills by anemia, infection and debility, and by spreading to and interfering with
the function of critical body areas, such as the lung and brain. Any cancer that is not
successfully treated will eventually lead to the patient's demise, but this may be a very
rapid (weeks) or very slow (many years) process. Also, for bone some tumors have a
varying degree of aggressiveness, and the same type of tumor (i.e. Giant Cell Tumor)
may range from indolent to aggressive in different patients. Thus, even true bone
cancers may be classed as merely "bone tumors," which doesn't say if it is a true cancer
or not. Ar, essential of the evaluation is to try to detemine how aggressive. or
"malignant," the tumor is.

It is important to note that this transcript discusses PRIMARY bone cancers, which
means those that arise in the cortex of the bone. Cancers originating in other areas may
have a strong predilection to spread to bone. such as prostate, lung and breast cancer.
The treatment for these when they have metastasized to bone is discussed under the
transcripts dealing with those particular cancers. Also, some cancers arise from cells
which normally live in bone, such as lymphomas, myelomas, plasmacytomas. and
leukemias from the blood cells within the bone marrow. These are also discussed in
their own transcripts, as they are not primary bone cancers.

How Common Is Bone Cancer?

There are about 500 new cases of primary bone cancer each year in the U.S.A, making
this a rare cancer. Bone cancers represent 3% of childhood cancers with about 200 new
cases per year. The majority of cases are in the second decade (during adolescence),
but there is a second peak in the 6th decade. About 3 per 100.000 people will ever
develop a primary bone cancer. In children under 10 years old, only 20% of bone
tumors are malignant. However, in adults malignant bone tumors are twice as common
as benign bone tumors. Recall that most malignant tumors found in bone have spread
there from another organ, and so are not primary bone cancer.

What are the Common Types of Bone Cancer?

If multiple myetoma is considered a primary bone tumor (even though it arises in the
marrow and not the cortex) then it represents 40% of bone tumors. Classically, the
major common types of bone cancer are "Chondrosarcoma" (arising from cartilage),
"Osteosarcoma" (arising from bone), "Fibrosarcoma" (arising from scar tissue),
"Liposarcoma" (arising from fat), "Ewing's Sarcoma" (from primitive cells) and the
increasingly popular "Malignant Fibrous Histiocytoma" (MFH) of disputed origin. Rare
types exist, like "Hemangiopericytoma" from blood vessels within the bone, "Malignant
Giant Cell Tumor," and "Adamantinoma" (from enamel in teeth).

It is important to note that sub-varieties of the above types exist, and there may be a
mixture of elements in a given tumor. Primary examples of this are
"osteochandrosarcoma" which is made of up both bone and cartilage, and
'fibrochondrosarcoma" made up of both fibrous tissue and cartilage. Another crucial
thing to know is that there has been a gradual "reclassification" of bone cancers, so that
MFH, which was once a rare diagnosis, is now the most common in many series! Also.
various pathologists (doctors who make diagnosis from tissue samples) may give
different diagnosis from examining the same bone tumor under the microscope! In fact.
there is as much as a 20% disagreement by even expert pathologists when classifying
biopsies (samples) of bone tumors from the same patient.

While most cancer in bone is from spread of other cancers there (such as lung or breast
cancer) certain patients get "primary bone cancer". This means the cancer actually
originates in the bone. Historically the treatment of these cancers was drastic
amputation of a limb or other major operation to remove the bone. Unfortunately,
patients often died anyway. However, newer research has shown more effective
treatment for bone cancers; patients today are often cured while keeping their limb.
It is crucial to be educated and make the proper treatment choices for bone cancer. This
can make the difference between keeping or loosing the limb, or life and death. It is
important to have the peace-of-mind of knowing you have done everything possible to
fight this cancer successfully.

Unfortunately, bone cancer is a very serious form of cancer.

CancerGroup.com materials explain, in plain English, the definition, types, frequency,

symptoms, evaluation, historical treatment and results, and latest effective treatments
and results for bone cancer. We describe surgery, radiation and chemotherapy and tell
you their results. We tell you everything you need to know to help you make the right
decisions today for a bone cancer problem.