There are over 80 different types of sarcomas and they can occur anywhere in the body. While sarcomas often form in the connective tissues, they can also form in the bones and spine. These cancers are rare, and treatment will be dependent on the type and location of the sarcoma. The OSUCCC – James is home to central Ohio’s only Sarcoma Clinic with full-time staff dedicated to treating these cancers.
Types of bone and spine sarcomas
Sarcoma is a rare cancer that forms in the body’s fat cells, soft tissues such as muscles, nerves or tendons, blood vessels, tissues that surround joints, the spinal cord or the bones. There are several different types of bone and spine sarcomas (primary bone tumors) and each have a unique and specialized treatment.
The main subtypes include:
- Osteosarcoma
- Chondrosarcoma
- Chordoma
- Giant cell tumors of bone (GCTs)
- Ewing’s sarcoma
For some subtypes, there’s a close need for collaboration with surgical oncology, radiation oncology and medical oncology teams for management of primary chordomas, and for giant cell tumors, surgical oncology and medical oncology teams will collaborate for management of GCTs.
Bone and spine sarcoma symptoms
Bone and spine sarcomas at first may not have any symptoms at all. However, osteosarcoma, chondrosarcoma and Ewing’s sarcoma all have similar symptoms.
These can include:
- Swelling over a bone or bony part of the body
- Constant pain at rest in a bone or joint
- Intractable pain
- Fever for no known reason (only for Ewing’s sarcoma)
- A bone that breaks for no known reason
- Neurological deficit (spine sarcoma)
- Spinal instability (spine sarcoma)
Just because you have any of these symptoms doesn’t mean you have bone or spine sarcoma. There are many other conditions that can cause similar symptoms. Talk to your doctor if you’re experiencing any unusual symptoms.
Bone and spine sarcoma risk factors
A risk factor is anything that could increase the likelihood that you develop a condition. Risk factors are things you can and can’t influence.
When it comes to bone and spine sarcomas, there are a few risk factors that could influence if you’re at risk.
- Age: Ewing’s sarcoma and osteosarcoma are usually found in children and young adults
- Previous radiation therapy for other conditions
- Previous treatment with anticancer drugs
- Having a certain change in the retinoblastoma gene or hereditary retinoblastoma
- Having certain conditions, such as:
- Paget‘s disease
- Li-Fraumeni syndrome
- Rothmund-Thomson syndrome
- Werner syndrome
- Multiple hereditary exostoses (MHE)
- Ollier disease
- Maffucci syndrome
Just because you may have a risk factor doesn’t mean you’ll get the disease. It’s important to talk to your doctor to understand your risks.
Metastatic carcinoma of bone and spine
Sometimes, cancer can spread and requires a different approach. Metastatic carcinoma of bone and spine (also called metastatic bone disease) is a cancer that begins in an organ, such as the lungs, thyroid, kidney or prostate or breast, and then spreads to bone. The OSUCCC – James is the only facility in central Ohio that provides comprehensive multidisciplinary care of this disease.
When cancer begins in an organ and then spreads, it may go to the lung or liver or will spread to a part of the skeleton.
When cancer spreads to the skeleton, it will often go to one or more of the following places:
- Spine
- Pelvis
- Ribs
- Skull
- Long bones of the upper arm
- Long bones of the leg
Metastatic bone carcinoma symptoms
Some of the common symptoms for metastatic bone carcinoma may include:
- Pain (especially pain that increases with weight bearing) in the spine, pelvis, legs or arms
- Constant pain at rest
- Fractures, even from a seemingly minor trauma
- Hypercalcemia (high levels of blood calcium)
Bone and spine sarcoma treatments
Experts at the OSUCCC - James use a multidisciplinary approach to treating sarcomas. We understand that your cancer is different and requires a customized treatment plan. Our team of surgical oncologists, radiation oncologists and other experts will work together to determine the right options for you. Your team may recommend one or a combination of treatments. Whether your cancer is localized to one area or has spread, our team can help.
The most common treatments include:
Surgery
Surgery for bone and spine sarcoma is specialized by the type of sarcoma you have. You may need surgery to remove the sarcoma as well as reconstruction surgery to restore function.
Your OSUCCC – James specialized sarcoma surgeon will perform surgery to remove the sarcoma. If you have osteosarcoma or Ewing’s sarcoma, chemotherapy is most often given before surgery to make the tumor smaller and require removal of less bone tissue. You may also require chemotherapy after surgery to help prevent potential spread of the tumor. In select cases of Ewing’s sarcoma, you may receive radiation therapy after surgery if the tumor hasn’t responded well to chemotherapy.
Your sarcoma surgical oncologist may replace the removed tissue and bone to improve your function after surgery. The healthy tissue, bone or metal bone replacements used for reconstruction may be taken from another area of your body or the surgeon may use an implant of artificial bone or tissue and/or a metal implant. These metal bone replacements restore the function of the damaged bone and require continued long-term care for optimal outcomes.
Chemotherapy
Chemotherapy drugs stop cancer cell growth by either by destroying the cells or stopping them from dividing. When chemotherapy is given before surgery, it can shrink a sarcoma. After surgery, it can lower the risk that the bone sarcoma will return.
Chemotherapy drugs can be taken by mouth or injected into a vein or muscle. They may be given over a period of months, although most sarcoma chemotherapy is given within an inpatient environment to get rid of the cancer.
When the drugs enter the bloodstream, they can reach cancer cells throughout the body (called systemic chemotherapy). Combination chemotherapy uses more than one anti-cancer drug.
Chemotherapy treatment for clinical trials can take place in an outpatient part of the hospital, at your doctor's office or in your home. You may need to stay in the hospital for treatment.
Radiation therapy
Radiation therapy can be used instead of surgery in select cases of Ewing’s sarcoma to achieve local control of the tumor.
Radiation therapy uses high-energy X-rays or high-energy protons to kill cancer cells or keep them from growing. Doing this can also shrink a tumor, making surgery more successful. This is done prior to surgery to shrink the tumor and to pull it away from other structures such as veins and arteries.
Postoperative radiation therapy is used to destroy any remaining cancer cells. Some tumors cannot be removed by surgery and you will have radiation therapy to destroy the tumor. Radiation also is used to treat sarcomas that spread to other parts of the body.
Targeted therapy
Targeted therapies are drugs that attack cancer cells without destroying healthy surrounding cells. By delivering these drugs in combination with chemotherapy, targeted therapies interrupt certain proteins and receptors to stop cancer cells from growing.
Bone and spine sarcoma clinical trials
If you have specific bone or spine sarcomas, you may be eligible to participate in a clinical trial at the OSUCCC – James. Currently, there are over 20 clinical trials underway to find new treatments for sarcoma. We are one of only a few U.S. cancer centers funded by the National Cancer Institute (NCI) to conduct phase I and phase II clinical trials on novel anticancer drugs. Not everyone is a candidate for a clinical trial, but your team of doctors will determine if it’s right for you.
To make an appointment with our bone and spine sarcoma specialists, please call The James Line at 614-293-5066 or 800-293-5066.