osteosarcomas

Cancer that starts in a bone is uncommon. Cancer that has spread to the bone from another part of the body is more common.

There are three types of bone cancer:

• Osteosarcoma - occurs most often between ages 10 and 19. It is more common in the knee and upper arm.
• Chondrosarcoma - starts in cartilage, usually after age 40
• Ewing's sarcoma - occurs most often in children and teens under 19. It is more common in boys than girls.

The most common symptom of bone cancer is pain. Other symptoms vary, depending on the location and size of the cancer. Surgery is often the main treatment for bone cancer. Other treatments may include amputation, chemotherapy, and radiation therapy. Because bone cancer can come back after treatment, regular follow-up visits are important.

NIH: National Cancer Institute

Paget's disease of bone is a chronic bone disorder. Normally, there is a process in which your bones break down and then regrow. In Paget's disease, this process is abnormal. There is excessive breakdown and regrowth of bone. Because the bones regrow too quickly, they are bigger and softer than normal. They may be misshapen and easily fractured (broken). Paget's usually affects just one or a few bones.

Researchers do not know for sure what causes Paget's disease. Environmental factors may play a role. In some cases, the disease runs in families, and several genes have been linked to the disease.

The disease is more common in older people and those of northern European heritage. If you have a close relative who has Paget's, you are much more likely to have it.

Many people do not know that they have Paget's, because it often has no symptoms. When there are symptoms, they are similar to those of arthritis and other disorders. The symptoms include:

• Pain, which may be due to the disease or to arthritis, which can be a complication of Paget's
• Headaches and hearing loss, which can happen when Paget's disease affects the skull
• Pressure on the nerves, which can happen when Paget's disease affects the skull or spine
• Increased head size, bowing of a limb, or curvature of the spine. This can happen in advanced cases.
• Hip pain, if Paget's disease affects the pelvis or thighbone
• Damage to the cartilage of your joints, which may lead to arthritis

Usually, Paget's disease gets worse slowly over time. It does not spread to normal bones.

Paget's disease can lead to other complications, such as:

• Arthritis, because the misshapen bones can cause increased pressure and more wear and tear on the joints
• Heart failure. In severe Paget's disease, the heart has to work harder to pump blood to affected bones. Heart failure is more likely if you also have hardening of the arteries.
• Kidney stones, which can happen when the excessive breakdown of the bone leads to extra calcium in the body
• Nervous system problems, since the bones can cause pressure on the brain, spinal cord, or nerves. There may also be reduced blood flow to the brain and spinal cord.
• Osteosarcoma, cancer of the bone
• Loose teeth, if Paget's disease affects the facial bones
• Vision loss, if Paget's disease in the skull affects the nerves. This is rare.

Your health care provider may use many tools to make a diagnosis:

• A medical history, which includes asking about your symptoms
• A physical exam
• An x-ray of the affected bones. Paget's disease is almost always diagnosed using x-rays.
• An alkaline phosphatase blood test
• A bone scan

Sometimes the disease is found by accident when one of these tests is done for another reason.

To avoid complications, it is important to find and treat Paget's disease early. The treatments include:

• Medicines. There are several different medicines to treat Paget's disease. The most common type is bisphosphonates. They help reduce bone pain and stop or slow down the progress of the disease.
• Surgery is sometimes needed for certain complications of the disease. There are surgeries to
  • Allow fractures (broken bones) to heal in a better position
  • Replace joints such as the knee and hip when there is severe arthritis
  • Realign a deformed bone to reduce the pain in weight-bearing joints, especially the knees
  • Reduce pressure on a nerve, if enlargement of the skull or spine injuries effects the nervous system

Diet and exercise do not treat Paget's, but they can help to keep your skeleton healthy. If you do not have kidney stones, you should make sure to get enough calcium and vitamin D through your diet and supplements. Besides keeping your skeleton healthy, exercise can prevent weight gain and maintain the mobility of your joints. Talk with your health care provider before you start a new exercise program. You need to make sure that the exercise does not put too much stress on the affected bones.

NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases