Treatment Plan

Best Hospitals for Bone cancer treatment in India

Treatment Plan

Any cancer of the bone is referred to as bone cancer. Primarily there are two types of bone cancers. They are true bone cancers that originate from the bone and metastatic bone cancers that have spread from other organs.

As we all know, bone forms the framework that support our body. Bones are made up of an outer core and an inner hollow where the bone marrow resides. At the end of the bone, is a soft bone-like tissue called the cartilage. This acts as a cushion in joints, the area where one bone connects with another bone. The joints are stabilised by connective tissue-like ligaments, tendons, fat tissue and muscles. Cancer can occur in any of these tissues, apart from cancers originating from the bone and cartilage cells.

Bone cancer can occur due to the spread or metastasis of cancer from other organs. These are more common than true bone cancers. There is a fundamental difference between metastatic bone cancer and true bone cancer. Metastatic bone cancer cells retain the original character of the cells from where the cancer has spread. If the cancer has spread from another organ, the bone cancer cells look and act like cancer cells of respective organs. Hence the treatment for these types of cancers is the same as that of the respective cancers. That is, a metastatic spread of lung cancer to the bone should be treated like a lung cancer. This holds true for cancers from other cells as well.

Bone cancer risk factors:

·       Certain genetic disorders like Li-fraumeni syndrome, Rothmund-Thompson syndrome, Multiple exostoses syndrome

·       Certain diseases like Paget disease

·       Previous history of radiotherapy

·       History of bone marrow transplantation

Prevention of bone cancer:

While there is no way to prevent cancer, there are always ways to minimize the risk of contracting cancer.

     •       Stay away from tobacco. Smoking and chewing tobacco have been linked to many forms of cancers. Avoiding/quitting smoking is an essential part of cancer prevention.

     •       Maintaining a healthy diet. Eating a lot of fruits and vegetables, avoiding or limiting the intake of alcohol, managing weight and reducing the consumption of processed meat can reduce the risk of getting cancer.

     •       Being physically active. It is very important to maintain a healthy weight and be physically active. Yoga, meditation and physical workout should be incorporated into our daily routine.

     •       Ontime diagnosis. It is very important to detect cancer before metastasis. If there is a history of bone cancer in your family, then getting regulars tests/screening done is required.

 

Pain is one of the most common symptoms of bone cancer. People with bone cancer may experience the below mentioned symptoms.

     •       Pain ranging from mild to moderate to severe depending on the stage

     •       Swelling of the affected area

     •       Stiffness and swelling of the joints close to the affected area

     •       Fracture of the affected bone 

 

Some other general symptoms are:

     •       Fever 

     •       Weight loss

     •       Malaise

     •       Anaemia

 

The existence of signs and symptoms, physical exams and imaging tests are conducted to determine if a person has bone cancer. In most cases, doctors will also conduct a biopsy - study tissue or cell samples under a microscope – to confirm the presence of cancer. Accurate diagnosis can be achieved by combining two or more of these tests. Some of these methods of diagnosing bone cancer are:

       X-rays: Most bone cancers can be detected on x-rays. The area where the cancer has developed will look more serrated and sometimes a hole can also be detected in the bone. Occasionally, a tumour can also be detected around the defect of the bone. A chest x-ray is conducted to find out if the cancer has spread to the lungs.

       CT Scans: CT Scans help in determining the stage of the cancer. They help show the extent of the spread of the cancer and if the cancer has spread to the lungs, livers or other organs.

       MRI Scans: These help in outlining the bone tumour.

       PET Scans: PET scans can show the growth of cancer in the whole body. PET scans and CT scans are used together to detect the exact location of the cancer.

       Biopsy: Biopsy helps in accurately diagnosing the grade and type of tumour.

 

Bone cancer stages:

Once the doctors have confirmed that a person has bone cancer, they will try to figure out if the cancer has spread, and if yes, then how far. This is known as staging. There are four stages of bone cancer. Each of these stages have certain sub-stages as well.

Stage 1

The tumour is less than 8cm 

There is no lymph node involvement

Cancer is low grade

TNM Stage- T1N0M0G1

Stage 1b

The tumour is more than 8cm

The tumour can be seen in different parts of the same bone.

No lymph node involvement

TNM Stage-T2N0M0G2 0R T3N0M0G2

Stage 2a

Tumour is more than 8cm long

No lymph node involvement

No spread to distant sites

Tumour is aggressive or high grade

TNM Stage T1N0M0G2 or T2N0M0G2

Stage 2b

The cancer is more than 8 cm long

No lymph node involvement 

No distant spread

High grade tumour

TNM Stage T2N0M0G3 OR T3N0M0G3

Stage 3 

Tumour is more than 10 cm 

Different parts of the bone are affected

No lymph node involvement 

No distant spread

High grade tumour

TNM STAGE T3N0M0G3

 Stage 4a

The tumour can be any size  

No lymph node involvement

Has spread only to the lungs

TNM STAGE T3N0M1Ag3

 Stage 4b

Tumour can be of any size

Has spread to surrounding lymph nodes

Has spread to other organs

TNM Stage any T, any N, M1 b and G3

As with any other types of cancer, treatment of bone cancer is also multidisciplinary. Surgery, chemotherapy, radiation therapy, as well as palliative treatment, are all used. 

Surgery-Surgery for bone cancer involves the removal of the tumour along with a part of normal tissue. Wide excision surgery is the most preferred mode of treatment. This helps to eliminate the need for an amputation of the limbs. Reconstructive surgery after wide excision helps to restore the size and shape of the limbs. But amputations may be necessary if the bone cancer is not in an area that can be easily approached.

Chemotherapy-Chemotherapy destroys cancer cells by preventing their multiplication. High grade and fast -growing tumours are treated with chemotherapy before surgery. The aim is to reduce the tumour size and to destroy metastatic deposits. Chemotherapy before surgery is referred to as neo-adjuvant chemotherapy. Chemotherapy may also be given after surgery to destroy any remnants of cancer. This type of chemotherapy is known as adjuvant chemotherapy.

Radiation therapy- Radiation therapy uses x-rays or other high energy rays to destroy cancer cells. External beam radiation therapy and brachytherapy using implantable radioactive devices are the common methods. Radiation therapy is used in cases of bone cancer where surgery is not feasible due to a variety of factors. It may also be used to shrink the tumours before surgery.

Palliative treatment – This aims to reduce the symptoms and to improve the quality of life. It uses medicines to relieve the pain. It also provides emotional and social support to the patients and their families to cope up with the situation.

Is bone cancer curable?
The chances of complete cure are much more if the cancer is detected very early. Treatments can bring about remission, but the periods may vary. If the condition is detected reasonably early, the bone cancer survival rate is estimated as five years.

Bone cancer treatment is available in all major hospitals in India. The total cost of bone cancer treatment in India depends on the individual cost of the various treatment procedures involved like chemotherapy, radiation, surgery etc. 

Cost of an evaluation is usually around 1500 USD.
Cost of Chemotherapy is 1300 – 1500 USD per cycle.

Apart from these patients will also need to factor in expenses such as travelling costs, hotel stay for the patient and their fellow traveller(s), food and miscellaneous expenses.

Metastatic bone cancer occurs when the cancer has spread from a key organ site to bone. The spine, pelvis and thigh are the most common location of metastatic disease. Unfortunately, bone metastases usually mean that the cancer has progressed to an advanced stage and isn’t curable.

Bone metastasis may not be curable, but with proper treatment, the patient can live a longer life and feel less pain.

Most times, bone metastases may not show any symptoms immediately. If they do, then the following symptoms can be noticed:

       Pain in the bone

       Broken bones

       Urinary and bowel incontinence

       High levels of calcium in the blood

 

For a lot of bone metastasis patients, it is quite possible to maintain a good quality of life. Certain activities will of course be difficult to perform, and a lot of activities will be restricted as well. Since bone metastases can cause bone fractures, patients will need to make certain lifestyle changes to be more careful. However, barring certain restrictions, patients can still continue to live a certain degree of quality life.

Any cancer of the bone is referred to as bone cancer. Primarily there are two types of bone cancers. They are true bone cancers that originate from the bone and metastatic bone cancers that have spread from other organs.

As we all know, bone forms the framework that support our body. Bones are made up of an outer core and an inner hollow where the bone marrow resides. At the end of the bone, is a soft bone-like tissue called the cartilage. This acts as a cushion in joints, the area where one bone connects with another bone. The joints are stabilised by connective tissue-like ligaments, tendons, fat tissue and muscles. Cancer can occur in any of these tissues, apart from cancers originating from the bone and cartilage cells.

Bone cancer can occur due to the spread or metastasis of cancer from other organs. These are more common than true bone cancers. There is a fundamental difference between metastatic bone cancer and true bone cancer. Metastatic bone cancer cells retain the original character of the cells from where the cancer has spread. If the cancer has spread from another organ, the bone cancer cells look and act like cancer cells of respective organs. Hence the treatment for these types of cancers is the same as that of the respective cancers. That is, a metastatic spread of lung cancer to the bone should be treated like a lung cancer. This holds true for cancers from other cells as well.

Bone cancer risk factors:

·       Certain genetic disorders like Li-fraumeni syndrome, Rothmund-Thompson syndrome, Multiple exostoses syndrome

·       Certain diseases like Paget disease

·       Previous history of radiotherapy

·       History of bone marrow transplantation

Prevention of bone cancer:

While there is no way to prevent cancer, there are always ways to minimize the risk of contracting cancer.

     •       Stay away from tobacco. Smoking and chewing tobacco have been linked to many forms of cancers. Avoiding/quitting smoking is an essential part of cancer prevention.

     •       Maintaining a healthy diet. Eating a lot of fruits and vegetables, avoiding or limiting the intake of alcohol, managing weight and reducing the consumption of processed meat can reduce the risk of getting cancer.

     •       Being physically active. It is very important to maintain a healthy weight and be physically active. Yoga, meditation and physical workout should be incorporated into our daily routine.

     •       Ontime diagnosis. It is very important to detect cancer before metastasis. If there is a history of bone cancer in your family, then getting regulars tests/screening done is required.

 

Pain is one of the most common symptoms of bone cancer. People with bone cancer may experience the below mentioned symptoms.

     •       Pain ranging from mild to moderate to severe depending on the stage

     •       Swelling of the affected area

     •       Stiffness and swelling of the joints close to the affected area

     •       Fracture of the affected bone 

 

Some other general symptoms are:

     •       Fever 

     •       Weight loss

     •       Malaise

     •       Anaemia

 

The existence of signs and symptoms, physical exams and imaging tests are conducted to determine if a person has bone cancer. In most cases, doctors will also conduct a biopsy - study tissue or cell samples under a microscope – to confirm the presence of cancer. Accurate diagnosis can be achieved by combining two or more of these tests. Some of these methods of diagnosing bone cancer are:

       X-rays: Most bone cancers can be detected on x-rays. The area where the cancer has developed will look more serrated and sometimes a hole can also be detected in the bone. Occasionally, a tumour can also be detected around the defect of the bone. A chest x-ray is conducted to find out if the cancer has spread to the lungs.

       CT Scans: CT Scans help in determining the stage of the cancer. They help show the extent of the spread of the cancer and if the cancer has spread to the lungs, livers or other organs.

       MRI Scans: These help in outlining the bone tumour.

       PET Scans: PET scans can show the growth of cancer in the whole body. PET scans and CT scans are used together to detect the exact location of the cancer.

       Biopsy: Biopsy helps in accurately diagnosing the grade and type of tumour.

 

Bone cancer stages:

Once the doctors have confirmed that a person has bone cancer, they will try to figure out if the cancer has spread, and if yes, then how far. This is known as staging. There are four stages of bone cancer. Each of these stages have certain sub-stages as well.

Stage 1

The tumour is less than 8cm 

There is no lymph node involvement

Cancer is low grade

TNM Stage- T1N0M0G1

Stage 1b

The tumour is more than 8cm

The tumour can be seen in different parts of the same bone.

No lymph node involvement

TNM Stage-T2N0M0G2 0R T3N0M0G2

Stage 2a

Tumour is more than 8cm long

No lymph node involvement

No spread to distant sites

Tumour is aggressive or high grade

TNM Stage T1N0M0G2 or T2N0M0G2

Stage 2b

The cancer is more than 8 cm long

No lymph node involvement 

No distant spread

High grade tumour

TNM Stage T2N0M0G3 OR T3N0M0G3

Stage 3 

Tumour is more than 10 cm 

Different parts of the bone are affected

No lymph node involvement 

No distant spread

High grade tumour

TNM STAGE T3N0M0G3

 Stage 4a

The tumour can be any size  

No lymph node involvement

Has spread only to the lungs

TNM STAGE T3N0M1Ag3

 Stage 4b

Tumour can be of any size

Has spread to surrounding lymph nodes

Has spread to other organs

TNM Stage any T, any N, M1 b and G3

As with any other types of cancer, treatment of bone cancer is also multidisciplinary. Surgery, chemotherapy, radiation therapy, as well as palliative treatment, are all used. 

Surgery-Surgery for bone cancer involves the removal of the tumour along with a part of normal tissue. Wide excision surgery is the most preferred mode of treatment. This helps to eliminate the need for an amputation of the limbs. Reconstructive surgery after wide excision helps to restore the size and shape of the limbs. But amputations may be necessary if the bone cancer is not in an area that can be easily approached.

Chemotherapy-Chemotherapy destroys cancer cells by preventing their multiplication. High grade and fast -growing tumours are treated with chemotherapy before surgery. The aim is to reduce the tumour size and to destroy metastatic deposits. Chemotherapy before surgery is referred to as neo-adjuvant chemotherapy. Chemotherapy may also be given after surgery to destroy any remnants of cancer. This type of chemotherapy is known as adjuvant chemotherapy.

Radiation therapy- Radiation therapy uses x-rays or other high energy rays to destroy cancer cells. External beam radiation therapy and brachytherapy using implantable radioactive devices are the common methods. Radiation therapy is used in cases of bone cancer where surgery is not feasible due to a variety of factors. It may also be used to shrink the tumours before surgery.

Palliative treatment – This aims to reduce the symptoms and to improve the quality of life. It uses medicines to relieve the pain. It also provides emotional and social support to the patients and their families to cope up with the situation.

Is bone cancer curable?
The chances of complete cure are much more if the cancer is detected very early. Treatments can bring about remission, but the periods may vary. If the condition is detected reasonably early, the bone cancer survival rate is estimated as five years.

Bone cancer treatment is available in all major hospitals in India. The total cost of bone cancer treatment in India depends on the individual cost of the various treatment procedures involved like chemotherapy, radiation, surgery etc. 

Cost of an evaluation is usually around 1500 USD.
Cost of Chemotherapy is 1300 – 1500 USD per cycle.

Apart from these patients will also need to factor in expenses such as travelling costs, hotel stay for the patient and their fellow traveller(s), food and miscellaneous expenses.

Metastatic bone cancer occurs when the cancer has spread from a key organ site to bone. The spine, pelvis and thigh are the most common location of metastatic disease. Unfortunately, bone metastases usually mean that the cancer has progressed to an advanced stage and isn’t curable.

Bone metastasis may not be curable, but with proper treatment, the patient can live a longer life and feel less pain.

Most times, bone metastases may not show any symptoms immediately. If they do, then the following symptoms can be noticed:

       Pain in the bone

       Broken bones

       Urinary and bowel incontinence

       High levels of calcium in the blood

 

For a lot of bone metastasis patients, it is quite possible to maintain a good quality of life. Certain activities will of course be difficult to perform, and a lot of activities will be restricted as well. Since bone metastases can cause bone fractures, patients will need to make certain lifestyle changes to be more careful. However, barring certain restrictions, patients can still continue to live a certain degree of quality life.