The most common bone sarcoma is osteosarcoma. The highest incidence is among the young and the very old. Children, teenagers and young adults are more likely to be diagnosed as a result of a strange pain or a bony lump, while with more elderly people it can be a result of Paget's disease or other complications of age and only diagnosed following a fall or fracture.
The next most common primary bone cancer is Ewing's sarcoma - a family of tumours named after the doctor who first identified them as a separate cancer. The majority of Ewing's patients are in their teens and it is very rare indeed over the age of 30.
Among adults two further bone cancers are found. Malignant fibrous histiocytoma (MFH) is a cancer of fibrous tissue. Chondrosarcoma is a cancer with its origin in cartilage. Some soft tissue tumours, norably leiomyosarcoma, can also appear in bone. There are also very rare tumours such as chordoma and giant cell tumour (GCT).
As with most solid tumour cancers the initial aim is to remove the tumour completely and to ensure that the patient is disease free. The approach with all these bone cancers differs. Ewings tumours respond to radiotherapy and the treatment may consist of a combination of surgery, radio and chemotherapy according to the extent and location of the disease. Osteosarcoma and MFH will usually be treated with a course of high dose chemotherapy prior to surgery, followed by further chemotherapy after surgery. Chondrosarcoma does not respond well to chemotherapy so surgery will usually be the principal option.
Most bone sarcomas in younger people affect the leg while in adults there are more varied sites. Because of the difficulty of removing or replacing diseased bones surgery can be quite radical and disabling. Although less commmon nowadays, the consultant may discuss with the patient and their family the option of amputation of a diseased limb. There is a lot to consider and the specialist orthopaedic surgeons who treat bone cancer are very experienced in discussing the issues and the options. Limb salvage surgery with the insertion of a replacement artificial bone is sometimes a practical option and there are also other techniques.
New drugs are beoming available which can help patients with certain bone tumours. Mifamurtide is given with post surgical chemotherapy to patients with osteosarcoma. In clinical trials it has shown an improvement in long term survival. Denosumab is a licensed treatment which can be made available 'off label' for Giant Cell Tumour.
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