The “Yellow April” campaign, which the Brazilian Association of Orthopedic Oncology (ABOO) is developing this month to alert the population about the importance of early diagnosis of bone cancer, has physicians as its main focus. The president of ABOO, Edgard Engel, said that because it is a rare disease, the professionals themselves find it difficult to know what is the best conduct for the treatment.
“That’s why we chose to run a campaign aimed at the doctor who is faced with a patient with a bone tumor, so that he can be referred to a specialized center where he can make the diagnosis and undergo the best possible treatment”.
Despite corresponding to only 1% or 2% of cancers in general, bone is a very important focus for the spread of cancer from other organs. “It’s the bone metastases. Therefore, it ends up having a double interest”, commented the oncological orthopedist. In children and adolescents, bone cancer is the third most frequent, after leukemias and brain cancer.
Edgard Engel explained that primary bone cancer has two peaks of incidence, one in children, adolescents and young adults and another in the elderly patient, where the main diagnosis is multiple myeloma. In the younger age group, one of the common manifestations of bone neoplasia is the appearance of a hard mass, or bone mass, often accompanied by more or less intense pain. “Eventually, you may have another symptom related to the location, such as limitation of movement, difficulty walking.”
The doctor clarified that bone cancer, with the exception of Ewing’s sarcoma, usually has no systemic clinical symptoms, such as fever and weight loss. The first evaluation of the patient can be done by a general practitioner at a health center, advised the president of ABOO. “A bone pain that appears and has no explanation, that limits activity, does not go away with time, a pain that persists after two weeks, deserves investigation with radiography”.
A quality X-ray will show what the cause is and, if it is cancer, skeletal changes will appear. A more careful observation of the radiograph already allows the doctor to say that something is wrong and, then, refer to an orthopedist or, if cancer is already confirmed, refer to a referral center.
“We are very keen that this referral, after the suspicion of bone cancer is confirmed, is to a referral center, because the biopsy, one of the first procedures to be performed, has to be carried out sparingly. Ideally, the surgeon who will perform the definitive treatment also performs the biopsy. We reinforce the idea that this referral is early”. These specialized centers are more prompt and quick to perform the necessary tests, he noted.
Bone neoplasm is an uncontrolled growth of cells that causes solid tumors or large abnormal cell growth. When this tumor has the ability to spread to other organs and becomes a life-threatening neoplasm, it is called a malignant tumor.
On the other hand, neoplasms in which there is growth and, eventually, destruction of bone or neighboring tissues, but without the ability to spread to the rest of the body and affect other organs, are called benign tumors. For the most part, they are not life-threatening, unless they are located in a region that is very difficult to access or treat.
It is estimated that 6,300 new cases of malignant bone tumor arise in Brazil each year. There are no statistics for benign bone tumors, explained the president of ABOO. This explains why many of these tumors are asymptomatic. They don’t have any kind of damage to health, complaints, pain. “None of that shows up. Many of them are found, fortuitously, in a simple X-ray exam or an MRI”.
As there are several types of bone cancer that can affect different age groups, treatment varies greatly. The most common tumors, which affect children and adolescents, are osteosarcoma and Ewing’s sarcoma. They are initially treated with chemotherapy for about three to four months, so that blood tests are normalized. There, it is possible to have surgery to remove the tumor, followed by reconstruction. The patient then returns to chemotherapy. The complete treatment lasts eight to ten months. “It is important that he returns to chemotherapy to consolidate the treatment and achieve the expected result”.
In the case of the elderly, some patients are operated on immediately, soon after diagnosis, and others dispense with chemotherapy. Some tumors are initially treated with chemotherapy and eventually do not even need surgery. It will depend on the initial evaluation of the doctor, made with the help of exams.
The “April Amarelo” campaign warns of the importance of early diagnosis of bone cancer. Edgard Engel highlighted that the rarity of the disease is the main difficulty for early diagnosis, since the pain can be confused with other more common conditions and treated symptomatically.
Metastases are the most common malignant bone tumors. The primary cancers that most commonly lead to the development of bone metastases are prostate, breast, lung, kidney, thyroid, bladder, intestine, and stomach. The bones most affected are those of the skull, ribs, spine, pelvis, humerus (arm bone) and femur (thigh bone).
Orthopedic oncology deals with the treatment of benign and malignant, primary and metastatic bone tumors and soft tissue tumors. Some cancers, such as osteosarcoma and Ewing’s sarcoma, are highly capable of producing metastases, while others, such as chondrosarcoma, rarely do so, the association said.
The entity holds the Brazilian Congress of Orthopedic Oncology, considered the largest event on musculoskeletal tumors in Brazil. This year, the twelfth edition of the congress will be held from the 27th to the 30th of this month, in Gramado (RS). National and international speakers will discuss advances in diagnostic imaging, novelties in the treatment of bone and soft tissue sarcomas, desmoid tumors, bone metastases, among other topics.