UNITED INDIAN SCHOOL

BIOLOGY INVESTIGATORY PROJECT

TOPIC: BONE CANCER

NAME: SIVAGANGA
A.M
CLASS: XII 2023-24
Roll No: 40
 BONAFIED CERTIFICATE
 ACKNOWLEDGEMENT
 INDEX
 

INTRODUCTION

 The primary bone cancer is a rare type of cancer that

affects the human skeleton, but it most commonly affects
the pelvis or the long bones in the arms and legs. Bone
cancer is rare, making up less than 1 percent of all
cancers. In fact, noncancerous bone tumors are much
more common than cancerous ones.
 The term "bone cancer" doesn't include cancers that
begin elsewhere in the body and spread (metastasize) to
the bone. Instead, those cancers are named for where
they began, such as breast cancer that has metastasized
to the bone.
 Some types of bone cancer occur primarily in children,
while others affect mostly adults. Surgical removal is the
most common treatment, but chemotherapy and radiation
therapy also may be utilized. The decision to use surgery,
chemotherapy or radiation therapy is based on the type of
bone cancer being treated.
  BONES

Bones are also a common site for other cancers to spread

(metastasise) to. Cancers that arise in bone are called
"primary" cancers, although such cancers are rare. Metastases
within bone are "secondary" cancers, with the most common
being breast cancer, lung cancer, prostate cancer, thyroid
cancer, and kidney cancer. Secondary cancers that affect bone
can either destroy bone (called a "lytic" cancer) or create bone
(a "sclerotic" cancer). Cancers of the bone marrow inside the
bone can also affect bone tissue, examples including leukemia
and multiple myeloma. Bone may also be affected by cancers
in other parts of the body. Cancers in other parts of the body
may release parathyroid hormone or parathyroid hormone-
related peptide. This increases bone reabsorption, and can lead
to bone fractures.
 

BONE CANCER
 The place where a cancer starts in the body is
called the primary cancer. Primary bone
cancer is a rare type
of cancer that begins
in the bones. This is
a separate condition
from secondary
bone cancer, which
is cancer that
spreads to the
bones after developing in another part of the
body
 Sometimes cells break away from the primary
cancer and are carried in the bloodstream or
through the lymphatic system to another part
of the body. The cancer cells may settle in that
part of the body and form a new tumour. This
is called secondary cancer.
 Secondary cancer in the bone happens when
cancer cells spread to the bone from a primary
tumour somewhere else in the body.
Secondary cancers in the bone are sometimes
called bone secondaries or bone metastases.

Types of bone cancer

 Some of the main types of bone cancer are:

 Osteosarcoma – the most common type, which mostly affects

children and young adults under 20
 Ewing sarcoma – which most commonly affects people aged
between 10 and 20
 Chondrosarcoma – which tends to affect adults aged over 40
 Young people can be affected because the rapid growth that
occur during puberty may make bone tumours develop.
 These types of bone cancer affect different types of cell. The
treatment and outlook will depend on the type of bone cancer
you have.

SIGNS
AND SYMPTOMS
Bone cancer can affect any bone, but most cases develop in
the long bones of the legs or upper arms.

The main symptoms include:

 Persistent bone pain that gets worse over time and

continues into the night.
 Swelling and redness (inflammation) over a bone, which
can make movement difficult if the affected bone is near
a joint.
 A noticeable lump over a bone.
 A weak bone that breaks (fractures) more easily than
normal.
 Sudden and unexplained weight loss is another symptom
of bone cancer that must never overlook.
Bone pain - Pain caused by bone cancer usually begins with
a feeling of tenderness in the affected bone. This gradually
progresses to a persistent ache or ache that comes and goes,
which continues at night and when resting.

STAGING
Staging is determined by the size and location of the tumor,
and whether or not cancer has spread to other areas. Primary
bone cancer is categorized into four stages:
 Stage 1: The tumor is low-grade, and the cancer cells are
still localized.

 Stage 2: The cancer cells are still localized, but the tumor
is high-grade.

 Stage 3: The tumor is high-grade and cancer has spread

to other areas within the same bone.

 Stage 4: Cancer had spread from the bone to other areas

of the body, such as the lungs or liver.
 RISK FACTOR

 Genetics: Children with familial

retinoblastoma, which is a type of eye
cancer, have an increased risk of
developing osteosarcoma. People with a
history of sarcoma in their family, such as
with Li-Fraumeni syndrome, are also at
high risk for osteosarcoma. Researchers
are finding genes that are passed from
generation to generation that give people a higher risk of developing
osteosarcoma than the general population. All of these conditions are
rare.

 Previous radiation therapy: People who have had radiation treatment for
other conditions have a higher risk of developing bone sarcoma at the site
of the radiation therapy. Bone sarcomas related to radiation therapy
appear many years, even decades, after the treatment, so it is a good idea
to watch for any symptom arising in an area previously treated with
radiation, even if you are an adult and were treated as a child. The
majority of sarcomas caused by radiation therapy include angiosarcoma,
undifferentiated pleomorphic sarcoma (UPS) of soft tissue, or
osteosarcoma, but other types may occur.

 Chemotherapy for another cancer: Some drugs used to treat cancer,

including alkylating agents and anthracyclines, may increase the risk of
developing a secondary cancer, usually osteosarcoma.

 Benign tumors or other bone conditions: Paget’s disease of the bone may
lead to osteosarcoma. Other noncancerous bone diseases, such as fibrous
dysplasia, may increase the risk of osteosarcoma.

DIAGNOSIS
 To diagnose bone cancer, healthcare provider will often
first use X-rays to view images of bones. Magnetic
resonance imaging (MRI) and CT (computed
tomography) scans provide more detailed images of the
areas around the bones and are usually obtained before
any treatment.
 To confirm the diagnosis, healthcare provider will
perform a biopsy, where a small piece of tissue is
removed from the bone to be examined under a
microscope. A biopsy provides specific information about
the cancer, including where it formed. Having this
information helps providers know which course of
treatment will work best for the specific cancer.
 In 2023, an estimated 3,970 people of all ages (2,160 men
and boys and 1,810 women and girls) in the United States
will be diagnosed with primary bone sarcoma. In 2020, it
was estimated that about 400 of these cases occurred in
people ages 15 to 19.
 It is estimated that 2,140 deaths (1,200 men and boys and
940 women and girls) from this disease will occur in the
United States in 2023.
 In adults, chondrosarcoma makes up most primary bone
sarcomas. The next most common type of bone sarcoma
in adults is osteosarcoma, followed by chordoma and
Ewing sarcoma. The remaining types of bone sarcoma are
rare.
 In teens and children, osteosarcoma and Ewing sarcoma
are diagnosed far more often than chondrosarcoma and
other bone cancers.
 MANAGEMENT AND TREATMENT

 Bone cancer treatment depends on the type of cancer,

whether it has spread and if so, where. People with bone
cancer often work with a team of healthcare providers to
treat the condition. This group includes doctors who
specialize in cancer (oncologists and radiation
oncologists) and doctors who specialize in bones and
joints (orthopaedic surgeons).
 Bone cancer treatment typically involves a combination
of approaches. The type and duration of these treatments
vary depending on several factors, including the type of
bone cancer, the size of the tumor and whether it has
spread to other parts of the body.

 The treatments most commonly used include:

 Surgery: Your surgeon removes the tumor and some
healthy tissue around it. They can also repair or rebuild
affected bones with real or artificial bone grafts.
Sometimes, an entire limb must be removed to treat
cancer. In this case, an artificial limb (prosthetic) can be
used. Sometimes repeat surgery is needed if all of the
cancer cells were not removed the first time around.
 Radiation therapy: This treatment shrinks the tumors
with high doses of X-rays. Healthcare providers often
use radiation before surgery to shrink the tumor so less
tissue has to be removed.
 Chemotherapy: This type of treatment kills cancer cells
throughout the body with medicine. People usually
receive this medicine by swallowing a pill or having it
injected into a vein. Your provider can use chemotherapy
to treat primary bone cancers or bone cancers that have
spread.

 PREVENTION
 Since experts don’t really know what causes bone
cancer, there is currently no known way to prevent it.
And because radiation therapy (another known cause of
bone cancer) is necessary for treating other types of
cancer, it can’t be avoided altogether.

CASE STUDY

 19 year old female with a mildly painful enlargement

on the outside of her left knee for several months.
 The patient gave a history of a twisting injury to the
knee several months prior to the onset of pain.
 The patient was otherwise healthy.
 She was born in the U.S. and gave no history of
travel. There were no fevers, night sweats or weight
loss.
 Blood tests were normal.
 X-rays demonstrated a geographic, expansile lesion of
the head of the fibula. There was a surrounding "egg
shell" rim of calcification indicating the periosteum
was intact.
 There were internal trabeculations within the
lesion/tumor.
 The lesion was expansile and displaced the peroneal
nerve and popliteal blood vessels.
 The entire head of the fibula was destroyed by the
neoplasm.

 CT SCAN

 CT scan shows a thin cortical shell around the tumor

indicating the periosteum is intact and the tumor is
likely benign.
 There was no ossification or calcification within the
tumor indicating that the tumor was probably not a
bone or cartilage producing tumor.
  MRI

 The MRI findings were not specific for a particular

type of neoplasm or infection.
 The lesion was low to intermediate signal on T1 and
intermediate to high signal on T2 weighted images.
The tumor diffusely enhanced with contrast. There
were no "fluid-fluid" levels that would indicate cystic
changes.
 The MRI nicely demonstrated the tumor's local
extent and proximity to the vascular structures.

 Differential Diagnosis

 The radiographic differential diagnosis included-

 Giant Cell Tumor

 Aneurysmal Bone Cyst
  Chondroblastoma
 Enchondroma
 Osteoblastoma
 Atypical Infection
 Desmoplastic Fibroma
 Non-ossifying Fibroma

 Differential Diagnosis

 The radiographic studies support the diagnosis of a

benign aggressive neoplasm. The lesion expands the
bone and the periosteum appears to be intact and to
contain the lesion. There is a sharp zone of transition
between the tumor and normal bone (geographic
pattern of bone destruction). Given the age, benign
aggressive appearance, origin in the metaphysis and
involvement of the epiphysis and lack of
mineralization, the most likely diagnosis is a Giant
Cell Tumor of Bone.

Diagnosis

 The diagnosis is Giant Cell Tumor

 Giant Cells can be seen in many different tumors.
The key is that the cells surrounding the giant cells
are all mononuclear cells and their nuclei are very
similar to the nuclei within the giant cells. These
mononuclear cells coalesce to form the giant cells.
Notice that the nuclei are all clumped within the
center of the giant cell. Giant cells are also present
in TB and Fungal infections, these types of giant
cells are called Langerhan's Giant Cells. The nuclei
 of these giant cells are arranged around the
periphery of the giant cell.

Surgery

 The surgery consists of a wide/radical resection of

the tumor/proximal fibula.

 The biceps femoris muscle and lateral collateral

ligament are released from the insertion on the
tumor/head of fibula. They are later repaired with
suture anchors to the tibia.
 The remaining muscles are subsequently rotated
and closed to each other to cover the defect.
 After physical therapy, most patients have a normal
functioning, stable knee. The gait is normal and the
leg is virtually normal for almost all patients.
 Possible complications include foot drop, tumor
recurrence, infection, knee pain annd instability and
neurovascular injury.
 The fibula is considered an expendable bone and
can be sacrificed with very little compromise in
function.
 CONCLUSION

Cancer begins when healthy cells in the bone change

and grow out of control, forming a mass called a tumor.
A bone tumor can be cancerous or benign. A cancerous
tumor is malignant, meaning it can grow and spread to
other parts of the body. A malignant tumor can destroy
the bone and spread to nearby tissue.
Many cases of bone cancer are successfully treated. In
these instances, cancer never returns. Sometimes people
need multiple surgeries to accomplish this outcome.
Other people with bone cancer might need to continue
treatments including radiation therapy and
chemotherapy to keep cancer from spreading. These
treatments may go on indefinitely to control cancer.
It is important to follow up with your healthcare
provider regularly to look for signs that the cancer is
coming back (recurrent) or spreading. The earlier a
recurrence is detected, the sooner your provider can
start treating it.
  BIBILIOGRAPHY

 https://my.clevelandclinic.org/health/diseases/17745-
bone-cancer
 https://www.cancer.net/cancer-types/bone-cancer-
sarcoma-bone/diagnosis
 https://www.oncoplus.co.in/bone-cancer/