Walaupun kanser tulang ini tidak kerap berlaku seperti kanser pada organ-organ yang lain, namun ia perlu juga diambil perhatian serius, terutama apabila telah ada tanda-tanda kanser tersebut.
Sebagaimana yang diakui oleh pakar perubatan, kebanyakan kanser tulang terjadi pada peringkat kanak-kanak atau awal remaja, jarang yang didapati pada peringkat dewasa. Oleh itu, ibu bapa jangan sekali-kali mengabaikan perkara ini, dan jika terdapat tanda-tanda yang disyakki, pergilah berjumpa doktor dengan secepat mungkin sebelum terlewat atau sehingga tidak dapat diubati lagi.
Berikut dipanjangkan info mengenai kanser tulang untuk dijadikan makluman, perhatian dan tindakan pencegahan jika perlu…...
Awasi bengkak keras
Oleh ADHAM SHADAN
SALMIAH HARUN (bukan nama sebenar) tidak pernah menyangka anak lelakinya yang berusia 11 tahun menghidap kanser tulang. Pada mulanya dia menganggap lebam pada lutut anaknya yang muncul tiba-tiba itu cuma lebam biasa. Tambah pula si anak memang gemar bermain bola sepak dan kecederaan satu perkara lazim.
Apabila anaknya mengadu tidak boleh berjalan, Salmiah, 35, dan suaminya mula berasa risau. Mereka merujuk kepada doktor pakar di sebuah hospital di Selangor. Setelah pemeriksaan demi pemeriksaan yang dijalankan melalui teknik MRI, CT Scan dan Biopsi di hospital berkenaan, anaknya itu disahkan menghidap kanser tulang. Lebih memeritkan Salmiah untuk menerima kenyataan apabila sel kanser tulang anaknya itu telah merebak ke paru-paru.
Hati Salmiah bagai direntap apabila doktor pada awalnya memberitahu anaknya diramalkan hanya punya masa sekitar dua hingga tiga tahun untuk hidup. Namun, selepas tabah mengikuti rawatan yang disarankan doktor meliputi pembedahan, rawatan kimoterapi dan fisioterapi keadaannya bertambah baik.
Sememangnya apabila bercakap tentang penyakit tulang, ramai orang terfikirkan penyakit osteoporosis yang menyebabkan tulang rapuh, namun kanser tulang merupakan penyakit tulang yang perlu diambil perhatian. Tambah pula kanser tulang primer lazim terjadi pada kanak-kanak.
Media pada 2001 pernah melaporkan nisbah satu dalam 100,000 penduduk didapati menghidap kanser tulang setiap tahun. Walaupun penyakit kanser ini kurang terjadi berbanding penyakit-penyakit kanser yang lain, namun ia masih perlu dirawat segera sebelum terlambat. Kanser tulang yang lewat dirawat boleh menyebabkan tulang retak dan akhirnya membawa maut.
Menurut Pengarah Perubatan dan Perunding Onkologi Klinikal Pusat Perubatan Antarabangsa Wijaya, Datuk Dr. Mohamed Ibrahim A. Wahid, terdapat dua jenis kanser tulang.
Pertama, kanser tulang primer bermula daripada tulang manakala kanser tulang sekunder ialah kanser yang merebak ke tulang.
Kanser tulang primer biasanya berlaku kepada kanak-kanak dan individu bawah 30 tahun manakala kanser tulang sekunder pula banyak terjadi kepada orang dewasa dan tua.
“Setakat ini punca kanser tulang terjadi dan bagaimana mekanismenya masih tidak diketahui. Jika kanser yang lain seperti kanser paru-paru ia mungkin disebabkan oleh amalan menghisap rokok. Kanser payu dara pula mungkin disebabkan oleh pengambilan lemak dalam pemakanan,” ujar Mohamed Ibrahim.
Jelas beliau, kanser yang ‘memakan’ tulang akan menyebabkan komposisi tulang kurang padat dan menjadi reput lalu menyebabkan tulang mudah retak.
Jika tulang belakang retak seperti dalam kes kanser tulang sekunder, keadaan itu boleh menyebabkan saraf tunjang tertekan atau tersepit sekali gus boleh menyebabkan lumpuh.
Mengenai kanser tulang primer, Mohamed Ibrahim berkata, ia paling banyak berlaku dalam kalangan kanak-kanak yang berusia lapan hingga 12 tahun. Ia masih boleh terjadi kepada orang dewasa namun sangat jarang,
Bahagian tulang lutut merupakan antara kawasan yang paling banyak berlaku kanser iaitu kira-kira 60 peratus, diikuti 15 peratus di kawasan punggung, 10 peratus di bahu dan kurang lapan peratus di bahagian rahang.
Antara simptomnya ialah apabila terasa sakit dan bengkak yang semakin membesar pada bahagian tulang yang diserang kanser.
“Misalnya, ibu bapa boleh mengesan anak mereka mungkin mendapat kanser tulang dengan melihat terdapat bengkak di bahagian lutut sehingga kanak-kanak itu berasa sakit dan sukar atau bermasalah untuk berjalan. Bengkak biasanya keras kerana ia berpunca daripada bahagian tulang.
“Jika kanser berlaku pada tulang tangan, pesakit mungkin berasa sakit apabila menggunakan lengan tangan ketika melakukan aktiviti menggunakan anggota itu,” katanya.
Bagaimanapun, peluang untuk pesakit kanser tulang primer sembuh lebih cerah jika ia masih berada di tahap pertama atau awal.
Kanser tulang sekunder pula banyak berlaku pada bahagian tulang belakang, tulang rusuk dan tengkorak. Ia biasanya dianggap sebagai kanser tahap empat kerana kanser telah merebak daripada satu bahagian lain ke tulang.
Mohamed Ibrahim memberitahu, kanser tulang primer dan kanser tulang sekunder mempunyai perbezaan karakter dan doktor membezakannya dengan karakter tersebut.
“Jika imbasan sinar-X pada tulang menghasilkan imej seperti sinar matahari pada tempat kanser, itu menandakan kanser tulang primer. Sementara kanser tulang sekunder pula akan menunjukkan gambaran tulang hancur atau berlubang-lubang dengan kesan seperti digigit atau dimakan,” jelasnya.
Berhubung rawatan, Mohamed Ibrahim memberitahu, bagi kanser tulang primer, rawatan sebaiknya yang perlu dilalui pesakit ialah pembedahan, kimoterapi dan radioterapi.
“Kalau zaman dahulu, bila sesuatu tempat itu ditumbuhi kanser, anggota badan itu akan dipotong. Kalau kena pada kaki, kaki akan dipotong. Namun, sekarang tidak radikal lagi. Terdapat pembedahan seperti limb salvage surgery, satu kaedah pembedahan yang hanya membuang bahagian yang terkena kanser dan mengekalkan anggota yang sedia ada. Terdapat juga rawatan tulang prostesis untuk membina semula tulang,” katanya.
Bagi kanser tulang sekunder, rawatan yang sama juga diperlukan namun pesakit turut diberikan rawatan tambahan menerusi pengambilan bisphophanat.
Bahan tersebut membantu membaiki tulang dengan meningkatkan aktiviti osteoblast yang bertindak membaiki semula tulang.
“Dalam pertumbuhan tulang, ia melibatkan tindakan dua sel tulang iaitu osteoklast dan osteoblast. Osteoklast bertindak memakan tulang dan osteoblast membina semula tulang. Apabila kanser tulang berlaku, osteoklast bertindak lebih aktif, lalu pengambilan bisphopanat sama ada secara suntikan atau oral membantu meningkatkan aktiviti osteoblast,” ujarnya sambil memberitahu contoh-contoh kanser yang sering merebak ke tulang ialah kanser prostat, paru-paru dan serviks.
“Banyak juga kes di mana pesakit hanya mengetahui mereka menghidap kanser lain setelah dikesan mempunyai kanser tulang,” tambahnya.
Sebagai tambahan kepada info di atas, dipanjangkan juga artikel yang terperinci mengenai kanser tulang daripada pakar perubatan sendiri……
Medical Author: Jason C. Eck, DO, MS
Medical Editor: Melissa Conrad Stöppler, MD
Bone Cancer At A Glance
* The majority of cancer involving the bones is metastatic disease from other remote cancers. Primary bone cancer is much rarer.
* Not all bone tumors are cancerous.
* The most common symptom of bone cancer is pain. The pain is usually mild initially and gradually becomes more intense.
* Treatment of bone cancer includes a combination of surgery, chemotherapy, and radiation therapy.
* Treatment is based on the size and location of the cancer and whether or not the cancer has spread from the bone to surrounding tissues.
What are bones for?
Your body has 206 bones. These bones serve multiple different functions. First, your bones provide structure to your body and help provide its shape. Muscles attach to the bones and allow you to move. Without the bones, your body would become a pile of soft tissues without structure, and you would be unable to stand, walk, or move. Second, the bones help to protect the more fragile organs of the body. For example, the bones of the skull protect the brain, the vertebrae of the spine protect the spinal cord, and the ribs protect the heart and lungs. Third, the bones contain bone marrow, which makes and stores new blood cells. Finally, the bones help control your body’s collection of various proteins and nutrients including calcium and phosphorus.
What is cancer?
Your body is made up of many small structures called cells. There are many different types of cells that grow to form the different parts of your body. During normal growth and development, these cells continuously grow, divide, and make new cells. This process continues throughout life even after you are no longer growing. The cells continue to divide and make new cells to replace old and damaged cells. In a healthy person, the body is able to control the growth and division of cells according to the needs of the body. Cancer is when this normal control of cells is lost and the cells begin to grow and divide out of control. The cells also become abnormal and have altered functions in patients with cancer.
There are many different type of cancer. The cancer is usually named based on the type of cell that is affected. For example, lung cancer is caused by out of control cells that form the lungs, and breast cancer by cells that form the breast. A tumor is a collection of abnormal cells grouped together. However, not all tumors are cancerous. A tumor can be benign (not cancerous) or malignant (cancerous). Benign tumors are usually less dangerous and are not able to spread to other parts of the body. Malignant tumors are usually more serious and can spread to other areas in the body. The ability of cancer cells to leave their initial location and move to another location in the body is called metastasis. Metastasis can occur by the cancer cells entering the body’s bloodstream or lymphatic system to travel to other sites in the body. When cancer cells metastasize to other parts of the body, they are still named by the original type of abnormal cell. For example, if a group of breast cells becomes cancerous and metastasizes to the bones, it is called metastatic breast cancer. Many different types of cancer are able to metastasize to the bones. The most common types of cancer that spread to the bones are lung, breast, prostate, thyroid, and kidney. Most of the time, when people have cancer in their bone, it is caused by cancer that has spread from elsewhere in the body to the bones. It is much less common to have a true bone cancer, a cancer that arises from cells that make up the bone. It is important to determine whether the cancer in the bone is from another site or is from a cancer of the bone cells. The treatments for cancers that have metastasized to the bone are based on the initial type of cancer.
What is bone cancer?
Bone cancer is caused by a problem with the cells that make bone. More than 2,000 people are diagnosed in the United States each year with a bone tumor. Bone tumors 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.
There are many different types of bone cancer. The most common bone tumors include osteosarcoma, Ewing’s sarcoma, chondrosarcoma, malignant fibrous histiocytoma, fibrosarcoma, and chordoma.
* 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. This type of cancer is often very aggressive with risk of spread to the lungs. The five-year survival rate is about 65%.
* 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 old. It most commonly occurs in the middle of the long bones of the arms and legs. The three-year survival rate is about 65%, but this rate is much lower if there has been spread to the lungs or other tissues of the body.
* 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, chondrosarcoma is most common in people over 40 years old. It is slightly more common in males and can potentially spread to the lungs and lymph nodes. Chondrosracoma most commonly affects the bones of the pelvis and hips. The five-year survival for the aggressive form is about 30%, but the survival rate for slow-growing tumors is 90%.
* Malignant fibrous histiocytoma (MFH) 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. The overall five-year survival rate is about 35%-60%.
* Fibrosarcoma is much more rare 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.
In addition to bone cancer, there are various types of benign bone tumors. These include osteoid osteoma, osteoblastoma, osteochondroma, enchondroma, chondromyxoid fibroma, and giant cell tumor (which has the potential to become malignant). As with other types of benign tumors, these are not cancerous.
There are two other relatively common types of cancer than develop in the bones: lymphoma and multiple myeloma. Lymphoma, a cancer arising from the cells of the immune system, usually begins in the lymph nodes but can begin in the bone. Multiple myeloma begins in the bones, but it is not usually considered a bone tumor because it is a tumor of the bone marrow cells and not of the bone cells.
What are the symptoms of bone cancer?
The most common symptom of bone tumors is pain. In most cases, the symptoms become gradually more severe with time. Initially, the pain may only be present either at night or with activity. Depending on the growth of the tumor, those affected may have symptoms for weeks, months, or years before seeking medical advice. In some cases, a mass or lump may be felt either on the bone or in the tissues surrounding the bone. This is most common with MFH or fibrosarcoma but can occur with other bone tumors. The bones can become weakened by the tumor and lead to a fracture after little or no trauma or just from standing on the affected bone. Fever, chills, night sweats, and weight loss can occur but are less common. These symptoms are more common after spread of the tumor to other tissues in the body.
How is bone cancer diagnosed?
The first thing your doctor will do is to take a complete medical history. This will give your doctor clues as to your diagnosis. Some types of cancer are more common in people if they have close family members that have had that type of cancer. A description of your symptoms can help your doctor identify the possibility of bone cancer from other possible causes. Next, a complete physical examination can help find the cause of your symptoms. This may include testing your muscle strength, sensation to touch, and reflexes. Certain blood tests can be ordered that can help to identify a possible cancer.
Next, your doctor will likely order some imaging studies. Plain x-rays are often ordered first. In some cases, if the cancer is identified very early it may not show up on plain x-rays. The appearance of a tumor on the x-ray can help determine the type of cancer and whether or not it is benign or malignant. Benign tumors are more likely to have a smooth border while malignant tumors are more likely to have a ragged border. This is because the benign tumors typically grow more slowly and the bone has time to try to surround the tumor with normal bone. Malignant tumors are more likely to grow more quickly, not giving the normal bone a chance to surround the tumor.
A CT scan (CAT scan or computed tomography) is a more advanced test that can give a cross sectional picture of your bones. This test gives very good detail of your bones and is better able to identify a possible tumor. It also gives additional information on the size and location of the tumor.
An MRI (magnetic resonance imaging) is another advanced test that can also provide cross sectional imaging of your body. The MRI provides better detail of the soft tissues including muscles, tendons, ligaments, nerves, and blood vessels than a CT scan. This test can give better detail on whether or not the bone tumor has broken through the bone and involved the surrounding soft tissues.
A bone scan is a test that identifies areas of rapidly growing or remodeling bone. The bone scan is often taken of the entire body. This test may be ordered to see if there are any other areas of bone involvement throughout the body.
If a tumor is identified, your doctor will use all of the information from the history and physical examination along with the laboratory and imaging studies to put together a list of possible causes (differential diagnosis).
Your doctor may then obtain a biopsy sample of the tumor. This involves taking a small sample of the tumor that can be examined in the laboratory to determine what kind of tumor it is. The biopsy can be obtained either through a small needle (needle biopsy) or through a small incision (incisional biopsy).
How is bone cancer treated?
There are many different methods available for your doctor to treat bone cancer. The best treatment is based on the type of bone cancer, the location of the cancer, how aggressive the cancer is, and whether or not the cancer has invaded surrounding or distant tissues (metastasized). There are three main types of treatment for bone cancer: surgery, chemotherapy, and radiation therapy. These can be used either individually or combined with each other.
Surgery is often used to treat bone cancer. The goal of surgery is usually to remove the entire tumor and a surrounding area of normal bone. After the tumor has been removed, a pathologist examines it to determine if there is normal bone completely surrounding the tumor. If a portion of the cancer is left behind, it can continue to grow and spread, requiring further treatment. Historically, amputations were frequently used to remove bone cancer. Newer techniques have decreased the need for amputation. In many cases, the tumor can be removed with a rim of normal bone without the need for an amputation. Depending on the amount of bone removed, the surgeon will replace something in its location. For smaller areas, this may be either bone cement or a bone graft from another place in your body or from the bone bank. For larger areas, the surgeon may place larger grafts from the bone bank or metal implants. Some of these metal implants have the ability to lengthen when used in growing children.
You may be referred to a medical oncologist for chemotherapy. This is the use of various medications used to try to stop the growth of the cancer cells. Chemotherapy can be used prior to surgery to try to shrink the bone tumor to make surgery easier. It can also be used after surgery to try to kill any remaining cancer cells left following surgery.
You could also be referred to a radiation oncologist for radiation therapy. The radiation therapy uses high-energy x-ray aimed at the site of the cancer to try to kill the cancer cells. This treatment is given in small doses daily over a period of days to months.
What are the side effects of treatment for bone cancer?
Unfortunately, there are risks and side effects with each of the treatments for bone cancer. The main risks associated with surgery include infection, recurrence of the cancer, and injury to the surrounding tissues. In order to remove the entire cancer and reduce the risk of recurrence, some surrounding normal tissue must also be removed. Depending on the location of the cancer, this may require the removal of portions of bone, muscle, nerves, or blood vessels. This could cause weakness, loss of sensation, and the risk of fracture or fracture of the remaining bone. You could be referred to a rehabilitation specialist for physical and occupational therapy after surgery to try to improve your strength and function.
Chemotherapy uses very powerful medication to try to kill cancer cells. Unfortunately, some normal cells are also killed in the process. The medications are designed to kill rapidly dividing or growing cells. The normal cells that are affected often include hair, blood-forming cells, and cells lining the digestive system. Side effects include nausea and vomiting, loss of hair, infection, and fatigue. Fortunately, these side effects usually resolve after the chemotherapy is over. Good nutrition is important for your body to fight the cancer. You may be referred to nutrition specialist to help with this, especially if you experience nausea and loss of appetite.
The main side effects from radiation therapy include fatigue, loss of appetite, and damage to the surrounding skin and soft tissues. Prior radiation therapy can also increase the risk of wound problems from surgery in the same area.
What does the future hold for patients with bone cancer?
There has been much recent advancement in the understanding and treatment of bone cancer. These have led to more focused radiation therapy to reduce the risk to surrounding tissues, better combinations of chemotherapy with less risk and side effects, and improved treatment options, including limb-salvaging surgery, that decrease the need for amputation.
There is currently much work being conducted in each of these areas as well as investigations into the causes of cancer. It is hoped that a better understanding of the specific causes of cancer will lead to gene-therapy techniques to target specific cancer cells with limited risk to other normal cells.
What resources are available for patients with bone cancer?
There are many resources available for patients with bone cancer. These include sources of information and emotional support.Advertisements
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