Dr. Rajesh Patel, MD. Ask the Doctor! September 2009 Q: What is bone cancer exactly, and does it always come accompanied by a previous kind of cancer? I’ve known people who developed bone cancer, only after having gotten other cancers before. Also why and how is it terminal? -- C. Miller, McHenry, IL A: Bone cancer is a severely abnormal tissue growth that resides among normal, healthy bone structure. The cells keep dividing without a brake system and they live beyond their age limit. As a result, this growth pattern can destroy surrounding structures that are necessary for proper functioning of the body. Before describing a tumor (growth) as cancer, we look at the cells to see if they fit a certain criteria. The tumor can then be classified as either malignant (cancerous tumor) or benign (noncancerous tumor). Both tumors can impinge on neighboring healthy tissue and eventually cause pain. However, unlike its benign counterpart, a malignant tumor can spread to inflict substantial damage in distant areas. It is possible for a malignancy to grow primarily from the bone itself. These primary bone cancers are divided into subcategories, according to how they appear under the microscope. Examples of true bone malignancies include chondrosarcoma, osteosarcoma, Ewing sarcoma, and malignant fibrous histiocytoma. However, based on statistics, most bone cancers will come from another source of tissue (such as the breast, lung, or prostate). That is why we hear about secondary bone cancers more often than those stemming from the bone itself. Moreover, a primary bone cancer accounts for less than 0.2% of all cancers of the body. Regardless of its origin, a bone malignancy can pose a big threat to our bodies. It carries a poor prognosis when it spreads beyond the scope of removal. The staging and grade of cancer greatly dictates how we begin to approach treatment. Staging assesses the actual size of the tumor, how far and where it has spread, and if it has specifically reached any lymph nodes. Grade refers to how irregular the tumor appears under the microscope. Prognosis is also based on the statistical outcomes gathered from comparable patients of similar age. It is important to note that prognosis is not an absolute term. Patients can defy the traditional numbers. A major factor in recovery is the individual's capacity to handle the stressors associated with treatment. Physicians will carefully look at every option to best limit this stress. Throughout the years, we have found great progress in treatment options through clinical trials. Advances in surgical techniques, chemotherapy drugs, and radiation have helped a number of patients reach better outcomes than previously expected. Submit your questions to askthedoctor@nowoodennickels.org Copyright 2009 - No Wooden Nickels All Rights Reserved.