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Bone Cancer
Dr Kingsley’s comments Cancer of the Bone. This section refers to primary bone cancer, as the bones can be the site of spread from other primary cancers, such as of the breast or prostate, when it is described as secondary bone cancer. Primary bone cancer, often referred to as an osteogenic sarcoma, occurs mainly in young people, mainly young men, aged from 10 to 20 years of age, although it can rarely occur later in life as a complication of Paget’s disease of the bone. Secondary bone cancer tends to occur in older people who have had cancer earlier on and will inevitably cause a degree of pain. Signs and Symptoms. Any bony swelling somewhere near the shoulder, hip or knee in a young person is assumed to be a primary bone cancer until proved not to be so. It can inevitably cause pain and swelling, with a degree of limitation of movement and a limp if in a lower limb. The appearances on X-ray are classical to an experienced Radiologist, as the tumour tends to occur at the growing end of the bone. Because of the serious significance of the diagnosis and the possible need to amputate the affected limb, the other possible explanations for the swelling need to be seriously considered. These are osteomyelitis, a condition called myositis ossificans (which is basically a bony-like response within nearby muscles and tendons to some sort of injury), a benign aneurysmal cyst, and two other types of cancer, namely a Giant cell tumour or a Ewing’s sarcoma.Conventional Treatment. Chemotherapy, using various combinations of drugs, is the first line of treatment. I find it interesting that medical textbooks talk about achieving significant regression of the primary tumour in over 80%, but an overall survival rate of only 40% at five years. This is an improvement on the 15% 5-year survival rate that used to be achieved before pre-operative chemotherapy was introduced. Once the course of chemotherapy has been completed, the tumour is assessed to see what sort of operation is possible. Various limb-preserving procedures are possible, sometimes needing a prosthesis to be inserted into a hip, knee or shoulder to stabilise it, which it may be possible to remove at a later stage. If a local operation is not practical, amputation above the level of affected bone will be considered, so long as there are no secondaries. If there are, amputation is considered to be of no value, in which case further courses of chemotherapy will be recommended. Spread tends to be into the lungs, which it may be possible to remove surgically if there is only one solitary tumour or only a few accessible secondaries confined to one lung. An Explanation by Dr Kingsley Before Your Consultation about your Bone Cancer “Most consultations with doctors are fairly quick affairs, lasting perhaps five minutes, even if you are suspected of having bone cancer. You may be lucky to have more time spent on you, but when you have your consultation with me, I will spend as much time as you want. There is no time limit. We will take as long as you want. Often when I see some people for the first time, they are in a state of panic. They haven’t a clue what it is all about. No one has explained anything to them. Perhaps in the past they have been admitted for an emergency operation, or they had simply been told to come into hospital on such-and-such a day when they were either operated on or started a course of chemotherapy or radiotherapy. Once in hospital some sort of explanation may have been given, and you were probably seen by a junior doctor who not only took a short history of any symptoms you had, but also examined you to look for any signs of your bone cancer, but, by then, you were already captive and didn’t really have much choice in the matter. To be fair to doctors, they assume that their advice is the best on offer. After all, they are the experts. Virtually all doctors would treat your condition in roughly the same way, so it seldom occurs to them that you just might not want to follow their advice. In any case, most patients have been frightened by their diagnosis and want to get on with the treatment, assuming that the doctor can deal with it for them. Most people put their faith in their doctor, assuming he knows what he is doing. There is absolutely no intention on my part to tell you whether to follow your doctor’s advice of not. That is a decision you have to make. No one can make it for you, but I will help you make up your mind. The Consultation The virtual consultation with me has been planned as though you are with me in my consulting room. I will go though your history, or the history that I come across so often, explaining the parts of it that give me clues to the cause of people’s problems. The chances are that, having taken a medical history from many thousands of patients over nearly forty years of medical practice, especially in the detail that I find so valuable, it is likely that much of it will be appropriate to you. The consultation is one of the longest parts of this programme, as you would imagine, and it is full of fascinating information. Periodically I lecture to medical colleagues on the subject of ‘What a clinical history and the clinical examination can tell me’. All this information is the result of my many years of listening to patients, letting them tell their stories, believing in their observations that have often been ignored, and learning by experience. So, enjoy yourself, feel enlightened, smile, be happy and radiate confidence in what you are going to do. Be positive and forget the doom and gloom merchants. If someone has given you a poor prognosis, forget it. You no longer fit into their statistics. You are going to do something for yourself. You are now in charge. ---------------------------------------- What you do now is in your own hands. We would like you to take advantage of all the benefits of becoming a member of our Cancer Help Centre, which is free to join, so please look at the Members’ Area Overview, where you will find a summary of all that is on offer. |
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(c) 2006 |
