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Overview of Hong Kong
Bone cancer can be classified as primary or metastatic, with the latter referring to cancer that has spread to the bones from other parts of the body. The majority of cases are metastatic bone cancer. Primary bone cancer, which originates in bone cells, is much rarer. According to the American Cancer Society, primary bone cancer accounts for less than 0.2% of all cancer cases. The three most common types of primary bone cancer are:
Osteosarcoma and Ewing’s tumours mainly affect children, adolescents, and young adults between the ages of 10 and 25. Data from Cancer Research UK in 2017 shows that in the UK, there were 0.9 male and 0.8 female cases of osteosarcoma per 100,000 people, with a slightly higher incidence in males. Chondrosarcoma, on the other hand, is more common in adults, with an average diagnosis age of 51. The age of onset for primary bone cancer is significantly younger compared to most other cancers. Although the number of new cases does not rank among the most common cancers annually, its lethality should not be underestimated.
Survival rates vary depending on the type of primary bone cancer. The American Cancer Society reports that if detected early, the five-year survival rates for osteosarcoma, chondrosarcoma, and Ewing tumours are 77%, 91%, and 82%, respectively.
The exact cause of bone cancer remains unknown, and research is ongoing. However, the following factors may increase the risk:
Bone Cancer Symptoms
The symptoms of bone cancer vary depending on the tumour’s location and severity.
Primary bone cancer often goes unnoticed due to its lack of public awareness and subtle early symptoms, making it one of the most challenging cancers to prevent and detect. However, there are still identifiable signs, including:
Common Diagnostic Methods
If a doctor suspects bone cancer, initial examinations will be conducted, such as checking for pain, deformities, or visible lumps. Further tests may follow for a more accurate diagnosis, including:
Measuring alkaline phosphatase (ALK-P) levels, which increase in bone cancer patients, as this enzyme is abundant in bones and the liver.
a. X-rays
Essential for locating the tumour and assessing its size and bone damage. While X-rays can detect tumours, they cannot confirm malignancy without a biopsy.
b. Bone scan
Evaluates tumour activity and checks for cancer spread in other bones.
c. Computed Tomography (CT) Scan
Provides cross-sectional images to assess tumour size, spread, and its relation to nearby tissues, blood vessels, and joints. A chest CT is often performed to detect lung metastases, which may not appear on standard X-rays.
d. MRI
Precisely maps the tumour’s extent and invasion into muscles, fat, organs, nerves, or blood vessels.
e. PET scan
Highly sensitive in detecting early cancer spread and determining the disease stage by tracking metabolic activity.
After diagnosis through the above methods, if doctors confirm bone cancer, further tests may be conducted to determine the cancer stage accurately. Staging depends on tumour size and whether it has spread locally or metastasised to distant tissues. The detailed staging is as follows:
| Stage | Description |
| IA | Tumour diameter ≤8 cm, no spread to nearby lymph nodes. |
| IB | Tumour diameter >8 cm, no spread to nearby lymph nodes. /Tumour present in multiple locations within the same bone. |
| IIA | Tumour diameter ≤8 cm, no spread to nearby lymph nodes or distant sites. High-grade cancer. |
| IIB | Tumour diameter >8 cm, no spread to nearby lymph nodes or distant sites. High-grade cancer. |
| III | The tumour is in multiple locations within the same bone and has no spread to nearby lymph nodes or distant sites. |
| IVA | Tumour of any size, possibly in multiple bone locations. No spread to nearby lymph nodes, but has metastasised to the lungs. |
| IVB | Tumour of any size, possibly in multiple bone locations. Spread to nearby lymph nodes and may (or may not) have metastasised to the lungs or other bones. |
Main Treatment Methods
Once diagnosed, doctors will determine the most appropriate treatment plan based on the type of bone cancer, extent of spread, patient’s age, and overall health. The primary treatment methods include:
Surgery is the primary treatment for bone cancer. The procedure involves removing the cancerous tissue along with some surrounding healthy tissue. In the past, amputation was common, but modern surgical techniques aim to preserve the limb whenever possible. Advances in surgery, combined with postoperative chemotherapy and radiation therapy, have made limb-sparing procedures more feasible.
a. Chemotherapy
Chemotherapy uses various drugs, typically administered intravenously or in pill form, to kill cancer cells. While effective, it may cause side effects such as fatigue, nausea, chest discomfort, or hair loss. Chemotherapy is commonly used for osteosarcoma and Ewing sarcoma, but is less effective for chondrosarcoma. Doctors often prescribe chemotherapy before and after surgery to shrink tumours and reduce the risk of recurrence.
b. Radiation Therapy
Radiation therapy targets cancer cells with high-energy beams to shrink tumours. However, many bone cancer cells resist radiation, requiring high doses that may damage nearby healthy tissues, nerves, and blood vessels. Radiation is typically used when surgical removal of the tumour is not possible.
Healthy Living
Patients may require physical therapy after surgery. Those who undergo amputation will need prosthetics to restore mobility. Regular follow-up appointments are essential to monitor recovery progress and detect potential recurrence.
Prevention Methods
As mentioned earlier, the exact cause of bone cancer remains unknown, and no specific prevention methods have been established. Since early symptoms are often subtle, bone cancer is one of the most challenging cancers to prevent and detect. If unexplained bone pain occurs, seeking medical attention promptly is crucial.
Frequently Asked Questions
Many symptoms, such as back pain or joint stiffness, are common and not necessarily caused by cancer. However, since primary bone cancer symptoms are often vague, persistent or worsening symptoms should prompt a medical evaluation to rule out severe conditions and ensure timely treatment.
No foods or medications have been proven to prevent or cure bone cancer, as its exact cause remains unclear. However, maintaining bone health through adequate calcium and vitamin D intake is beneficial.
A cancer diagnosis is emotionally challenging, but maintaining a positive mindset is essential for treatment outcomes. Patients should communicate openly with doctors, family, or social workers, follow medical advice, and adopt healthy habits to support recovery.
Diagnostic and treatment approaches vary by individual. X-rays are the standard initial test, but advanced cases may require bone scans or other imaging. While surgery is often the primary treatment, radiation or chemotherapy may be preferred for widespread or inoperable tumours.
Like other cancers, bone cancer can recur. Patients should monitor bone health and report any abnormalities even after full recovery. Some recurrences result from tissue contamination during biopsies, making regular check-ups vital for early detection.
▣ The information on this website has been reviewed by the HEAL Medical Team and is regularly updated according to the most recent clinical evidence. All content is provided for general informational purposes only and should not replace professional medical advice. Please consult your doctor or another qualified healthcare professional for personalized medical guidance.
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