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Overview of Bone Cancer in India
Bone cancer is when cells in the bone divide in an unregulated fashion. Like all cancers, bone cancer can develop as a small mass in a part of the body or spread to the surrounding tissues and organs, which is metastatic cancer. When the organs, such as the lungs and breast cancer, develop in the bone, it is called primary bone cancer. Primary bone cancer is sporadic and occurs in less than 1% of cases. Most of this cancer, which is present in the bone in cases of metastasis, is from other parts of the body. In case of bone cancer, India has the most cases in the age group of 11-20 years.
Bone cancer can be classified into several different types, including osteosarcoma, Ewing’s sarcoma, chondrosarcoma, multiple myeloma and sarcoma. Osteosarcoma is the most common type of bone cancer. The prognosis of the cancer after diagnosis usually depends on the stage of the disease, the location of the tumour, the overall health of the individual, and whether the cancer has spread. In some people, it is possible to cure the cancer completely, but in other cases, the cancer may have spread to other areas, which makes it impossible to get rid of all the cancer. In such cases, a combination of treatments is used rather than a single treatment.
In India, for the treatment of bone cancer, the costs can fluctuate from 300 to 3626 USD. The price may vary based on the treatment procedure, hospital infrastructure, doctor's experience, patient's health, and city.
What Is Bone Cancer?
"Bone cancer" encompasses a range of cancers that occur in the bones of the body. When any type of cancerous cell grows in a bone, normal tissue can be destroyed. Bone cancers can develop in any bone in the body, although they tend to occur more frequently in the femur, tibia, or humerus.
Cancers that occur in bone itself, and which are classified as primary bone cancers, or bone sarcomas, are relatively rare. Many malignant tumours that arise from inside organs, or other tissues in your body, can spread to the bones as well as to different places in your body, and these growths are called "bony metastases." The most common tumours, which are most likely to metastasise (i.e., spread to bones), are those arising from breast, prostate and lung cancers.
Bone cancers are serious and require immediate treatment. The good news is that health care providers can treat bone cancers and, in some cases, cure them.
Types of Bone Cancer:
There are three primary types of bone cancer. The type of cell and tissue where the cancer begins specifies the type of bone cancer:
Osteosarcoma. This is the most common type of bone cancer. An osteosarcoma is a malignant, aggressive neoplasm of bone that arises from cells when new bone tissue is formed. Most osteosarcomas are found in patients who are adolescents and/or teenagers, but they may also occur in young adults or children.
Ewing sarcoma. This term refers to tumours that can also originate in your bones, but will also originate in soft tissue associated with your bones. Ewing sarcomas are soft tissue tumours most commonly found in children and teenagers, but can occur in young adults, too.
Chondrosarcoma. Acknowledging that these tumours arise from so-called soft tissue. Chondrosarcoma tumours arise from soft connective tissue (cartilage) that allows joints and bones to move against each other. Chondrosarcoma in young adults is very rudimentary.
Rarer types of bone cancer include:
Chordoma. These tumours develop in the spine or the base of the skull.
Fibrosarcoma. These tumours develop in the fibrous connective tissue at the ends of bones.
Giant cell tumour. These benign (non-cancerous) tumours may become cancerous, but this is rare.
Undifferentiated pleomorphic sarcoma. These aggressive tumours develop in soft tissue and bone.
The staging of bone cancer is necessary because it helps determine the extent of the tumour and provides guidance regarding treatment. The American Joint Committee on Cancer (AJCC), or TNM system, is the most recognised staging system for bone cancer. There are three main factors evaluated with the TNM system:
T (Tumour): Describes the size and degree of the primary tumour.
N (Node): Describes the absence/presence of cancer in regional lymph nodes.
M (Metastasis): Describes whether cancer has spread (metastasised) to other areas of the body.
G (Grade): Describes how abnormal the cancer cells look under a microscope. The nuclear feature of cancer cells is the most commonly considered factor when determining the grade of cancer. This can also suggest how quickly the cancer may grow and spread.
The stages of bone cancer are:
Stage 1: Cancer is confined to the bone. This can be further classified into two phases:
- Stage 1A: The tumour size is less than 8 cm and is either low-grade (diagnosed low-grade) or grade unknown.
- Stage 1B: The tumour (regardless of its grade) is more than 8 cm or multifocal (found at multiple places within the same bone).
Stage 2: Cancer remains in the bone but is now high-grade.
- Stage 2A: The tumour is less than 8 cm.
- Stage 2B: The tumour is more than 8 cm.
Stage 3: Multiple, high-grade tumours exist within the same bone.
Stage 4: Cancer has metastasised to other locations in the body. Stage 4 can be further divided into two sub-stages:
- Stage 4A: Cancer has metastasised to the lungs.
- Stage 4B: Cancer has metastasised to a lymph node (or nodes) or an organ other than the lung.
Procedure:
Chemotherapy
Drugs in this treatment can be administered either orally or injected into a vein, which then travels to the tumour location and kills the cancer cells. For the cancer that has moved away from one area and not settled, chemotherapy will be chosen because of its systemic availability. Some of the drugs used to kill the cancer cells in the bone cancer treatment are:
Etoposide (VP-16)
Ifosfamide
Cyclophosphamide
Doxorubicin (Adriamycin)
Cisplatin
Radiation Therapy
Radiation therapy destroys the cancer cells by using high-energy rays. The common procedures for radiation therapy include:
External beam radiation therapy: High-energy X-rays from the source outside the body are directed to the tumour by penetrating through the skin. The X-rays are powerful enough to destroy the tumour cells.
Intensity modulated radiation therapy: stable doses of the high-energy rays are directed to the tumour from multiple different angles, all at the same time, to kill more of the cancer cells and limit the damage to normal tissue in the surrounding area.
Stereotactic radiosurgery: high doses of radiation are directed at a tiny tumour. This is usually done in a single session.
Proton beam radiation therapy: uses protons (instead of X-rays) to destroy the tumour cells. This is very important for very delicate areas that limit the intense radiation to the surrounding area.
Target Drug Therapy
The objective of these drugs is to limit the growth of cancer cells. It does so by blocking the specific proteins in the tumour cells that promote the development of those tumour cells. The drugs that are given are:
Sunitinib
Erlotinib
Lapatinib
Sorafenib
Immunotherapy
This treatment uses the body's natural defence against the tumour-growing cells, and the drugs used are:
Pembrolizumab
Interferon alfa-2b
Surgery
The surgery to remove the tumour due to bone cancer is not cosmetically acceptable. There are two main types:
Limb salvage surgery: Limb salvage surgery is a limb-sparing surgery. It involves the removal of cancer cells, as well as some adjacent normal tissue and the limb itself.
Amputation: Amputation is the removal of the affected arm or leg where the cancer has spread to the entirety, and removal of the entire limb is critical for stopping the cancer cell division.
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Cost of Bone Cancer in India
|
Treatment |
Min |
Max |
|
Chemotherapy |
300 USD |
600 USD |
|
Radiation therapy |
3800 USD |
5800 USD |
|
Surgery |
5000 USD |
7000 USD |
|
Others |
500 USD |
800 USD |
The total cost of the procedure also varies, depending on the patient's conditions and choices. Some of the parameters for each are:
Type of hospital and room selected (general, twin sharing, or single accommodation)
The stage and type of cancer
Repetition of investigation through PET CT and related tests after surgery/chemotherapy/radiotherapy (often needed)
Additional tests are required to determine the status of the disease during treatment
A longer hospitalisation period
Cost of accommodation during follow-ups (in case the patient is not a local person, may take a longer duration in case of chemotherapy or radiotherapy sessions]
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Indications of Bone Cancer:
Bone cancer is not common. It accounts for only less than 1% of all cancers in the U.S. While they can occur at any age, bone cancers are more common in children, teens and young adults than in older adults.
Tumours that grow in your bones have a greater chance of being benign. Benign tumours do not spread through the body, unlike bone cancers.
What Are The Symptoms Of Bone Cancer?
Many people with bone cancer have no telling symptoms beyond a painless lump. Others can develop a range of symptoms. Some symptoms are easily confused with other conditions, and providers might think you have something like “growing pains,” sports injuries, arthritis, or Lyme disease. This can complicate the process of narrowing it down and delay your diagnosis.
The most common symptoms of bone cancer include:
Bone pain that becomes progressively constant (usually worse at night and can feel throbbing, aching, or stabbing)
A lump in the area that could be hard or soft
Unexplained swelling around the affected area of the bone
Difficulty getting around (swelling near a joint)
Fatigue
Fever
The process of diagnosing bone cancer involves several tests or procedures to confirm the presence of cancerous cells in the bone and determine the stage of the cancer. The following describes the diagnostic process in greater detail:
Medical History and Physical Exam
Your doctor will first want to know information about your symptoms, any previous medical history and risk factors. During a physical exam, the doctor will evaluate you to see if there are any noticeable lumps or areas of tenderness.
Imaging Tests
These studies produce images of the bones and adjacent tissues, which can help locate tumours or irregularities. Imaging studies can be used in several ways and are listed below:
- X-Rays: X-rays are the primary choice for detecting tumours in the bone. Changes in bone can be seen on plain X-rays, and abnormal bone growth can be demonstrated on X-ray images.
- CT scans: CT scans produce horizontal images of the body. CT scans are used to determine the exact size and location of the tumour in the bone.
- MRI scans: MRI scans produce these images by imposing magnetic fields on a person. MRI scans produce images of both soft tissues and bones. MRI scans can help distinguish between benign tumours and malignant tumours.
- PET scans: PET scans can be used to find areas of high sugar consumption in the body. Cancer cells typically consume more sugar than normal cells, and this imaging study can help identify cancerous cells.
- Bone scans: Bone scans involve the injection of a radioactive substance, after which you will lie on a bed for the scanner to find abnormalities in your bones.
Blood Tests
Blood tests can reveal information, but they cannot identify bone cancer on their own. Elevated levels of certain enzymes may indicate the presence of bone tumours.
Biopsy
There is a strong chance of confirming bone cancer through this route. Small pieces of tissue will be removed from suspicious areas for evaluation, with a focus on identifying cancer cells under a microscope.
- Core Needle Biopsy: Most commonly recognised method uses a hollow needle to obtain tissue samples. Most can be done as an outpatient under local anaesthesia.
- Incisional Biopsy: In certain clinical situations, a minor surgical procedure may be necessary to obtain a larger tissue sample for diagnostic purposes. This would occur during a general anaesthesia procedure.
Risk Factors:
Genetics
Individuals who have a positive family history of eye cancer are significantly more likely to go on to develop bone cancer during their lifetimes. Other positive family history of sarcoma raises the risk of boner cancer in first-degree relatives.
Prior Radiation Therapy
The individuals who have had high doses of radiation in the past are at a significantly increased risk of developing bone cancer, in the exact location where they received the radiation. It may take many years to decades. Thus, people treated with radiotherapy should be screened after 4-5 years.
Benign tumours
Fibrous dysplasia and Paget's disease of bone in adults place individuals at risk of developing bone cancer. They increase the risk of the most typical form of cancer, which is osteosarcoma.
Cancer in Another Site
Cancers in any area may metastasise to the bone via blood or lymph nodes. Because cancer may develop anywhere in the body, the presence of bone cancer via a tumour in a different area of the body is always a possibility.
Prior Chemotherapy chars of chemotherapy
Some of the classes of chemotherapeutic agents (e.g., alkylating agents and anthracyclines) are risk factors for developing bone cancer.
Mitigating the Risk of Bone Cancer
Identifying effective prevention methods for bone cancer is a difficult venture as we still do not fully understand what causes it. However, understanding the risk factors and early detection can help with the diagnosis and destruction of bone cancer by remaining aware of risk factors. With this, there are recommended approaches to take into consideration:
- Genetic Testing: For people with a familial risk of bone cancer or a family history of related genetic syndromes, genetic testing and counselling can provide information about what risks may exist.
- Limiting Radiation: Radiation therapy is a primary treatment technique for certain cancers. However, limit exposure to ionising radiation, and you may even think about not exposing yourself to the result of incidental doses used in some imaging studies.
- Ongoing Imaging: Stay up to date with regular check-ups and X-ray reports to monitor for any bone abnormalities or tumours. The ability to detect these early will contribute to the effectiveness of the treatment approach.
- Healthy lifestyle choices: Maintain a healthy lifestyle even if there is no direct relationship between the two, and you do not have a cousin who has had bone cancer. Maintaining frequent exercise and healthy diet habits will lead to feeling better and being more nutritious, while contributing to the prevention of many diseases as we move forward on a healthy path.
Frequently Asked Questions (FAQ’s)
There live the blind texts separated they right at the coast of the Semantics.
Although the price of bone cancer surgery varies greatly, it usually falls between $5,000 and $12,000 in India. The price range in the US is between $80,000 and $150,000. The type of surgery, the hospital or clinic, the surgeon's fees, and the necessity of further treatments, such as radiation therapy or chemotherapy, are some of the variables that affect the cost.
Indeed, there are numerous instances in which bone cancer can be cured, especially if caught early and stopped from spreading. Numerous variables, including the cancer's form, stage, and treatment approach, affect the likelihood of a full recovery.
Depending on the type of surgery, the hospital, and the physician's experience, bone surgery in India can cost anywhere from ₹20,000 to ₹5,00,000 or more. Several factors, including pre-operative examinations, anaesthesia, the surgical method, implants, and post-operative care, influence the final cost.