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Bone Cancer
→ KEY TESTS AND DIAGNOSTIC PROCEDURES YOU SHOULD KNOW ABOUT
- NDC Editorial
- July 4, 2024
- 3:06 pm
The frightening possibility of bone cancer faces thousands of people each year. Many have an excruciating agony that doesn’t go away when they rest, deep within their bones. A trip to the doctor is typically prompted by this chronic pain, which starts a series of vital diagnostic tests meant to identify the source.
Diagnosing Bone Cancer can be intimidating, with many unknown jargon and procedures. For this reason, it’s crucial to raise awareness of the diagnosis process during this Bone Cancer Awareness Month. Patients and their loved ones can feel more empowered and at peace if they are aware of the procedures involved.
This article explores the diagnostic tests used by physicians to identify bone cancer, offering a thorough overview for better understanding. Every stage of the process, from the first physical examination to sophisticated imaging methods and biopsies, is vital to diagnosing and staging the illness.
Awareness and early detection can make a world of difference, improving outcomes and offering hope to patients and their families.
Table of Contents
What is Bone Cancer?
Bone cancer is when abnormal cells start growing in a bone. It can develop in any bone but usually affects the thighbone. As cancer cells grow, they damage healthy bone tissue. The type of bone cancer depends on the cell and tissue where it starts.
Cancers that start directly in the bone are known as primary bone cancers. However, cancer from other parts of the body, like the breast, prostate, or lungs, can spread to the bones. These are called secondary or metastatic bone cancers.
Diagnosing bone cancer involves understanding these types and their origins to determine the right treatment.
Types of Bone Cancer
There are two types of bone cancers primary and secondary. Most people with cancer in their bones don’t have primary bone cancer. Instead, they have secondary or metastatic bone cancer, which means cancer has spread from another part of the body, like the breast, prostate, or lungs, to the bones.
Types of Primary Bone Cancers:
Osteosarcoma
Osteosarcoma is the most common primary bone cancer in adolescents (10 to 19 years). It usually develops in the thigh bone, upper shin bone, or upper arm bone.
Chondrosarcoma
Chondrosarcoma typically affects adults aged 30 to 60. It’s a cancer of the cartilage cells within the bone, commonly found in the hips, shoulder bones, upper thigh bone, and ribs.
Ewing Sarcoma
Ewing sarcoma mostly occurs in children (0 to 14 years) and adolescents. It often starts in the pelvis, thigh bone, shoulder bones, or ribs. It can also appear in soft tissues.
Spindle Cell Sarcoma
Spindle cell sarcomas are rare and found mostly in adults aged 30 to 60. These cancers typically appear in the bones of the legs and are similar to osteosarcomas but don’t produce osteoid.
Chordoma
Chordoma is a very rare, slow-growing cancer that arises from remnants of the notochord. It commonly develops in the bones at the bottom of the spine or in the skull.
Understand Symptoms Key to Diagnosing Bone Cancer
Some individuals with bone cancer just have a painless lump as their only symptom. Others may have a range of symptoms. Other illnesses like Lyme disease or arthritis may potentially be the cause of these symptoms, delaying a diagnosis. Among the most typical indications of bone cancer are:
- Pain (usually worse at night).
- Unexplained swelling.
- Difficulty moving around.
- Feeling extra tired (fatigue).
- Fever
Why Early Diagnosis is Crucial
Early diagnosis of bone cancer is vital. Detecting cancer in its initial stages can greatly increase the effectiveness of treatment and improve survival rates. Patients diagnosed early have a better chance of successful treatment and recovery compared to those diagnosed at a later stage.
Initial Steps in Diagnosing Bone Cancer
The journey to diagnosing bone cancer typically starts with a detailed patient history and physical examination. Doctors look for risk factors such as familial history and exposure to radiation. A thorough physical examination helps identify any unusual signs that warrant further investigation.
Imaging Tests
X-rays are often the first imaging test used to diagnose bone cancer. They can reveal abnormal areas in the bone, indicating the presence of a tumor.
Bone scans involve injecting a small amount of radioactive material into the bloodstream. This material collects in the bones and is detected by a special camera, highlighting abnormal areas.
CT scans provide detailed cross-sectional images of the body, allowing doctors to see the bone and surrounding tissues in greater detail. They are useful in determining the size and location of the tumor.
MRI scans use powerful magnets and radio waves to produce detailed images of soft tissues. This is particularly beneficial for detecting bone cancer as it provides a clearer image of the tumor and its impact on surrounding structures.
PET scans offer functional imaging by using a radioactive sugar solution that cancer cells absorb more than normal cells. This helps in detecting the spread of cancer to other parts of the body.
FNA involves using a thin needle to extract a small sample of cells from the tumor. It’s minimally invasive but may not always provide enough tissue for a conclusive diagnosis.
A core needle biopsy uses a larger needle to remove a small cylinder of tissue. This method is more accurate than FNA and provides a more comprehensive sample for analysis.
Surgical Biopsy
When other biopsy methods are inconclusive, a surgical biopsy might be necessary. This involves removing a portion of the tumor or the entire tumor for examination.
Blood Tests
Elevated levels of ALP in the blood can indicate bone disease or bone cancer, as this enzyme is released into the bloodstream during bone formation or destruction.
High levels of LDH can be a sign of tissue damage, including cancer. It is often measured alongside other tests to assess the overall condition of the patient.
Other Relevant Blood Markers
Other blood tests might include markers like ESR (erythrocyte sedimentation rate) or CRP (C-reactive protein), which indicate inflammation and can support a diagnosis of bone cancer.
Staging of Bone Cancer
Staging describes the extent of cancer in the body. Bone cancer is typically staged from I to IV, with higher numbers indicating more advanced disease. Staging helps determine the most appropriate treatment plan.
MusculoSkeletal Tumor Society (MSTS) Staging System
The MSTS system, also called the Enneking system, is often used to stage bone cancer. It looks at three main things:
- Grade (G): This shows how likely the cancer is to grow and spread, based on how the cells look under a microscope.
- Low Grade (G1): Cells look more like normal cells and are less likely to grow and spread quickly.
- High Grade (G2): Cells look more abnormal and are more likely to grow and spread quickly.
- Extent of the Primary Tumor (T): This shows how far the tumor has grown.
- Intracompartmental (T1): The tumor has stayed within the bone.
- Extracompartmental (T2): The tumor has grown beyond the bone into nearby structures.
- Metastasis (M): This shows if the cancer has spread to other parts of the body.
- M0: The tumor has not spread to other areas.
- M1: The tumor has spread to other areas, like lymph nodes or other organs.
By combining these factors, an overall stage is indicated using Roman numerals ranging from I to III. Tumors classified as extracompartmental (B) or intracompartmental (A) in stages I and II.
- Low-grade, localized tumors are stage I.
- High-grade, localized tumors are stage II.
- Metastatic tumors (regardless of grade) are stage III.
AJCC TNM Staging System
The American Joint Committee on Cancer (AJCC) TNM system is another way to stage bone cancer, using four main pieces of information:
- Tumor Size and Spread (T): This tells us how large the tumor is and whether it has spread to nearby bones or exists in multiple spots within the bone.
- Lymph Node Involvement (N): Shows if the cancer has spread to nearby lymph nodes.
- Metastasis (M): Indicates if the cancer has spread to distant parts of the body like the lungs, other bones, or the liver.
- Grade of Cancer Cells (G): Determines how abnormal the cells appear under a microscope, which helps predict how fast the cancer might grow.
Each category (T, N, M, G) is further detailed with numbers or letters. Higher numbers often mean more concerning features. For instance, the grade scale ranges from 1 to 3:
- Grade 1 (G1): Cancer cells look similar to normal bone tissue and tend to grow slowly.
- Grade 2 (G2): Cancer cells look more abnormal.
- Grade 3 (G3): Cancer cells appear highly abnormal and may grow quickly.
Once T, N, M, and G categories are identified, they are combined into stages using Roman numerals I to IV. These stages help guide treatment decisions and prognosis. The TNM system also considers where the cancer started (e.g., arms, legs, pelvis) to tailor staging criteria accordingly.
There are two types of stages in this system:
- Clinical Stage: Based on exams and tests before surgery, helping to plan treatment.
- Pathological Stage: Determined after surgery, using findings from exams, imaging, and surgical results.
Sometimes, the clinical and pathological stages differ, especially if surgery reveals more extensive cancer spread than initially seen on tests.
Role of Genetic Testing
Genetic testing can identify mutations that increase the risk of bone cancer. Understanding these genetic factors can help tailor treatment and provide information on the likelihood of recurrence.
Further Reading
Role of Genetic Testing
Genetic testing can identify mutations that increase the risk of bone cancer. Understanding these genetic factors can help tailor treatment and provide information on the likelihood of recurrence.
Emerging Diagnostic Techniques
Advances in imaging technology and molecular profiling are paving the way for more accurate and less invasive diagnostic methods. Techniques like liquid biopsies and advanced genomic sequencing offer promising avenues for early detection and personalized treatment.
- General Cancer Screening: 18F-FDG PET is generally preferred for a wide range of cancers due to its ability to detect high metabolic activity.
- Specific Tumor Imaging: If dealing with neuroendocrine tumors or prostate cancer, PET Ga-68 is often the better choice for its targeted imaging capabilities.
Common Challenges in Diagnosis
Diagnosing bone cancer can be challenging due to its rarity and the similarity of its symptoms to other conditions like arthritis or injuries. Misdiagnosis can delay treatment, underscoring the importance of thorough and precise diagnostic procedures.
Diagnosing bone cancer involves a combination of medical history, physical examinations, imaging tests, biopsies, and blood tests. Early detection is crucial for effective treatment and better outcomes. Stay informed and proactive about your health, and don’t hesitate to seek medical advice if you have concerns.
At North City Diagnostic Center we offer personalized testing schedule that aligns with your medical history and risk factors. Consistent monitoring can be invaluable for early detection and effective management of arthritis. It’s not just about how often you test but making sure that the tests are aligned with your overall health profile for maximum benefit.
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References
- https://www.mayoclinic.org/diseases-conditions/bone-cancer/symptoms-causes/syc-20350217
- https://my.clevelandclinic.org/health/diseases/17745-bone-cancer
- https://www.webmd.com/cancer/bone-tumors
- https://www.cancer.gov/publications/dictionaries/cancer-terms/def/bone-cancer
- https://www.cancer.org/cancer/types/bone-cancer/about/what-is-bone-cancer.html
- https://www.mayoclinic.org/diseases-conditions/bone-cancer/diagnosis-treatment/drc-20350221
- https://www.healthline.com/health/bone-cancer
- https://www.medicalnewstoday.com/articles/171372
- https://www.cancerresearchuk.org/about-cancer/bone-cancer
- https://www.cancerresearchuk.org/about-cancer/bone-cancer/types
