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Confronting bone cancer

Bone cancer can begin in any type of bone tissue, although it is uncommon. This year, 2,890 new cases of bone cancer will be diagnosed and 1,410 people will die from the disease, estimates the American Cancer Society.

Types
The National Cancer Institute explains that there are three common kinds of bone cancer: osteosarcoma, Ewing's sarcoma and chondrosarcoma.

Osteosarcoma predominantly afflicts the young and starts in the bone's osteoid tissue. It frequently appears in the upper arm or knee.

The Ewing's Sarcoma Family of Tumors (ESFTs) also commonly affect younger people. It typically arises in soft tissue: muscle, blood vessels, fat or fibrous tissue. Scientists argue that it forms in primitive nerve tissue. It is common in the arms, legs, backbone and pelvis.

Patrick Leavey, associate professor of pediatrics at UT Southwestern, explained that ESFTs' most "clinically relevant difference from osteosarcoma includes its sensitivity to radiation therapy if it occurs in a part of the body not amenable to surgical removal."

Chondrosarcoma predominantly afflicts the elderly and starts in the cartilage pads on the ends of bones. These are known as cartilaginous tissue. This often appears in the pelvis, upper leg and shoulder.

Causes
Like other cancers, bone cancer begins when an error in the cell's DNA instructs it to multiply at an uncontrolled rate. These abnormal cells amass into a tumor. This tumor can then metastasize, invading surrounding tissue and corrupting previously healthy body parts.

Osteosarcoma is reportedly more common in people who have taken anticancer drugs or undergone high-dose external radiation therapy.

According to the Mayo Clinic, certain genetic syndromes (Li-Fraumeni syndrome and hereditary retinoblastoma) increase your risk of developing bone cancer. Paget's disease of the bone also increases the risk for older people.

Symptom
The most common symptom is pain. Depending on the size and location of the tumor, warning signs may vary.

Cancer Research UK reports that swelling and movement problems are other common warning signs. The tumor's surrounding area, in particular, will feel tender and hurt. Fatigue, fever, unexplained weight loss, profuse sweating and pathological fracture (a bone broken due to extreme weakness) are less common signs.

Diagnosis
If bone cancer is suspected, doctors will perform a thorough medical examination, including laboratory tests, imaging tests and a biopsy.

Memorial Sloan-Kettering Cancer Center reports that when bone-forming cells are exceptionally active, the alkaline phosphatase enzyme will appear at high levels in a patient's blood. Laboratory tests can detect the extent of the enzyme's presence in the blood. This occurs when a child is growing or a broken bone is recuperating. But it also occurs when a tumor is causing the growth of abnormal bone tissue.

Doctors use imaging tests (X-rays, CTs, MRIs or PETs) to detect abnormal areas in the skeleton. Doctors can assess the size, shape, location and progress of the tumor.

The biopsy is the definitive step on the way to diagnosis. The doctor will either open the skin or use a needle to extract a tiny portion of the tumor for a pathologist to study. She or he will determine whether it is malignant or benign.

Treatment
Leavey said, "Adolescent and pediatric bone cancer are often curable and while they require interdisciplinary and intensive therapy the overall survival for the majority of patients is good."

Surgery is the primary bone cancer treatment. It is often combined with chemotherapy and/or radiation to eliminate as much of the disease as possible. Whenever possible, surgeons attempt to remove the cancer without significant damage to the limb. Although rare, if the cancer is large, amputation may be necessary. Radiation uses high power X-rays to destroy the cancer. Chemotherapy uses drugs to kill cancerous cells.

Tobey MacDonald, oncologist at the Aflac Cancer Center, explained that, based on the latest genetic studies, scientists understand that tumors with the same name and appearance may be quite different from one another. Because of this complexity, MacDonald said, "it is important to have experts in pathology, genetics, oncology, radiation oncology and neurosurgery so that the best and most appropriate therapy can be administered."