Bone Cancer Support Group

Bone Tumors can be divided into primary and secondary tumors. Secondary tumors can be further subdivided into:

• Metastatic tumors
• Tumors resulting from contiguous spread of adjacent soft tissue neoplasms
• Tumors representing malignant transformation of the pre-existing benign lesions.

Primary bone tumors are rare (less than 1% of all malignant tumors) and are most common in young men. The four most common types of primary bone tumors are:

• Osteosarcoma
• Chondrosarcoma
• Ewing's sarcoma
• Multiple myeloma
• Osteoclastoma
• Fibrosarcoma

Osteosarcoma is the most common type of malignant bone cancer, accounting for 35% of primary bone malignancies. There is a preference for the metaphyseal region of tubular long bones. 50% of cases occur around the knee. It is a malignant connective (soft) tissue tumor whose neoplastic cells present osteoblastic differentiation and form tumoral bone. It is the 6th leading cancer in children under age 15. Osteosarcoma affects 400 children under age 20 and 500 adults (most between the ages of 15-30) every year. Approximately 1/3 of the 900 will die each year, or about 300 a year. A second peak in incidence occurs in the elderly, usually associated with an underlying bone pathology such as Paget's disease, medullary infarct, or prior irradiation. Although about 90% of patients are able to have limb-salvage surgery, complications, such as infection, prosthetic loosening and non-union, or local tumor recurrence may cause the need for further surgery or amputation.

Patients with this are best managed by an oncologist and an orthopedic oncologist experienced in managing sarcomas. Current standard treatment is to use neoadjuvant chemotherapy (chemotherapy given before surgery) followed by surgical resection. The percentage of tumor cell necrosis (cell death) seen in the tumor after surgery gives an idea of the prognosis and also lets the oncologist know if the chemotherapy regime should be altered after surgery.

Standard therapy is a combination of limb-salvage orthopaedic surgery and a combination of high dose methotrexate with leucovorin rescue, intra-arterial cisplatin (with or without caffeine(Japan)), adriamycin, ifosfamide with mesna, BCD, etoposide, muramyl tri-peptite (MTP).

Ifosfamide can be used as an adjuvant treatment if the necrosis rate is low. 3-year event free survival ranges from 50% to 75%. and 5-year survival ranges from 60% to 85+% in some studies. Overall, 60-65% treated 5-years ago(2000) will be alive today. Osteosarcoma as one of the lowest survival rates for pediatric cancer despite chemotherapy's success in osteosarcoma of 6 chemotherapies, interferon-alpha, interleukin-2, and being the prototype of solid tumors in cancer.

A chondrosarcoma is a cancer of the cartilage. It is in a category of cancers called sarcomas. Chondrosarcoma is a rare cancer that can affect people of any age. Chondrosarcoma is graded based on how fast it grows. Grade 1 is a low grade (slow growing) cancer, and grades 2 and 3 are high grade (fast growing) cancers. The most common sites are the pelvic and shoulder bones along with the superior regions of the arms and legs.

Ewing's sarcoma is the common name for primitive neuroectodermal tumor. It is a rare disease in which cancer cells are found in the bone or in soft tissue. The most common areas in which it occurs are the pelvis, the femur, the humerus, and the ribs. James Ewing (1866-1943) first described the tumor, establishing that the disease was separate from lymphoma and other types of cancer known at that time. Ewing's sarcoma occurs most frequently in male teenagers. Ewing's sarcoma is the result of a translocation between chromosomes 11 and 22, which fuses the EWS gene of chromosome 22 to the FLI1 gene of chromosome 11.

Multiple myeloma (also known as MM, myeloma, plasma cell myeloma, or as Kahler's disease after Otto Kahler) is a type of cancer of plasma cells, immune system cells in bone marrow that produce antibodies. Its prognosis despite therapy is generally poor, and treatment may involve chemotherapy and stem cell transplant. It is part of the broad group of diseases called hematological malignancies.

There are approximately 45,000 people in the United States living with multiple myeloma, and the American Cancer Society estimates that approximately 14,600 new cases of myeloma are diagnosed each year in the United States. It follows from here that the average prognosis is about three years.