Bone cancer treatment includes several therapeutic measures and procedures depending on the type of cancer, its stage, and the patient’s health condition. Bone cancer develops in the skeleton and destroys tissues, and it can spread to distant organs, such as the lungs. There are two main types, primary and secondary bone cancer. Primary bone cancer develops in bone cells. Treatment for bone cancer includes surgery, chemotherapy, radiation, or a combination of them.
Surgical Bone cancer treatment
The main goal of surgery is to completely remove cancer because if some cancer cells are left behind, they can grow, multiply, and create a new tumor.
To make sure that this does not happen, the surgeon removes the tumor in addition to some of the normal tissues that surround it, and in this case, it is called Wide-excision With Clean Margins, as removing some normal tissues helps ensure that the cancer is completely removed, and reduces the risk of cancer growing again in the place. from which it originated.
Bone cancer surgeries include:
Limb salvage surgery:
- The goal of limb salvage is to completely remove cancer and get rid of symptoms of bone cancer while keeping the patient’s leg or arm functioning. In more than 90% of patients with bone cancer in a limb, the limb remains without amputation, and it is usually performed when cancer has not spread. Outside the bone, it is possible to rebuild and repair the bone.
- This type of surgery is very complicated, as the surgeon tries to remove the entire tumor while preserving the nearby tendons, nerves, and blood vessels, and this is not always possible if cancer has grown significantly, the surgeon will need to remove them in addition to the tumor, which may lead to Sometimes a limb is painful or difficult to perform, and amputation may be the best option in this case.
- In this type of surgery, a wide resection is performed to remove the tumor and get rid of the symptoms and complications of bone cancer.
- An artificial bone or an artificial joint is used to replace the bone that has been removed, and the artificial joint may be made of metal and other materials, and it can be very advanced, because it may be used in children in the growth stage, as it allows it to be lengthened without any additional surgery during the period Child growth.
- Patients who undergo limb-saving surgery may need more surgeries over the next five years, some of which may eventually require amputation.
- The removed part of the bone can later be replaced with a metal implant called a prosthesis, or a piece of bone called a bone graft from elsewhere in the body. If the cancer is near a joint such as a knee, it may be possible to remove the joint and replace it with an artificial joint.
Amputation:
- Amputation is surgery to remove part or all of a limb (arm or leg).
- Amputation may be required if complete removal of cancer requires removal of underlying nerves, arteries, and muscles that would leave the limb without good function.
- Doctors usually resort to it if the tumor is very large, or has spread to important nerves or blood vessels, which makes it difficult to completely remove it and leave the functional limb.
- The surgeon determines the amount required to be amputated from the injured arm or leg based on the results of the MRI scans and examination of the tissues collected at the time of the surgery, after which the patient will need to install a prosthesis instead of the removed limb to be able to perform its various functions as much as possible.
Bone cancer treatment with radiotherapy
- Use in Radiotherapy high-energy rays or particles to kill cancer cells. The rays are directed to the body and focus on cancer.
- Most bone cancers are not easily destroyed by radiation and need to use high doses. Higher doses may damage healthy structures in nearby areas such as nerves. Therefore, radiotherapy does not play a significant role in treating most types of bone tumors, except Ewing’s tumors.
Radiation therapy reduces the size of tumors by using high doses of X-rays. Radiation is often used before surgery to shrink the tumor so that it reduces the amount of tissue that needs to be removed. Radiotherapy is used in a different case:
- Radiotherapy may be used after surgery to eliminate cancer cells that remained at the edges of the tissue after the tumor was removed.
- It is also used to treat bone cancer that cannot be completely removed by surgery; To help control tumor growth, and to relieve symptoms of bone cancer such as pain and swelling.
Chemotherapy is a treatment with drugs that enter the bloodstream and spread to reach and destroy cancer cells throughout the body. Chemotherapy is often part of the treatment for Ewing’s sarcoma and osteosarcoma but is rarely used to treat other bone cancers.
Chemotherapy may be useful for treating bone cancer that has spread through the bloodstream to the lungs or other organs.
Chemotherapy is usually used before surgery in combination with radiotherapy to shrink cancer. This allows the surgeon to use limb-sparing surgery. Chemotherapy can also be used to control the symptoms of bone cancer in cases where treatment is not possible, and this is known as palliative chemotherapy.
Among the most important drugs that may be used to treat bone cancer, as part of the chemotherapy plan, are the following:
- Doxorubicin.
- Cisplatin.
- Cyclophosphamide.
- Etoposide.
- Ifosfamide.
A cancer patient needs palliative care in addition to cancer treatment. This care includes trying to overcome the physical symptoms of bone cancer, the side effects of treatment, in addition to the psychological and social stresses caused by cancer and its treatment.
Surgical Bone cancer treatment in the pelvis or spine
Bone cancer in the pelvis is treated with Wide-excision With Clean Margins if possible, and if necessary, a bone graft can be used to reconstruct the bones of the pelvis, while for tumors in areas such as the spine, it is difficult to perform Wide-excision With Clean Margins.
Treating cancer in these bones requires a combination of treatments such as Curettage. This procedure involves scraping or scraping the tumor from the bone with special tools without removing part of the bone. This leaves a hole in the bone. In some cases, after most of the tumor has been removed, the surgeon may treat the adjacent bone tissue with other techniques to try to kill any remaining cancer cells. Examples of these techniques include:
Cryotherapy
- Bone cancer is treated with cryogenics or freezing by pouring liquid nitrogen into the hole that remained in the bones after removing the tumor, as nitrogen kills cancer cells by freezing them, and after freezing, the gap in the bones can be filled through bone grafts or with bone cement.
- Bone cement is in the form of a liquid and then becomes solid with time, and is used by placing it while it is liquid in the gap that remained in the bone as a result of removing the tumor, and when it becomes solid, it emits a lot of heat that helps kill any remaining cancer cells, which allows it to be used with some types of bone tumors without the need for freezing.
Surgical treatment of metastatic bone cancer
When treating bone cancer, cancer must be completely removed by surgery, including tumors that have spread to the lungs, which is the most common place for the distant spread of bone cancer. Surgery to remove bone cancer and spread it to the lungs must be planned very carefully.
Targeted therapy for bone cancer
Targeted therapy drugs target genetic, protein, or other changes in or around cancer cells.
Regular follow-up appointments after treatment
After treatment, people with bone cancer need regular check-ups every 3-12 months for several years, the aim of which is to ensure that cancer does not return, and to help manage and control any side effects of treatment, and over time the side effects of treatment decrease and medical follow-up appointments decrease with it.
For some patients, bone cancer may return after treatment again, and the risk of recurrence of bone cancer is greater within the first five years after treatment, and if cancer recurs, it is expected that the patient will undergo a combination of surgery, chemotherapy and radiotherapy, and in some cases of advanced bone cancer will focus Treatment is only to manage symptoms and improve the patient’s quality of life without trying to treat cancer itself.
The necessary follow-up procedures for people with bone cancer vary according to the type and stage of cancer. In general, patients undergo frequent examinations by a doctor, in addition to regular blood tests and x-rays. Regular follow-up includes discussing changes in health and addressing any problems as soon as possible.
Tips to help manage bone cancer pain
Here are some tips and advice that can help people with bone cancer manage and control pain:
- Massage: Since the skin is the largest organ in the human body and full of nerve endings, massage will help soothe the soft tissues and encourage them to relax.
- Follow a healthy diet and drink fluids regularly: To maintain bone health in general, it is recommended to eat healthy food and drink plenty of fluids during the day. Getting enough calcium and vitamin D helps protect bones, and protein plays an important role in healing fractures and supporting immune function.
- Strength exercises: Strength exercises aim to build strong bones and reduce bone loss. Examples include walking, climbing stairs, swimming, and yoga.
- Use of assistive devices: Assistive devices such as canes, walkers, braces, splints, orthopedic shoes, door rails, and handrails may help reduce the risk of falls, enhance balance, and reduce orthopedic pain.
- Hypnotherapy: a treatment based on the use of images to create a dreamy and relaxed state of mind, and this can help reduce some of the side effects of cancer treatment, such as nausea.
- Meditation: Meditation helps the mind bring about feelings of calmness and increased awareness. It also gives the patient many long-term health benefits if practiced regularly, such as reducing stress and blood pressure.
- Tai chi: one of the Chinese non-combat martial arts includes gentle movements that help clear the mind and relax the body.