I came across a patient recently, an 11-year-old girl with an infectious laugh and a vibrant personality. She had presented to the orthopedic outpatient department with a complaint of swelling and dull aching pain over the knee. Apparently, she had fallen from the staircase of her school. At first, the pain was mild, and her parents brushed it off as a minor injury that would get better with time. But as the pain grew more intense and a noticeable swelling appeared, her parents decided it was time to see a doctor. What they thought would be a routine check-up turned into a whirlwind of medical tests, culminating in a diagnosis of osteosarcoma, a type of bone cancer.
The above is how most children with bone cancers present. Osteosarcoma, like many sarcomas, is often diagnosed late because its symptoms mimic those of common sports injuries or growing pains. By the time the cancer is found, it has often spread, making treatment more challenging.
July is recognized as Bone Cancer and Sarcoma Awareness Month, focused on increasing awareness about these rare and formidable cancers that affect children. Sarcoma and bone cancer profoundly impact young patients and their families, bringing about physical and emotional hardships that go well beyond the initial diagnosis.
5 THINGS TO KNOW ABOUT BONE CANCERS:
A. Survival Rates:
The survival rates vary greatly depending on the type, stage, and spread of the cancer. Thus, early detection plays a key role in the prognosis. According to the American Cancer Society, the five-year survival rate for soft tissue sarcomas is 65.8 percent, while it is slightly higher at 68.9 percent for bone and joint sarcomas.
B. Symptoms to look out for:
The symptoms of primary bone cancers can vary widely due to the many different types, as well as their location and extent. Common symptoms across most bone cancer types include pain, a noticeable lump or swelling, and fractures.
Like other cancers, bone cancer can also lead to weight loss and fatigue. If the cancer has spread beyond the bone, additional symptoms related to the affected body part may occur.
For example, if bone cancer spreads to the lungs, you might experience difficulty breathing.
C. These Rare Childhood Cancers Have a Risk of Secondary Cancers:
Standard treatments for childhood bone cancer and sarcoma, which include surgery, chemotherapy, and radiation therapy, can have lasting effects on patients. Surgery can lead to pain, restricted mobility, or limb length discrepancies, often necessitating rehabilitation and physical therapy. Chemotherapy may result in temporary or long-term issues such as fatigue, nausea, hair loss, a weakened immune system, and a heightened risk of infections. Radiation therapy can cause skin irritation, fatigue, and long-term consequences such as impaired bone growth.
Survivors of sarcoma and bone cancer face the risk of developing secondary cancers later in life. These secondary cancers may include stomach cancer, thyroid cancer, melanoma, and acute myeloid leukemia.
D. The Potential Link to Inherited Disorders:
Bone cancer and sarcoma in children may be linked to certain inherited disorders. For instance, children with Li-Fraumeni syndrome, a rare genetic condition caused by mutations in the TP53 gene, have a higher risk of developing osteosarcoma, the most common type of bone cancer. Additionally, children with hereditary retinoblastoma, a genetic eye cancer, may be more susceptible to bone tumors, including osteosarcoma.
Genetic counseling and regular check-ups are recommended for individuals with these inherited disorders to monitor their health closely and detect any signs of sarcoma and bone cancer at an early stage.
E. Diagnosis and Treatment
To confirm the diagnosis a biopsy is done. Bone cancers and sarcomas although challenging to treat, the advancements in chemotherapy and radiotherapy have drastically improved the survival rates. Depending upon the type of cancer, chemotherapy and/or radiotherapy is given in cycles. Thanks to the advancements in surgery, depending upon the spread, a limb salvage surgery can be done where the affected limb can be saved, using an implant. In circumstances where the limb cannot be saved, an amputation is done.
WHAT TO EXPECT?
As bone cancers mainly affect the pediatric age group unfortunately, the parents must be counseled about the treatment regimen and the possible outcomes. Chemotherapy causes loss of hair, episodes of fever and infection might occur after each cycle, due to a decrease in the neutrophil count (A white blood cell that fights infection in the body) and not to mention the great deal of pain a patient experiences after an orthopedic surgery. The treatment is based on the collective effort made by the orthopedic surgeon, medical oncologist, nurses, physiotherapist, psychotherapist, etc.
HOW YOU CAN GET INVOLVED:
There are many ways to support Sarcoma Awareness Month and contribute to the fight against bone cancer:
Spread the Word: Share information on social media, participate in awareness campaigns, and talk to friends and family about the importance of early detection.
Donate: Support organizations dedicated to sarcoma research and patient support.
Volunteer: Offer your time to local cancer support groups and awareness events.
CONCLUSION:
The patient I mentioned above underwent neoadjuvant chemotherapy (chemotherapy given before and after surgery) and limb salvage surgery and is currently undergoing physiotherapy. The patient is thankfully alive and doing well.
As we navigate through Sarcoma Awareness Month, let’s remember the faces and stories behind the statistics. Together, we can bring hope to those affected by bone cancer and sarcomas, ensuring that no one faces this battle alone.
-Yousra Iftequar
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