Childhood Bone Cancer
About the disease
Cancer that begins in the bones is rare and affects more children than adults. Researchers don’t know why it occurs, but there may be a family predisposition in some cases.
- Osteosarcoma is found mostly in growing bone tissue. It is the most common type of bone cancer in children. Almost 80 per cent of cases are diagnosed in the distal femur, the part of the thigh bone closest to the knee. It can also occur in the proximal humerus, the upper arm bone attached to the shoulder.
- Ewing’s Sarcoma usually occurs in the immature tissue in the bone marrow. It is actually a group of four different kinds of cancer, known as the Ewing’s Family. It can occur at young ages but mostly affects those 10-20 years old.
There are about 10 cases of childhood bone cancer diagnosed in Alberta every year.
Risk factors
Risk factors are determined by analyzing the numbers of patients with cancer in a larger population and trying to find differences in the characteristics or behaviors between those individuals who develop cancer and those who do not. The Alberta Cancer Board’s Tomorrow Project, for instance, is tracking more than 50,000 Albertans over a fifty-year period to learn more about who develops cancer and why.
Radiation therapy for other cancers can increase the risk of developing bone cancer, although today’s treatments are more targeted and the risk is less than it was a decade ago.
Factors that may increase the risk of developing childhood bone cancer include:
- Gender: more common among boys
- Race: more common among Caucasians
Genetic link
Although the cause of bone cancer is not known, there may be a hereditary factor, including among those who have: Li-Fraumeni Syndrome (a hereditary mutation of a cancer susceptibility gene which also increases the risk of other cancers), Rothmund-Thomson Syndrome (a rare inherited disorder that appears in infancy), Hereditary Retinoblastoma (a gene mutation that causes cancer cells to grow on the retina) and Multiple Exostoses(a genetic disorder that produces bumps on the bones).
Ewing’s Sarcoma produces an abnormal gene that can be detected with DNA testing, however, it’s not passed from parent to child and it’s rare for the gene to occur in more than one member of the family.
Detection and diagnosis
Children with bone cancer usually feel pain in the bone. It can occur anywhere, but mostly frequently in the long bones of the arms and legs and it can be worse at night. The disease can weaken the body’s skeleton, sometimes leading to easy fractures. Children can also experience swelling of the joints, lumps that are warm to touch, fatigue, fever and unexplained weight loss.
An X-ray is usually the first test when a child has bone pain. That may not be enough to detect the signs, so a further imaging test such as an MRI or CT scan could be needed.
A bone scan involves injecting a tracer, or a tiny amount of radioactive material, into the bones to create images that can be tracked with a special camera.
A biopsy is the only way to confirm a cancer diagnosis. It may be done with a thin needle to remove small pieces of tissue that will then be examined under a microscope. A surgical biopsy involves removing all or part of the tumour.
Treatment
Treatment options for childhood bone cancer include surgery, chemotherapy and radiation therapy, sometimes in combination depending on the progression of the disease.
Surgery is the most common treatment for bone cancer. If the cancer hasn’t spread, then the tumour and a rim of healthy tissue surrounding it are removed. Amputation was once a common treatment for bone cancer in the arms and legs, but new treatments have meant the limbs can often be saved.
Chemotherapy is sometimes used in conjunction with surgery, and especially in cases of Ewing’s sarcoma, which has a tendency to spread quickly.
Radiation therapy, concentrated beams of high-energy X-rays, is sometimes used alone or in combination with chemotherapy.
Links:
Childhood Cancer Foundation
National Comprehensive Cancer Network (U.S.) guide to treatment decisions with links to other sites
National (U.S.) Cancer Institute guide to childhood cancers
Factors affecting prognosis
As with many cancers, the patient’s age and general health are factors in how they respond to treatment. Survival is affected by how early the bone cancer is detected. If the tumour is small and has not spread then almost 90 per cent of patients are still alive after five years. But the outcome is less promising if the cancer has spread to other parts of the body.
Childhood cancer can result in what’s called “late effects”, health problems caused by treatment that can show up months or even years later. For more information:
National (U.S.) Cancer Institute
Learn more
Support for childhood bone cancer patients and their families
- Psychosocial and spiritual support, Edmonton,
Cross Cancer Institute
- Phone: (780) 432-8703 or 8704
- Psychosocial and spiritual support, Calgary,
Holy Cross site of the Tom Baker Cancer Centre
- Compassion House
How you can help
Other Resources
Canadian Cancer Society
Child Cancer Net