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Bone Cancer

• Also Listed As
• Signs and Symptoms
• Who's Most At Risk?
• What to Expect at Your Provider's Office
• Treatment Options
• Treatment Plan
• Drug Therapies
• Surgical and Other Procedures
• Complementary and Alternative Therapies
• Prognosis/Possible Complications
• Following Up
• Supporting Research


Bone cancers are rare forms of cancer that can affect any bone in the body. Two types of bone cancer are multiple myeloma and bone sarcomas. Bone cancers can also happen when tumors that start in other organs, such as breasts, lung, and prostate, metastasize (spread) to the bone. Multiple myeloma is the most common type of bone cancer. The two most common bone sarcomas are osteosarcoma, which develops in new tissue in growing bones, and chondrosarcoma, which develops in cartilage. Osteosarcoma tends to occur more frequently in children and adolescents, while chondrosarcoma occurs more often in adults.


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Also Listed As
Cancer, Bone

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Signs and Symptoms

Bone cancer is accompanied by the following signs and symptoms.

• Pain
• Swelling or tenderness of the joints
• Fractures
• Fatigue, fever, weight loss, anemia


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Who's Most At Risk?

People with the following conditions or characteristics may be at risk for developing multiple myeloma.

• Radiation exposure
• Exposure to petroleum products, benzene, herbicides, insecticides
• Genetic factors
• Over 68 years of age
• Blacks twice as often as whites

People with the following conditions or characteristics may be at risk for developing osteosarcoma.

• Benign tumors and other bone diseases
• Radiation exposure
• Genetic factors
• Children, adolescents
• Males more than females

Your risk for developing chondrosarcoma is higher if you are between the ages of 40 and 60.



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What to Expect at Your Provider's Office

If you are experiencing symptoms associated with bone cancer, you should see your health care provider. Keep in mind that many of the same symptoms are associated with other, less serious health conditions. In addition to taking a personal and family medical history, your provider may suggest a blood test to measure the level of alkaline phosphate, an enzyme that increases when a tumor causes production of abnormal bone tissue. X rays and other imaging procedures can show the location, size, and shape of a bone tumor. Not all tumors are cancer. A biopsy—the removal of a sample of tissue from the bone tumor—will reveal whether cancer is present.



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Treatment Options


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Treatment Plan

The treatment plan depends on the type, size, location, and stage of the cancer, as well as the patient's age and general health.


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Drug Therapies

Your provider may prescribe the following therapies.
• For multiple myeloma: chemotherapy drugs, radiation treatment, medication for pain relief
• For osteosarcoma: cytotoxic drugs


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Surgical and Other Procedures

With multiple myeloma, a bone marrow transplant is sometimes performed. With bone sarcomas, surgery is often the main treatment. In most cases, chemotherapy has made limb-sparing surgery possible and amputation unnecessary.


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Complementary and Alternative Therapies

A comprehensive treatment plan for bone cancer may include a range of complementary and alternative therapies.

Nutrition
Eat organically-raised foods and foods that support detoxification, immunity, and are high in antioxidants: beets, carrots, artichokes, yams, onions, garlic, yellow and orange vegetables, shiitake mushrooms, sea vegetables, green tea, filtered water, dark leafy greens, and whole grains. Avoid refined foods, sugar, alcohol, caffeine, and saturated fats (animal products). Eliminate organ meats and processed meats.

Potentially beneficial nutrient supplements include the following.
• Vitamin C (250 to 500 mg two times per day), vitamin E (400 IU two times per day), beta carotene (50,000 IU once or twice a day), coenzyme Q10 (100 mg three times per day), and zinc (30 mg per day). Coenzyme Q10 and L-carnitine (600 mg three times per day) may protect the heart from the effects of chemotherapy.
• Selenium (200 mcg twice per day) and glutathione (500 mg twice per day) may minimize the side effects of chemotherapy.
• Magnesium (200 mg two to three times per day), vitamin D (400 IU per day), vitamin K (5 mg per day), and boron (3 to 5 mg per day) can help normal bone growth.
• Bromelain (250 to 500 mg between meals) may enhance chemotherapy.
• Glutamine (3 to 10 g per day) can be helpful after a bone marrow transplant.
• N-acetylcysteine (200 mg three times a day) may minimize the side effects of chemotherapy.


Herbs
Herbal remedies may offer relief from symptoms. Herbs are generally available as dried extracts (pills, capsules, or tablets), teas, or tinctures (alcohol extraction, unless otherwise noted). Dose for teas is 1 heaping tsp. per cup of water steeped for 10 minutes (roots need 20 minutes).
• Turmeric (Curcuma longa): 500 mg four times a day may enhance certain chemotherapies.
• Ginkgo (Ginkgo biloba): 120 mg standardized extract twice a day may reduce toxic effects of certain chemotherapies.

Include one or more of the following formulas to support your immune system.
• Scudder's Alterative Compound: Combine equal parts of corydalis tubers (Corydalis yanhusuo), black tag alder (Alnus serrulata), mayapple root (Podophyllum peltatum), figwort (Scrophularia nodosa), and yellowdock (Rumex crispus). Take 30 to 40 drops tincture three to four times per day for six months
• Herbal mixes containing burdock root (Arctium lappa), sheep sorrel (Rumex acetosella), slippery elm (Ulmus fulva), turkey rhubarb (Rheum palmatum), and other herbs: for brand name products, follow dosing instructions on the product labeling
• Combine equal parts of coneflower (Echinacea angustifolia), poke root (Phytolacca americana), red clover (Trifolium pratense), plantain (Plantago lanceolata), gotu kola (Centella asiatica), and yellowdock (Rumex crispus). Take 30 to 60 drops tincture three times per day, or drink three to four cups tea daily for up to six weeks at a time
• Combine equal parts of astragalus (Astragalus membranaceus), schizandra berry (Schizandra chinensis), licorice root (Glycyrrhiza glabra), lomatium root (Lomatium dissectum), barberry (Berberis vulgaris), and queen's delight (Stillingia sylvatica). Take 30 drops tincture twice a day for four to six months


Homeopathy
Although very few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of bone cancer based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type. A constitutional type is defined as a person's physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual. Homeopathic treatment, especially in the case of cancer, should only be used with guidance from a licensed and certified homeopath.
• Arnica Montana -- for a bruised sensation and restlessness
• Bryonia -- for fractures with stitching pains that are worse with the slightest movement
• Eupatorium -- for excruciating, aching bone pain that worsens with motion and is often accompanied by stiffness and chills
• Symphytum -- for fractures that heal poorly and are accompanied by persistent pain


Acupuncture
While acupuncture is not used as a treatment for cancer itself, evidence suggests it can be a valuable therapy for cancer-related symptoms (particularly nausea and vomiting that often accompanies chemotherapy treatment). There have also been studies indicating that acupuncture may help reduce pain and shortness of breath. Acupressure (pressing on rather than needling acupuncture points) has also proved useful in controlling breathlessness; this is a technique that patients can learn and then use to treat themselves.

Some acupuncturists prefer to work with a patient only after the completion of conventional medical cancer therapy. Others will provide acupuncture and/or herbal therapy during active chemotherapy or radiation. Acupuncturists treat cancer patients based on an individualized assessment of the excesses and deficiencies of qi located in various meridians. In many cases of cancer-related symptoms, a qi deficiency is usually detected in the spleen or kidney meridians.


Chiropractic
Chiropractors will not perform spinal manipulation over areas of the body where bone cancer is present, but they may use this procedure over areas that are free of bone cancer in an attempt to relieve pain associated with the condition.


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Prognosis/Possible Complications


With multiple myeloma, patients generally live for 15 months to five years. Complications may include heart attack, lung disease, diabetes, and stroke. With bone sarcomas, 60 to 70 percent of patients experience long-term survival. Potential complications include those arising from surgery and possible spread of the cancer to the lungs.



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Following Up

Your health care provider will want to see you regularly to check for complications and to make sure the cancer has not returned.



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Supporting Research

Alimi D, Rubino C, Leandri EP, Brule SF. Analgesic effects of auricular acupuncture for cancer pain [letter]. J Pain Symptom Manage. 2000;19(2):81-82.

Bartram T. Encyclopedia of Herbal Medicine. Dorset, England: Grace Publishers;1995:303.

Boik J. Cancer & Natural Medicine: A Textbook of Basic Science and Clinical Research. Princeton, Minn: Oregon Medical Press; 1996:166-168.

Carr AC, Frei B. Toward a new recommended dietary allowance for vitamin C based on antioxidant and health effects in humans. Am J Clin Nutr. 1999;69(6):1086-1107.

Cecil RI, Plum F, Bennett JC, eds. Cecil Textbook of Medicine. 20th ed. Philadelphia, PA: W.B. Saunders; 1996.

Dambro MR. Griffith's 5-Minute Clinical Consult. 1999 ed. Baltimore, MD: Lippincott Williams & Wilkins, Inc.; 1999.

De Vita VT, ed. Cancer: Principles and Practice of Oncology. 5th ed. Philadelphia, PA: Lippincott-Raven Publishers; 1997.

Ezzo J, Berman B, Hadhazy VA, Jadad AR, Lao L, Singh BB. Is acupuncture effective for the treatment of chronic pain? A systematic review. Pain. 2000;86:217-225.

Fauci AS, Braunwald E, Isselbacher KJ, et al, eds. Harrison's Principles of Internal Medicine. 14th ed. New York, NY: McGraw-Hill; 1998.

Filshie J, Penn K, Ashley S, Davis CL. Acupuncture for the relief of cancer-related breathlessness. Palliat Med. 1998;10:145-150.

Haldeman S, Chapman-Smith D, Peterson DM. Guidelines for Chiropractic Quality Assurance and Practice Parameters. Proceedings of the Mercy Center Consensus Conference. Gaithersburg, MD: Aspen Publishers; 1993:174.

JAMA Patient Page. How much vitamin C do you need? JAMA. 1999;281(15):1460.

Johnston CS. Recommendations for vitamin C intake. JAMA. 1999;282(22):2118-2119.

Lee GR. Wintrobe's Clinical Hematology. 10th ed. Baltimore, MD: Lippincott Williams & Wilkins, Inc.; 1999.

Levine M, Rumsey SC, Daruwala R, Park JB, Wang Y. Criteria and recommendations for vitamin C intake. JAMA. 1999;281(15):1415-1453.

Maa SH, Gauthier D, Turner M. Acupressure as an adjunct to a pulmonary rehabilitation program. J Cardiopulm Rehabil. 1997;17(4):268-276.

Moss RW. Alternative pharmacological and biological treatments for cancer: Ten promising approaches. J Naturopathic Med. 1996; 6(1): 23-32.

Navis I, Sriganth P, Premalatha B. Dietary curcumin with cisplatin administration modulates tumour marker indices in experimental fibrosarcoma. Pharmacol Res. 1999; 39(3):175-179.

NIH Consensus Statement: Acupuncture. National Institutes of Health, Office of the Director. 1997;15(5):1-34. Accessed at http://odp.od.nih.gov/consensus/cons/107/107_statement.htm on September 24, 2001.

Pan CX, Morrison RS, Ness J, Fugh-Berman A, Leipzig RM. Complementary and alternative medicine in the management of pain, dyspnea, and nausea and vomiting near the end of life: a systematic review. J Pain Symptom Manage. 2000;20(5):374-387.

Pizzo PA, Poplack DG. Principles and Practice of Pediatric Oncology. 3rd ed. Philadelphia, PA: Lippincott-Raven Publishers; 1997.

Morrison, R. Desktop Guide to Keynotes and Confirmatory Symptoms. Albany, Calif: Hahnemann Clinic Publishing; 1993.

Rakel RE, ed. Conn's Current Therapy. 51st ed. Philadelphia, PA: W.B. Saunders; 1999.

Scalzo R. Naturopathic Handbook of Herbal Formulas. 2nd ed. Durango, Colo: Kivaki Press; 1994: 35-36.

Sellick SM, Zaza C. Critical review of five nonpharmacologic strategies for managing cancer pain. Cancer Prev Control. 1998;2(1):7-14.

Shen J, Wenger N, Glaspy J, et al. Electroacupuncture for control of myeloablative chemotherapy-induced emesis. JAMA. 2000;284(21):2755-2761.

Vickers AJ. Can acupuncture have specific effects on health? A systematic review of acupuncture antiemesis trials. J R Soc Med. 1996;89:303-311.

Ziegler TR, Bye RL, Persinger RL, Young LS, Antin JH, Wilmore DW. Effects of glutamine supplementation on circulating lymphocytes after bone marrow transplantation: a pilot study. Am J Med Sci. 1998; 315(1):4-10.

 

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