The tumour that eats up teenagers’ bones
Bone cancers are some of the rarest types of cancer in Uganda, so rare in fact that they do not merit their own slot in the Uganda cancer institute statistics that monitor new cancer cases and are instead grouped with other rare cancers.
Doctor Evelyn Nakkazi, an orthopedic, describes bone cancer as bone disease where the cells multiply abnormally causing a tumour.Bone cancer can be classified into two; primary and secondary bone cancers. Though the two are both bone cancers, Dr Fred Okuku an oncologist with Uganda Cancer Institute at Mulago says the two are treated differently.
Primary bone cancer is the cancer that begins in the bones, and spreads to other parts of the body. Primary bone cancer is commonly known to spread to the lungs.” explains doctor Okuku. Secondary bone cancer according to the doctor is that which starts from another part of the body and spreads to the bone. He adds that it is very likely for most other cancers to also affect the bone if left untreated for long.
There are several bone cancers but the commonest in Uganda is Osteosarcoma which affects teenage males. The cancer attacks long bones like the limbs and manifests through a progressive painful swelling at the end of the long bones.
Signs and symptoms
Dr Okuku says the growth of the cancer causes increased pain, deformation, numbness, tingling and pathological fractures (fractures which are not caused by any form of trauma).
There is no clear reason as to why the cancer only seems to affect young people-mainly teenagers, but doctor Nakkazi thinks the growth spurt during these years could be a contributing factor. “It probably attacks this group of people because this is the stage in which the long bones grow. The ends of long bones are prominent growth sites, thus have a lot of multiplying cells.” she says.
When bone cancer is not discovered early, it spreads to the lungs through the lymphatic system and causes respiratory distress. Dr Okuku says in some instances, the bone cancers can affect other bones like ribs, the skull or the jaw bones.
Bone cancer may share certain characteristics with several other bone ailments like Osteoblastoma and bone cysts, but an X ray and CT scan should be able to give a correct diagnosis.
“An X ray might not show bone cancer in its early stages but a CT scan which shows a cross section of the bone will show any anomalies.” Says Dr Nakkazi. A long with physical examinations, testing bone strength and patient history, a doctor will be able to diagnose the cancer.” She adds. If all these fail, a biopsy which involves removal of some tissue from the affected area and testing it should provide a conclusive diagnosis.
Treatment
Treatment for primary bone cancer can either be limb sparing surgery or amputation. “If it is early, surgery can help remove as much of the tumour as possible while chemotherapy and radiation kill the cancer cells,” says Dr Okuku. He goes on to warn that at later stages, bone cancer necessitates amputation of the affected limb. Palliative chemotherapy and radiation is offered for patients with very advanced bone cancer more to reduce pain than to cure it.
The biggest challenge according to Dr Okuku is that many people report bone cancer in its advanced stages and are then reluctant to lose their limbs giving the cancer time to spread to other parts. He advices anyone who experiences symptoms similar to those of bone cancer or growth around the ends of long bones to report to the cancer Institute immediately.
For secondary bone cancer, the oncologists fight it by treating the point of origin. “If it begun as colon or breast and spread to the bone, we treat the breast tumour and the one in the bone responds,” says Dr Okuku.
