Primary bone sarcomas are rare cancers that arise directly from the bone and represent 0.2% of all tumors. A majority of bone cancers arise sporadically without any known cause, however, some bone sarcomas are associated with a pre-existing condition such as Paget disease, radiation injury, genetic mutation, bone infarction, chronic infection and pre-existing benign tumors. The most common location is around the knee and the pelvis, but any bone can be involved. Primary bone sarcomas have a bimodal age distribution, having a higher incidence in young adults and elderly patients. The most common symptoms associated with a bone sarcoma include progressive pain, swelling, pathologic fracture and secondary finding. In particular, non-mechanical or non-weight bearing pain, specifically pain at night while at rest, is a common complaint with primary bone sarcomas. At the Parkview Cancer Institute, we have a dedicated Sarcoma Care Team including radiation oncology, medical oncology, interventional radiology, pathology, plastic surgery, nurse navigation, genetics, nutrition, spiritual support, and financial support, led by our orthopedic oncology team.
Types of Bone Sarcoma:
- Ewing sarcoma
- Undifferentiated pleomorphic sarcoma of bone
Diagnostic Studies and Tests:
In general, the imaging workup consists of x-rays and MRI of the affected location to assess the tumor. At the Parkview Cancer Institute, we utilize a 3 Tesla MRI scan to obtain the highest of quality and most detailed images possible. If the imaging results show concern for a bone sarcoma, the patient will typically undergo a biopsy to obtain pathologic analysis. If pathology results are consistent with a bone sarcoma, a whole-body bone scan and CT chest scan will be obtained for staging purposes and to assess for the two most common locations of metastatic disease to lungs and bone. Once a diagnosis is obtained and staging studies are completed, the case will be reviewed at the Parkview Cancer Institute’s Multidisciplinary Sarcoma & Musculoskeletal Tumor Conference by our dedicated Sarcoma Care Team to develop a personalized treatment plan.
Bone Sarcoma Treatment:
Treatment depends on the type of bone sarcoma as well as its anatomic location, grade and staging. For example, osteosarcoma is typically treated with preoperative chemotherapy, followed by limb-sparing tumor resection and reconstruction, and completed with postoperative chemotherapy. However, Chondrosarcomas, a unique type of bone sarcoma derived from cartilage, is generally not responsive to chemotherapy and radiation treatment. This type of sarcoma is typically treated with wide surgical excision and limb-sparing surgery only. In some clinical scenarios, radiation therapy may be utilized in bone sarcoma treatment. Our orthopedic oncology team provides surgical treatment of bone sarcomas, which often require complex joint and bone reconstruction, avoiding amputation, and leading to improved long-term functional outcomes.
Surveillance and Survival:
After tumor removal and completion of adjuvant therapies with no detectable signs of active cancer, surveillance begins. Surveillance typically lasts for 5 – 10 years and is based off the sarcoma subtype and grade of the tumor. Surveillance is performed with periodic imaging of the chest utilizing CT scans or chest x-rays to assess for metastatic disease. In some clinical scenarios periodic MRI scans of the affected extremity will be obtained to assess for local recurrence of the tumor. During the surveillance period patients undergo physical therapy, spiritual counseling, nutritional support, and financial support as needed, all which is coordinated by our sarcoma nurse navigator.