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Bone Cancer

Definition:
Cancer that starts in a bone is rare.Bone cancer can begin in any bone in the body, but it most commonly affects the long bones that make up the arms and legs.

Primary bone cancer is cancer that forms in cells of the bone. Some types of primary bone cancer are osteosarcoma, Ewing sarcoma, malignant fibrous histiocytoma, and chondrosarcoma. Secondary bone cancer is cancer that spreads to the bone from another part of the body (such as the prostate, breast, or lung).

Some types of bone cancer occur primarily in children, while others affect mostly adults.

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Bone cancer also doesn’t include blood cell cancers, such as multiple myeloma and leukemia, that begin in the bone marrow — the jelly-like material inside the bone where blood cells are made.

Symptoms:
The symptoms of bone cancer depend where the tumour grows (about half occur in or near the knee). By the time a lump or swelling is detectable, the cancer may have been present for some time. (Swelling and tenderness near the affected area)

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Pain, especially at night, is a common problem and may cause a limp if the leg is affected, because weight-bearing is uncomfortable or the cancer interferes with the way the joints work.

There may also be generalised symptoms such as weight loss, sweats, fever and lethargy , tiredness or fatigue. Sometimes, bone cancer is discovered incidentally – when an x-ray is taken after an accident, for example – or occasionally when the bone breaks due to weakness caused by the cancer.

Weakened bones, sometimes leading to fractures.

Causes:
It’s not clear what causes most bone cancers. Doctors know bone cancer begins as an error in a cell’s DNA. The error tells the cell to grow and divide in an uncontrolled way. These cells go on living, rather than dying at a set time. The accumulating mutated cells form a mass (tumor) that can invade nearby structures or spread to other areas of the body.

Unlike most cancers, bone cancer tends to affect the young. Osteosarcoma usually appears in children and young adults, while Ewing’s sarcoma is most common between the ages of 10 and 20.

Other risk factors include:

•Previous radiotherapy treatment, especially at a young age. Some chemotherapy drugs also increase the risk of osteosarcoma
•As many as one in eight people who develop a tumour of the eye will go on to develop an osteosarcoma, possibly because of a genetic susceptibility to both conditions and the additional effect of anti-cancer treatments
•Genetic conditions linked to bone tumours including Li-Fraumeni syndrome, HME, inherited breast cancer and congenital umbilical hernia (Ewing’s sarcoma is three times more common in children with this condition)
•Paget’s disease, a bone disease that generally occurs in older people and increases the risk of osteosarcoma, as does another bone condition called chondroma
•Bone cancer has often been linked to injuries to a limb, but it’s questionable and may simply be that the injury draws attention to a tumour that was already growing

Diagnosis:
Imaging tests :-
What imaging tests you undergo depends on your situation. Your doctor may recommend one or more imaging tests to evaluate the area of concern, including:

*Bone scan
*Computerized tomography (CT)
*Magnetic resonance imaging (MRI)
*Positron emission tomography (PET)
*X-ray
Removing a sample of tissue for laboratory testing
Your doctor may recommend a procedure to remove (biopsy) a sample of tissue from the tumor for laboratory testing. Testing can tell your doctor whether the tissue is cancerous and, if so, what type of cancer you have. Testing may also reveal the cancer’s grade, which helps doctors understand how aggressive the cancer may be.

Types of biopsy procedures used to diagnose bone cancer include:

*Inserting a needle through your skin and into a tumor. During a needle biopsy, your doctor inserts a thin needle through your skin and guides it into the tumor. The needle is used to remove small pieces of tissue from the tumor.

*Surgery to remove a tissue sample for testing. During a surgical biopsy, your doctor makes an incision through your skin and removes either the entire tumor (excisional biopsy) or a portion of the tumor (incisional biopsy).

Determining the type of biopsy you need and the particulars of how it should be performed requires careful planning by your medical team. Doctors need to perform the biopsy in a way that won’t interfere with future surgery to remove bone cancer. For this reason, ask your doctor for a referral to an appropriate surgeon before your biopsy.

Tests to determine the extent (stage) of the bone cancer
Once your doctor diagnoses your bone cancer, he or she works to determine the extent (stage) of your cancer. The cancer’s stage guides your treatment options.

Stages of bone cancer include:

*Stage I. At this stage, bone cancer is limited to the bone and hasn’t spread to other areas of the body. After biopsy testing, cancer at this stage is considered low grade and is not considered aggressive.

*Stage II. This stage of bone cancer is limited to the bone and hasn’t spread to other areas of the body. But biopsy testing reveals the bone cancer is high grade and is considered aggressive.

*Stage III. At this stage, bone cancer occurs in two or more places on the same bone.

*Stage IV. This stage of bone cancer indicates that cancer has spread beyond the bone to other areas of the body, such as the brain, liver or lungs.

Treatment:
The treatment options for your bone cancer are based on the type of cancer you have, the stage of the cancer, how far it has spread, your overall health and your preferences. Bone cancer treatment typically involves surgery, chemotherapy, radiation or a combination of treatments.

Bone cancer that hasn’t spread outside the bone may be treated with surgery and may not require chemotherapy. More abnormal bone cancer that has spread will be more difficult to treat, and chemotherapy as well as surgery is usually recommended.

In general, treatment of bone cancer has a good outlook, especially if it’s in the early stages and can be completed during surgery. About two-thirds of people with primary bone cancer can be cured. But if the cancer is more advanced or has spread, the prognosis may not be so good, with five-year survival rates of only 10-20 per cent. It’s vital that you talk to your specialist to get a picture of how successful treatment is likely to be in your individual case.

Treatment usually consists of surgery often combined with chemotherapy to shrink the tumour and make it less likely to recur. Because surgery involves removing bone, it can be quite drastic. Where possible, the surgeon will try to replace the diseased bone with a graft of bone from elsewhere in the body or an implant, but sometimes amputation is necessary.

Some bone cancers, such as Ewing’s sarcoma, respond well to chemotherapy and other treatments such as radiotherapy.

Newer biological therapies based on natural body chemicals such as interferon are also being used. These may work, for example, by encouraging the body’s immune system to attack the cancer cells. A number of different research trials are looking at different combinations of these treatments in an effort to improve results.

After initial treatment, regular follow-ups are essential to check for recurrences and to manage the consequences of treatment, such as the use of an artificial limb.

You may click to see:-
*Bone and Tissue Transplantation
*Bone Sarcoma in the Upper Extremity
*Ewing’s Family of Tumors (PDQ)…(Also available in Spanish)

*Osteosarcoma/Malignant Fibrous Histiocytoma of Bone (PDQ) …..(Also available in Spanish)

*Surgical Management of Cancer that Spreads to the Bone

*Vertebroplasty and Kyphoplasty

Prevention, Genetics, Causes:-
Information related to prevention, genetics, and risk factors:

Understanding Gene Testing

Search: Cancer Genetics Services Directory

Cancer Genetics Overview
[ health professional ]

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.bbc.co.uk/health/physical_health/conditions/in_depth/cancer/typescancer_bone.shtml
http://www.mayoclinic.com/health/bone-cancer/DS00520/DSECTION=treatments-and-drugs

http://www.cancer.gov/cancertopics/types/bone

http://bone-cancer-symptoms.org/

http://www.beltina.org/health-dictionary/bone-cancer-symptoms-prognosis-treatment-survival-rate-primary-metastatic.html

Pain In Bones? Fear For Bone Cancer!

http://www.cancersymptomspage.com/bone-cancer-symptoms.html

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Categories
Diagnonistic Test

Bone Scan

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Alternative Names:Scintigraphy – bone

Definition:
The process of bone growth and renewal is part of your body’s metabolism — natural processes that create and use energy.

Changes in your bone metabolism can be caused by a number of problems. To get a picture of your bone metabolism, your doctor may order a procedure called a bone scan. A radiologist will look for evidence of abnormal metabolism on images from your bone scan.

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Your doctor may order a bone scan to help diagnose subtle or hidden bone fractures, such as a stress fracture, that may not show up on a routine X-ray. Bone scans can also help detect other conditions as well. It is a test that detects areas of increased or decreased bone metabolism (turnover). The test is performed to identify abnormal processes involving the bone such as tumor, infection, or fracture.
…...Nuclear Scan->
This is a nuclear scan, also called a radionuclide scan. In a bone scan, a radioactive tracer accumulates in places in your bones with a lot of repair activity. In this way, the tracer is used to identify areas that might be injured due to a fracture, bone infection, arthritis, or invading cancer. The tracer gives off gamma rays, which can be detected using a specialized camera. The camera relays information to a computer to produce images of the bones being scanned. In the images, bright spots appear in the areas where the tracer has collected. Bone scans are most frequently done for people with cancer to see if the cancer has spread to bones.

Why Bone Scan is Done:
Your doctor may order a bone scan to determine whether you have any bone abnormalities that may signify one of the following disorders:

*Fractures
*Arthritis
*Paget’s disease of bone
*Bone tumors
*Infection of the joints, joint replacements or bone (osteomyelitis)
*Fibrous dysplasia
*Avascular necrosis or impaired bone blood supply
*Unexplained bone pain

Your doctor may order a bone scan to determine whether cancer, such as prostate, lung or breast cancer, has spread (metastasized) to bone.

How the Test is Performed
A radiotracer (a bone-seeking radioactive material) is injected into vein, so it travels through the bloodstream. As the material wears away, it gives off radiation. This radiation is detected by a camera that slowly scans your body. The camera takes pictures of how much radiotracer collects in the bones.

If a bone scan is done to see if you have a bone infection, images will be taken shortly after the radioactive material is injected, as well as 3 to 4 hours later, when it has collected in the bones. This is called a 3-phase bone scan.

To evaluate metastatic bone disease, images are taken only after the 3 to 4 hour delay.

The scanning part of the test will last about 1 hour and may require you to change positions.

How do you prepare for the test?
No special preparation is required on your part before a bone scan, though you may be asked to remove jewelry or other metal objects. You can eat or drink anything you like before the test.

As with most tests, tell your doctor if you’re pregnant or think you might be pregnant. Bone scans aren’t usually performed on pregnant women because of concerns about radiation exposure to the fetus. You may be asked to wear a hospital gown.

What happens when the test is performed?
The test is performed in the radiology department of a hospital. You will be given a radionuclide. A machine with a specialized camera moves around you. The procedure is painless, but the machine can be noisy. The scan usually takes less than an hour.

There is a small amount of pain when the needle is inserted. During the scan there is no pain. You must remain still during the examination, and you will be instructed when to change positions by the technologist.

You may experience some discomfort due to lying still for a prolonged period of time.

Risk Factor.
The radioactivity you are exposed to is too small to cause side effects or complications except to a fetus. The small amount of radioactivity rapidly diminishes.If you are pregnant or nursing, the test may be postponed to prevent exposing the fetus to radiation.

The amount of radioactivity in the injection is very small, and virtually all activity is gone from the body within 2-3 days.

Although it is extremely rare with bone scanning agents, a person may develop rash, swelling, or anaphylaxis (severe allergic response).

There is a slight risk of infection or bleeding with any intravenous injection. The risk of an allergic reaction to the tracers is extremely rare.

You might find the injection and the need to lie still during the scanning procedure mildly uncomfortable.

Must you do anything special after the test is over?
Nothing.

How long is it before the result of the test is known?
Results are usually available within a few days.

What you can expect
A bone scan falls under the category of nuclear medicine procedures, which means that it uses tiny amounts of radioactive materials called tracers (radionuclides). These tracers accumulate in certain organs and tissues, such as bones. Once introduced into the body, tracers emit a type of radiation called gamma waves, which are detected by a special camera. This camera produces images that are interpreted by radiologists or nuclear medicine specialists.

In a sense, a nuclear procedure such as a bone scan is the opposite of a standard X-ray examination. An X-ray passes radiation into or through your body to create an image on film placed on the other side of your body. In a nuclear scan, the source of radiation is inside your body and travels to the surface, where a camera detects it.

A bone scan can be divided into two basic parts:

*The injection. You will receive an injection of tracers into a vein in your arm, and depending on the reason your doctor orders the scan, images of the injection may be taken immediately. You’ll then wait between two and four hours to allow the tracers to circulate and be absorbed by your bones. You may be allowed to leave the radiology department during this time. Your doctor will ask you to drink extra water to remove unabsorbed radioactive material from your system.

*The scan. During the scan, you’ll be asked to lie still on a table while a machine with an arm-like device supporting the gamma camera passes over your body to record the pattern of tracer absorption by your bones. This is painless. A scan of your entire skeleton takes as long as 60 minutes. Scanning a limited area of your body takes less time.
In some cases, your doctor might order a three-phase bone scan, which includes a series of images taken at different times. A number of images are taken as the tracer is injected, then shortly after the injection, and again three to four hours later.

For certain conditions your doctor might also order additional images called single-photon emission computerized tomography (SPECT). This can help analyze conditions that are especially deep in your bone or in places that are difficult to see with static or two-dimensional (planar) images. The additional SPECT images take approximately 30 minutes.

After the test
Once inside your body, the tracers don’t remain active for long. The radioactivity is eliminated within two days. You should feel no side effects after the procedure, and no aftercare is necessary.

Results:
The radiologist looks for evidence of abnormal bone metabolism on the scans. These show up as darker “hot spots” and lighter “cold spots” where the tracers have or haven’t accumulated.

Although a bone scan is very sensitive to abnormalities in bone metabolism, it’s less helpful in determining the exact cause of the abnormality. However, a thorough medical history often reveals the cause, such as a suspected fracture, infection or bone tumor. Other tests may be performed to help establish the diagnosis. For instance, in order to rule out bone cancer, your doctor may need further imaging studies (computerized tomography or magnetic resonance imaging) or a biopsy, which is a sample of bone tissue that’s removed for examination.
Normal Results
Normal distribution areas appear uniform and gray throughout all the bones in your body.

What Abnormal Results Mean
The images should show that the radioactive material has been evenly distributed throughout the body. There should be no

areas of increased or decreased distribution. “Hot spots” are areas where there is an increased accumulation of the radioactive material. “Cold spots” are areas that have taken up less of the radioactive material.

Resources:
https://www.health.harvard.edu/diagnostic-tests/bone-scan.htm
http://www.mayoclinic.com/health/bone-scan/
http://www.nlm.nih.gov/medlineplus/ency/article/003833.htm

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