Bone Cancer: Differentiating It From Children's Developmental Pain

Everyone can have bone cancer, but children and adolescents are more prone to this critical illness. According to the Hong Kong Cancer Registry statistics, bone cancer is one of the five most common cancers among those aged 0-19.

Sometimes, people may be confused or unaware of the early symptoms of bone cancer since the symptoms are pretty similar to osteoarthritis, growing pains, common back pains and soreness. In the 70s, amputation was the primary way to treat bone cancers in the arms or legs. Nowadays, bone cancer treatment incorporates tumour removal surgery and chemotherapy to raise patients’ survival rates and save more of their limbs.

What Is Bone Cancer?

Bone cancer is the most common type of cancer which starts in the cells that make up the bone. The tumour cancers cells are similar to the newly developed bone tissues, but the latter has an organised structure.

Locations of Bone Cancer Tumours

Bone cancer tumours usually start in areas where bones grow rapidly, such as the ends of long bones in the arms and legs.

• Most cases of bone cancer start in areas around the knee, referring to the distal femur and proximal tibia.
• The second most common location is the shoulders, the proximal humerus.

However, malignant tumours can be developed in other bones as well. For the elderly, bone cancer commonly starts in the pelvis bones (hip bones) and lower jaw.

Types of Bone Cancer

Bone cancer can be categorised as primary and secondary. Primary bone cancer is relatively rare in occurrence.

• Primary bone cancer forms directly in the bones or surrounding tissue
• Secondary bone cancer starts from another part of your body and is the result of bone metastasis.

Primary bone cancer can be further divided into the following types：

• Osteosarcoma: It is the most common type of bone cancer prevalent among children and adolescents. The incidence rate of males is slightly higher than that of females.
• Chondrosarcoma: It is the second most common type of bone cancer. Most patients are aged 40 to 60. It starts in the soft tissues at the joints.
• Ewing Sarcoma: It is more common in children and teenagers. The incidence rate of males is slightly higher than that of females.

Causes of Bone Cancer

It is not clear what causes bone cancer, but doctors have found certain factors are associated with an increased risk, including:

1. Inherited conditions: Individuals with a family history of bone cancer and other cancers have a higher risk.
2. Benign bone tumour: The risk of bone cancer increases if you currently or previously have had multiple tumours in the cartilage, which is the connective tissue in the bone.
3. Radiation therapy: Those received radiotherapy exposed to high doses of radiation during radiotherapy may cause cancerous changes in your bone cells at a later stage
4. Rare genetic conditions: Individuals with retinoblastoma (rare eye cancer in children that can be hereditary), Paget disease and Li-Fraumeni syndrome are more prone to bone cancer

Symptoms of Bone Cancer

Symptoms of bone cancer are easily overlooked since the symptoms are akin to osteoarthritis, common back pains and soreness. If you experience prolonged pain and observe unreasoned swelling in a particular bone, you should visit your doctor at the earliest advance.

• Pain: Persistent pain and tenderness at knee, pelvis, thigh, calf, upper arm, sternum and shoulder bone that continues at night and when resting.
• Swelling: A lump develops at the affected bone along with the growth of a tumour, which may hinder one’s movement if it is found near a joint.
• Easily broken bone: A symptom of the later stage as the bone tissues become fragile.
• Other symptoms: Fatigue, fever, unintended weight loss (less common symptom)

Bone Cancer Among Children And Adolescents

It can be confusing between growing pains and aches caused by bone cancer since both discomforts are commonly found among children and teenagers. To avoid delayed treatments, you could understand more about the differences between these two types of pain according to foreign research

Growing Pain in Children	Pain Caused by Osteosarcoma
Persistent pain that continues at night
3-5 years old, 8-11 years old	10-20 years old
No swelling	Swelling and lumps
Irregular pain spots	Pain at a fixed position
Muscle and bone aches	Merely bone ache
The pain lessened during exercise	The pain worsens during exercise

Stages of Bone Cancer

Stages of bone cancer are determined by the size and spread of a bone tumour.

• Stage IA: The tumour is 8 cm or less without spreading to the nearby lymph nodes.
• Stage IB: The tumour is over 8 cm without spreading to the nearby lymph nodes. It is in more than one place on the same bone.
• Stage IIA: The tumour is 8 cm or less. It has not spread outside the bone (like stage I) but is high grade.
• Stage IIB: The tumour is larger than 8 cm. It has not spread outside the bone (like stage I) but is high grade.
• Stage III: It has not spread outside the bone but is in more than one place on the same bone.
• Stage IVA: It can be any size and spreads outside of the bone it started in. The tumour has spread to the lung but not the nearby lymph nodes.
• Stage IVB: It can be any size and spreads outside of the bone it started in. The tumour has spread to nearby lymph nodes or distant sites other than the lung (or both)

How Is Bone Cancer Diagnosed?

Your doctors may conduct clinical checks at first. He/she may ask about your symptoms and examine the affected area before deciding whether you need to have any further tests, as shown below.

Tests for Bone Cancer		Principles
Blood Tests		Test the concentration of alkaline phosphatase (ALK-P) in the blood. Bone cancer patients have a higher concentration of ALK-P in their blood.
Radiography	X-Ray	Detects the location and size of a tumour. A biopsy is required to determine if the tumour is benign or malignant.
	Bone Scan	Detect if tumour metastasis to other bones
	CT Scan	Analyse the size and area of a tumour. Compare the affected area with the non-affected area to understand the difference. Chest CT scan is also conducted, as lungs have the highest risk of metastasis.
	MRI	Precisely locate the affected areas, including fats, muscles, other organs, blood vessels and nerves.
	PET Scan	Locate the tumour to understand if it spreads
Biopsy		A small piece of the tumour is obtained during a biopsy for an examination by a neuropathologist.

Treatments of Bone Cancer and the Costs

Your doctor may suggest the following bone cancer treatments according to the sizes and stages of bone tumours.

Cigna’s customers can exclusively enjoy the Care Manager Service. Your dedicated Care Manager will provide professional advice to help you better prepare for your surgery or treatment.

Treatments of Bone Cancer	Principles	Reference Fees for Treating Bone Cancer (HKD)*
Resection Surgery	It depends on the spread of cancer. For early stages, your doctor may employ local tumour resection. If cancer spreads to adjacent areas, large-scaled resection or even amputation is needed.	Please consult your doctor for more details.
Chemotherapy	Chemotherapy drugs can be taken orally or injected into a vein to enter the bloodstream and travel throughout the body to destroy cancer cells.	Application and preparation costs: $2,400 per day; chemotherapy drugs are charged separately at cost.
Radiotherapy	Use high-energy radiation emitted by a treatment machine to kill malignant tumours at specific locations.	Total body / skin irradiation (per session)： $9,430
Targeted Therapy Drug	Currently, targeted therapy drugs are used to prevent the bone metastasis complications of cancer patients. Targeted therapy drugs for bone cancer: zoledronate and denosumab.	Please consult your doctor for more details.

^*Charges as of 3 May 2021; With reference to the charges of local private hospitals and the Hospital Authority

Bone Cancer Survival Rate

Along with medical advancement, the survival rate of bone cancer has risen in recent years. If diagnosed early with suitable treatments, the five-year survival rate of bone cancer can be as high as over 70%.

Stages	Five-Year Survival Rate of Bone Cancer
Localised: There is no sign that cancer has spread outside of the bone where it started.	74%
Regional: Cancer has spread outside the bone and into nearby structures, or it has reached nearby lymph nodes.	66%
Distant: Cancer has spread to remote parts of the body, such as to the lungs or bones in other parts of the body.	27%
Overall Survival Rate	60%

How to Prevent Bone Cancer?

Since the causes and risk factors are unclear for scientists, there are no concrete ways to prevent bone cancer. Generally, you could stay healthy and lower your risk of cancer by having a balanced diet, exercising regularly, quitting smoking and avoiding excessive alcohol intake.

---

Cigna HealthFirst Elite 360 Medical Plan offers comprehensive and personalized medical coverage across the stage prevention, diagnosis, treatment and recovery, with a range of hospital and surgical benefits, optional insurance benefits with an annual limit of up to HK$50 million, personalized health assessment, three critical illnesses(cancer, stroke and heart attack) all-rounded care and international medical concierge service. A 360-degree total health protection that spans across all the key stages of your health journey. Learn more here.