The Bone Cancer Research Trust (BCRT) is calling on GPs to ensure that they do not miss cases of primary bone cancer after a report revealed that patients still only have a 54% chance of surviving five years after diagnosis - a figure that has barely changed in 25 years. Bone cancer is often undiagnosed in the early stages as there are usually no specific symptoms and the symptoms of pain or bone lump that do occur may be dismissed as harmless. Also, bone cancer has no unique symptoms.
Primary bone cancer is cancer started from cells in the hard bone tissue. It is a rare type of cancer accounting for only two in every 1,000 cancers diagnosed and affecting males more than females. Secondary (metastatic) bone cancer - cancer which started in another part of the body and has spread to a bone – is common and caused by many types of cancer including breast, prostate, lung, kidney and thyroid. The behaviour, treatment and outlook of secondary bone cancers is often quite different to primary bone cancer.
The young are often affected by primary bone cancer but the early signs often remain undiagnosed if the child fails to bring attention to them or if the parent fails to appreciate their potential significance. Bone cancers can also occur in children as well as adults with Ewing's sarcoma, commonly occurring between the ages of 10 and 20 and osteosarcomas occurring most commonly between the ages of 10 and 25. Primary bone cancer is considered quite rare and health professionals are therefore less likely to include it as a differential diagnosis.
Early detection improves the chances of survival and also decreases the chances of the need to have a limb removed. Malignant tumours are more likely to grow quickly and early detection is vital as the normal bone does not have a chance to surround the tumour. A CT or MRI scan can provide cross-section imaging of the patient’s body and allow a clearer picture of the tumour and whether it is contained in the bone or has broken through into the soft tissue. Once the tumour has been identified, a decision is made on surgery or other treatment options.
The goal of surgery is usually to remove the entire tumour and a surrounding area of normal bone. After the tumour has been removed, a pathologist examines it to determine if there is normal bone completely surrounding the tumour. If a portion of the cancer is left behind, it can continue to grow and spread, requiring further treatment. If the tumour specimen has normal cells completely surrounding it, there is a much better chance that the entire tumour has been removed and less chance for recurrence. Historically, amputations were frequently used to remove bone cancer. Newer techniques have decreased the need for amputation and tumours can now be removed with a rim of normal bone without the need for an amputation.
Alison Johnson, Clinical Negligence senior associate at Penningtons Solicitors LLP says: “We welcome the BCRT advice and the drive to diagnose and treat primary bone cancers early. We often see cases where young people or children have attended their GP with leg pain and been diagnosed with a simple musculoskeletal strain or injury even though they may not suffered any impact or undertaken any sport recently to account for their pain. It seems all too easy to put these symptoms down to ‘growing pains’ when a simple x-ray could make a definitive diagnosis and allow early treatment to begin. It may not be easy for GPs to diagnose primary bone cancers when the symptoms are so non-specific and to decide where further investigation is needed but, if they can recognise the possibility and refer for further investigations, the condition could be diagnosed much sooner.”