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Bone Cancer Treatment and Surgery in India

Overview

More than 2,000 people are diagnosed in the United States each year with a bone cancer. Bone Cancers occur most commonly in children and adolescents and are less common in older adults. Cancer involving the bone in older adults is most commonly the result of metastatic spread from another tumor. Cancer that begins is the bone is called primary bone cancer. It is found most often in the arms and legs, but it can occur in any bone in the body. Children and young people are more likely than adults to have bone cancer.

What is a Bone Cancer?

Bone cancer is a type of cancer that can affect both children and adults, although it is more common in children and teens. Bone cancer is very rare and the most common bone tumors which include osteosarcoma, Ewing's sarcoma, chondrosarcoma, malignant fibrous histiocytoma, fibrosarcoma and chordoma. The bones in the body serve several purposes. They support and protect internal organs (for example, the skull protects the brain and the ribs protect the lungs).

Types of Bone Cancer

There are many different types of Bone Cancer. The following are the types:

• Osteosarcoma: is the most common primary malignant bone cancer. It most commonly affects males between 10 and 25 years old but can less commonly affect older adults. It often occurs in the long bones of the arms and legs at areas of rapid growth around the knees and shoulders of children. 
  
• Ewing's sarcoma: is the most aggressive bone tumor and affects younger people between 4-15 years of age. It is more common in males and is very rare in people over 30 years of age. It most commonly occurs in the middle of the long bones of the arms and legs. 
  
• Chondrosarcoma: is the second most common bone tumor and accounts for about 25% of all malignant bone tumors. These tumors arise from the cartilage cells and can either be very aggressive or relatively slow growing. Unlike many other bone tumors, it is most common in people over 40 years of age. It most commonly affects the bones of the pelvis and hips. 
  
• Malignant fibrous histiocytoma (MFH): It affects the soft tissues, including muscle, ligaments, tendons, and fat. It is the most common soft-tissue malignancy in later adult life, usually occurring in people 50-60 years of age. It most commonly affects the extremities and is about twice as common in males as females. MFH also has a wide range of severity. 
  
• Fibrosarcoma: is much rarer than the other bone tumors. It is most common in people 35-55 years of age. It most commonly affects the soft tissues of the leg behind the knee. It is slightly more common in males than females.
  
• Chordoma: is a very rare tumor with an average survival of about six years after diagnosis. It occurs in adults over 30 years of age and is about twice as common in males as females. It most commonly affects either the lower or upper end of the spinal column.

Symptoms of Bone Cancer

The symptoms of bone cancer vary from one person to another according to the location and size of the bone cancer. Pain is one of the most common bone cancer symptoms. Generally, there is a gradual increase in the severity of the symptoms with time. At first, the pain may only be felt with activity or at night. According to the growth of the cancerous tumor, people may experience the symptoms for weeks, perhaps even months, sometimes even years until they seek medical help. Sometimes a lump or mass may occur either in the tissues that surround the bone or on the bone itself. This commonly occurs with fibrosarcoma or MFH, but can also occur with other types of bone tumors as well. Some of the less common bone cancer symptoms are weight loss, night sweats, chills, and fever. These symptoms usually occur when the cancerous tumor spreads to the other parts of the body. These symptoms are actually signs warning that something could be wrong. Hence, these symptoms of bone cancer should not be ignored. And, even though the symptoms may ultimately prove to be the root causes of some other ailment, it is better to make certain and not ignore these bone cancer symptoms.

Diagnosis for Bone Cancer

To diagnose bone cancer, the doctor asks about the patient’s personal and family medical history and does a complete medical exam. The doctor may suggest a blood test to determine the level of an enzyme called alkaline phosphatase. A large amount of alkaline phosphatase can be found in the blood when the cells that form bone tissue are very active—when children are growing, when a broken bone is mending, or when disease or a tumor causes production of abnormal bone tissue. Because high levels of this enzyme can normally be found in growing children and adolescents, this test is not a completely reliable indicator of bone cancer.

X-rays can show the location, size, and shape of a bone tumor. If x-rays suggest that a tumor may be cancer, the doctor may recommend special imaging tests such as a bone scan, a CT (or CAT) scan, an MRI, or an angiogram. However, a biopsy—the removal of a sample of tissue from the bone tumor—is needed to determine whether bone cancer is present.

The surgeon may perform a needle biopsy or an incisional biopsy. During a needle biopsy, the surgeon makes a small hole in the bone and removes a sample of tissue from the tumor with a needle-like instrument. In an incisional biopsy, the surgeon cuts into the tumor and removes a sample of tissue. Biopsies are best done by orthopedic oncologists—doctors experienced in the diagnosis of bone cancer. A pathologist—a doctor who identifies disease by studying cells and tissues under a microscope—examine the tissue to determine whether it is cancerous.

Preparing for Bone Cancer Surgery

Before having Bone Cancer surgery, find out all you can about the benefits, risks, and side effects of the operation. You may want to ask your doctor the following questions. The answers may help you feel more comfortable with your decision.

• Why am I having this operation? What are the chances of its success?
• How many operations like this have you done? What is your success rate? Are you experienced in operating on my kind of cancer?
• Exactly what will you are doing in this operation? What will you are taking out? Why?
• How long will the surgery take?
• How long will it take for me to recover enough to go back to my usual activities?
• What are the chances that the surgery will cure my Bone cancer?

Types of Bone Cancer Surgery

Surgery is a common method for treating certain types of Bone Cancer. The following are some examples of the types of surgery you and your expert care team may decide to incorporate into your bone cancer treatment plan:

• Diagnostic/staging surgery to determine the stage of bone cancer
• Limb-sparing surgery to remove only the cancer and some of the healthy tissue around the cancer
• Amputation to remove part or all of a limb or appendage (artificial devices or bones from other places in the body may be used to replace the bone that was removed)
• Lymph node dissection to remove the lymph nodes (if cancer has spread to lymph nodes)
• Reconstructive surgery to reshape or rebuild a part of the body changed by previous surgery
• Palliative surgery to ease bone cancer pain and other symptoms

The type of surgery you receive depends on the size and location of the tumor, how far the cancer has spread your age and general health, and other factors. Surgery is commonly used in combination with other bone cancer treatments, such as chemotherapy and/or radiation therapy.

Common Procedure of Bone Cancer Surgery

• Limb sparing surgery: If your bone tumour is in an arm, leg, shoulder or hip, your surgeon will want to do limb sparing surgery if at all possible. This means removing the cancer, but not the whole arm or leg. This is the most common type of surgery for primary bone cancer. More than 8 out of 10 (80%) Osteosarcomas are treated in this way. These days, it is often possible to remove just the tumour even if the cancer is in your hip bones (the pelvis). In the past, sometimes the whole leg and hip had to be removed. The surgeon removes the area of bone containing the cancer and replaces it with a metal implant called prosthesis. If the cancer is near a joint, the surgeon will remove the joint as well and replace it with a false one. False joints are precision made so that they can work almost as well as a real joint. The most important thing is that the surgeon removes all the cancer. So he or she will make sure that they also take out a margin of healthy bone tissue either side of the cancer.  They send this to the lab to be carefully checked to make sure all the cancer has been removed.  Once the cancer is all out, then the surgeon fixes the prosthesis in place. Once the prosthesis is in place, the surgeon works to reattach the tendons and muscles that move your bones and joints. If all goes well, once you have fully recovered from surgery, you should be able to use the limb almost as you did before the operation. You will have quite intensive rehabilitation to help you move around and use the limb as soon as possible after your surgery. There is more about coping after bone replacement surgery in the living with bone cancer section.
• Amputation: This means removing a part of the body completely. Usually, the surgeon removes part of an arm or leg rather than the whole limb. But sometimes amputation is extremely major surgery and involves removing a leg and its hip, or an arm and its shoulder. These operations are called hindquarter or forequarter operations. A surgeon will only do this if there is no other option. You may have an amputation if you cannot have limb sparing surgery because
  • The cancer has grown into the major nerves and blood vessels around your bone tumour
  • You developed an infection after your limb sparing surgery that meant the false bone had to be removed
  • The position of the tumour means that limb sparing surgery is not technically possible
  • It is not possible to completely remove the cancer with limb sparing surgery

Although amputation is a horrible thing to have to face, for some people it gives the best chance of curing the cancer. If the cancer can be completely removed, you may not have any further problems from it. You may have chemotherapy or radiotherapy after your surgery to try to reduce the risk of the cancer coming back. The type of treatment will depend on the type of bone cancer you have. After your surgery, you will have a stump or wound area that is very sore and sensitive. Some of the pain will be due to the damaged nerves in the stump. There are medicines you can have to help with this. Once the stump has healed, if at all possible you will have prosthesis fitted - a false arm or leg. Usually these are made especially for you.  You may have a plaster cast taken of your stump to make sure that the prosthesis is the best possible fit.  Some hospitals use computer assisted design (CAD) to design them. Over time, your stump can change shape and your prosthesis may no longer fit. If this happens, you can have a new one made. Your computerised limb details will be kept on file and new moulds can be designed electronically to fit perfectly.

After Bone Cancer Surgery

Patients who have surgery for bone cancer, particularly amputation, often need physical therapy and other types of rehabilitative therapies. Follow-up care should also address the patient’s quality of life, including social and emotional concerns, especially if amputation was necessary. Learn more about cancer rehabilitation. For bone cancer, follow-up care typically includes general physical examinations, blood tests, and imaging studies (such as a bone scan, CT scan, or x-rays) to check for signs that the cancer has come back. Tell your doctor about any new symptoms, such as swelling or bone pain, because they may be signs that the cancer has come back or signs of other medical conditions.

Recovery after Bone Cancer Surgery

People recovering from bone cancer are encouraged to follow established guidelines for good health, such as maintaining a healthy weight, not smoking, eating a balanced diet, and having recommended cancer screens tests. Talk with your doctor to develop a plan that is best for your needs. For bone cancer survivors who smoke, quitting smoking may help recovery and reduce the risk of cancer recurrence. Learn more about tobacco. Moderate exercise can help you rebuild your strength and energy level. Talk with your doctor about helping you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about healthy living after cancer.

Advance Bone Cancer Surgery

• Research for Bone Cancer is ongoing. The following advances may still be under investigation in clinical trials and may not be approved or available at this time. Always discuss all diagnostic and treatment options with your doctor. 
• Intraoperative radiation therapy: Clinical trials are evaluating the usefulness of radiation therapy given inside the body during surgery for some Ewing’s tumors. This is called intraoperative radiation therapy or internal radiation therapy. 
• Myeloablative therapy: A supplement to the treatment options for Ewing’s tumors is Myeloablative therapy with stem cell support. Myeloablative therapy, an intense regimen of chemotherapy, destroys all cells that are dividing rapidly. This includes cancer cells but also some normal cells. Stem cells are cells that create all other types of cells in the body. They may be given to the patient after Myeloablative therapy to boost the patient’s recovery. 
• Targeted therapy: is a treatment that targets specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. A type of targeted therapy being looked at for bone cancers, as well as other types of sarcoma, is called insulin-like growth factor receptor (IGFR) inhibitors. The IGFR is an important growth protein for sarcomas. Inhibiting its activity may be an important new way to improve sarcoma treatment. Early results look promising, but the clinical trials are still ongoing. Some research suggests that combining an IGFR inhibitor with other targeted therapies, as an example, an mTOR inhibitor, may be a more effective treatment.

Bone Cancer Treatment and Surgery in India

India is recognized as one of the most important destination for Bone Cancer Treatment and Surgery. Many patients from their advanced countries come to India for a nice blend of top-class medical expertise at attractive prices is helping more and more Indian corporate hospitals to bring more and more foreign patients, including from the developed nations for high end surgeries pertaining to various disease including the Bone Cancer.

The Cancer hospitals in India provide quality treatment to patient all across the globe. The hospitals help you and your dear ones on the fast track to recovery and revival as per your whims and fancies. The Indian Oncologists have excelled in dealing various cancer treatment and surgeries, and most of them have to their credit International fellowships and International Board Certification.

Personalized care and attention is provided with value added services besides results of world class standard at a very low cost affordable to all sections of society. The Bone Cancer Surgery in India is available at various hospitals in the following cities with latest amenities and state-of-art-facilities.

Cost of Bone Cancer Treatment and Surgery in India

India offers outstanding Bone Cancer Treatment and Surgery at 60-80% less than prevailing USA or UK rates. Even with travel expenses taken into account, the comprehensive medical tourism packages still provide a savings measured in the thousands of dollars for major procedures. A cost comparison of various medical treatments can give you the exact idea about the difference:

Some of the common countries from which patients travel to India for surgery are :

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