BENGALURU: Bone cancer (Sarcoma) is rare in adults (nearly two per cent of all cancers), but accounts for 20 per cent of all solid cancers in children. Bone cancers are known for their aggressive nature, often destroying the limb and spreading to other organs. Hence, it is important to identify these cancers early to prevent loss of limb and life. Several factors like socioeconomic environment, poor dietary habits, genetic factors, exposure to radiation have been proposed as the cause but are not conclusive.
Limbs are commonly involved, whereas spine, pelvis and other flat bones in the body have less predilection. A high index of suspicion is required when an individual has the following symptoms or signs: Bone pain that worsens at night or during rest, lumps that are more than the size of a lemon and growing rapidly, a fracture due to a fall or injury or paralysis, weakness, decrease appetite or loss of weight (advanced cases).
These are the types of bone cancer: Osteosarcoma (most common), Ewing’s Sarcoma, Chondrosarcoma and Adamantinoma are different types with specific behaviour and progress. It is important to identify the different types to provide appropriate treatment at the earliest. Tests to identify include: X ray (Plain Radiograph), relevant blood tests, MRI and/or CT scan, biopsy and staging by whole body scan (bone scan or PET CT).
Individuals with bone cancers have several treatment choices depending on the type of cancer/sarcoma and extent of the disease. They require a combination of chemotherapy, surgery and/or radiotherapy as per diagnosis. Amputation is not the only treatment option available currently. More than 90 per cent of bone cancers can be treated by Limb Saving Surgery.
What is limb saving surgery?
The goal of any limb saving surgery is to completely remove the tumour while preserving and maximising extremity mobility. It is possible to provide a customised limb saving surgery plan based on age, bone maturity, type of bone involved and functional demands of the individual, so that they can not only save their limb but use it well too. Different types of limb saving surgeries are as follows: Tumour Megaprosthesis, Custom Made Prosthesis Compos i te Recons t ruct ion, Biological Reconstruction (Use of Recycled Tumour Graft OR Bone Bank Allograft), Paediatric (Growing Tumour prosthesis), Pelvic, Sacrum and Spinal Tumour Surgeries.
About soft tissue (cancer) sarcoma
These are heterogeneous groups of sarcomas arising from mesenchymal cells of the body (other than the bone and cartilage). They are divided and named based on tissue or cell of origin. Due to advancements in molecular genetics and cellular differentiation soft tissue sarcomas are being reclassified regularly based on immunohistochemistry.
Soft Tissue Sarcoma (STS) can develop from cells of mesenchymal origin such as fat, muscle, nerves, fibrous tissues, and blood vessels. They can arise in any part of the body, but have a tendency to develop in extremities (nearly 60 per cent). Other sites are trunk, head and neck area, internal organs, retroperitoneal cavity. Currently, most STS are believed to arise spontaneously without any specific cause. Few risk factors postulated are as follows: Radiation exposure, exposure to certain toxic chemicals, lymphedema and hereditary cancer syndromes .
An individual with suspected STS presents with a painless lump which has grown over a period of weeks to months. Rarely, if lesions are superficial the skin may break down leading to ulcers and fungation. Pain is an uncommon presentation. Loss of weight or appetite are seen in advanced cases. Any lump more than 5 cm (size of a golf ball), growing lately or found deep to skin should be evaluated The main treatment options include: Surgical removal, radiation therapy, and chemotherapy.
(The author is Consultant - Orthopaedic Onco Surgery, Manipal Hospitals, and Old Airport Road)