"The big bad wolf which attacks young children"
Any cancer is bad but one that affects young children is even more so. It is sad to see young children who should be spending time in school, learning and playing, spend time in the hospital receiving medicines. One such big bad wolf which attacks young children is bone cancer
Bone cancer is not a single disease but a wide spectrum. The commonest and most famous is osteosarcoma. This cancer became famous because this was the final diagnosis in the book “ The Final Diagnosis” by Arthur Hailey. Apart from osteosarcoma there are other types of bone cancers like chondrosarcoma and Ewings Sarcoma. Apart from these bones can also get affected by cancers from some other region like lung or breast.
Osteosarcoma is not a common type of cancer but it has assumed significance because the average age of people getting this cancer is 15 years. It is quite rare to get this type of cancer after the age of 40 years.
The usual way of presentation is pain. This is usually accompanied with swelling. Most parents attribute the pain and swelling to some fall or injury which the child had but what actually would have happened is that the fall would just be an incident which has brought the swelling to their notice. The common areas osteosarcoma affects is around the knee and elbow.
Once a doctor suspects bone cancer the first investigation done is an xray. Osteosarcoma has a very characteristic look called as sunburst appearance on xray . For further confirmation usually MRI is ordered. For confirmation of the diagnosis the doctor usually does a biopsy
Treatment of osteosarcoma should always be taken at a comprehensive cancer centre where medical, surgical and radiation oncology facilities are available. This is because only a multidisciplinary approach can give good results. The team should be well experienced in dealing with these types of cancers.
Until the 1960’s the only treatment available for these bone cancers was amputation. The recommendation always used to be to amputate the limb one joint higher. This leads to young people being cripples for life. The advent of chemotherapeutic drugs and joint replacement prosthesis has changed things for children suffering from this disease. The usual course of treatment for patients with osteosarcoma is to give chemotherapy first and shrink the tumour. Following this the affected joint is removed and replaced with prosthesis. With this sort of treatment amputation is not required in almost 80-90% of patients. Only those patients who have very bulky disease which has gone into the blood vessels or those who do not respond to chemotherapy will require amputation. The chances of cure are to the tune of 60-70%.
A few unfortunate patients present very late with spread to the lungs. The patients too can be effectively treated but the results of treatment are not very good with only about 15% chance of cure. Surgical removal of the lung metastases is also done in a few patients.
Chondrosarcoma is another type of bone cancer. This originates from cartilage and affects older people. Treatment is mainly surgical and chemotherapy and radiation is not used often.
Ewings sarcoma is another rare type of bone cancer and usually affects young children between 10-20 years. This is treated mainly by chemotherapy though additional modalities like surgery and radiation may also be necessary
Terry Fox is one young Canadian who was diagnosed with osteosarcoma at the age of 22 and had to have his leg amputated. Rather than rue about his loss Fox decided to use his life to increase awareness about cancer and ran a cross country marathon with an artificial limb. Terry fox died a year later but the foundation which he started is worth more than 500 million dollars and funds cancer research and treatment across the globe. The Terry fox run is held annually in all countries including India.