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- Asymptomatic coronary artery disease
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- Central precocious puberty – CPP
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- Craniofacial growth problems
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- Male fertility problems, testosterone deficiency and sexual dysfunction
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- Overweight and obesity
- Peripheral neuropathy
- Premature ovarian insufficiency
- Psychosocial problems
- Spine scoliosis and kyphosis
- Spleen problems
- Stroke
- Subsequent neoplasms:
- Thyroid problems
SUBSEQUENT NEOPLASMS: BONE CANCER
This page is part of the PanCare PLAIN summaries about late effects and recommendations for long-term follow-up care for survivors of childhood, adolescent, and young adult cancer. Click here, for more information on the PLAIN summaries.
On this page you can find:
This brochure is a sequel to the brochure Subsequent neoplasms: general. Please read that brochure first before you continue.
This PLAIN summary is based on the PanCareFollowUp guideline about “Subsequent neoplasms” [1], which is based on the consensus of different national guidelines.
PLAIN version 2.1: 27/05/2024
Subsequent cancer: bone cancer
We need our bones to stay upright, help us move and to protect our organs. Each bone has a hard, calcified layer of bone on the outside. Underneath this hard layer is a softer, spongy bone. In the centre of bigger bones is the bone marrow, where our blood cells are formed. Inside the bone are bone cells, responsible for keeping the bone firm.
Sometimes, bone cells can become malignant. This means that they do not work properly any more and multiply uncontrollably, causing a tumour to grow. When this happens, this is called bone cancer (bone sarcoma).
Only a very few people who have had cancer before develop bone cancer.
Due to treatment of the first cancer, survivors sometimes have a higher risk of bone cancer.
Survivors
The bone
Created with BioRender.com
Hover over the numbers in the figure for more information.
Am I at higher risk of bone cancer?
Anyone, including people who have never had cancer treatment, may develop bone cancer. However, there are some cancer treatments that may increase the risk of having bone cancer as a subsequent cancer later in life.
The following treatment can increase the risk of bone cancer:
- Radiotherapy. The part of the body treated with radiotherapy is at higher risk of developing bone cancer.
You can find out if you have received radiotherapy by looking at your treatment summary. If you do not have a treatment summary or if you have any questions, do contact your treating hospital.
If you develop bone cancer, it does not always mean that this is caused by treatment for your first cancer. Bone cancer may have other causes.
Other causes
Radiotherapy
Your treatment summary can tell you which areas of your body were irradiated. If you do not have a treatment summary or if you don’t understand what is written about the radiotherapy you received, do contact your treating hospital.
Radiotherapy is a treatment for cancer which uses high-energy radiation to destroy cancer cells and to shrink tumours. The radiation comes from a machine outside the body (external beam radiotherapy) or occasionally from radioactive material that is placed in the body near cancer cells (intracavitary or interstitial radiotherapy). The aim of radiotherapy is to treat only one area of the body, around and near the cancer or where the cancer was before it was removed by surgery and as far as possible to protect unaffected areas. For example, if you have cancer in your lung, you will have radiation only to your chest, not to your whole body.
External beam radiotherapy is painless and takes only a few minutes. It is given once or occasionally twice a day often for several weeks. A radiation beam is like an invisible light beam. The machines which produce the radiation beam can be moved so that the beam enters the body from different directions, ‘spotlighting’ on the area to be treated. This means that the tumour is given a high dose whilst normal areas get either a lower or no dose at all.
Since the early 1980’s computers and other technical advances have improved radiotherapy. Before this there were not many ways to protect normal tissues which were in the path of a radiation beam. Even now, whilst modern techniques allow doctors to target the cancer cells more precisely than older techniques, healthy cells may still get damaged. This can result in some of the late effects covered in the PLAIN summaries. It will help you and your follow up specialist to know what long term effects there might be after your radiotherapy if you and they have your treatment summary.
Your treatment summary can tell you which areas of your body were irradiated. If you do not have a treatment summary or if you don’t understand what is written about the radiotherapy you received, please contact your treating hospital.
What are the symptoms and signs of bone cancer?
There are symptoms and signs that can tell you if you might have bone cancer. You might not have these symptoms and signs at the moment, but it is important to be aware of them in case they may develop in the future.
These symptoms and signs may suggest that you have bone cancer:
- A (sometimes painful) lump.
- Bone or joint pain (also at night), continuous or in waves.
- Breaking a bone after a small incident.
- Difficulty moving part of your body.
These symptoms and signs are often caused by something else. However, early diagnosis and treatment of bone cancer is very important. If you experience any of these symptoms or signs, please contact your general practitioner or follow-up care specialist soon.
Symptoms and signs
Soon
Pain
From a physical point of view, pain is a life-sustaining biological reaction to damaging influences – even if tissue damage has not yet occurred. Due to its function as a damage indicator or warning, pain is usually associated with negative feelings so that we pay sufficient attention to it and learn as quickly as possible when it is dangerous for us. How intensely we feel a pain stimulus, whether it causes us to feel fear and panic, depends not only on the pure nerve signal, but is an interplay of biological, psychological and social factors.
All pain whose duration exceeds the extent of an acute (recent) cause and lasts for an incomprehensibly long time is called chronic pain. Strong and prolonged pain stimuli can make the transmitting nerve cells of the spinal cord and brain more sensitive to subsequent pain stimuli. This means that even mild stimuli can be perceived as severe pain. Under certain circumstances, these nerve cells, which have become hypersensitive
I am at higher risk of bone cancer. What tests should I have and when?
If you are at higher risk of bone cancer, we do not recommend regular testing at this point. However, it is important that you are aware of the symptoms and signs of bone cancer. If you have any of these symptoms or signs, your general practitioner or follow-up care specialist may:
X-ray
In addition, there is also the option of CT (computer tomography) and MRI that are giving a more detailed look. The choice of imaging depends on what exactly needs to be looked at or examined. These images are used by healthcare professionals to make diagnoses or create treatment plans.
MRI
What happens if I (might) have bone cancer?
If you (might) have bone cancer, your general practitioner or follow-up care specialist will refer you to an oncology team. This team may include, but is not limited to:
- Orthopaedic oncological surgeon (physician specialised in bone cancer)
- Medical oncologist (physician specialised in cancer)
The specialist may discuss different treatment options with you.
What else can I do?
Knowing that you may be at increased risk of subsequent cancer can be difficult. Talking to friends and family can be helpful as well as specialist counselling and/or contact with support groups, such as patient organisations. For more information on taking care of your mental health, please read: Mental health problems.
Although we are not sure of its effect on your risk of bone cancer, adopting or maintaining a healthy lifestyle is important. Taking care of your mental health may be beneficial; even small changes to your lifestyle can have a positive impact on both your physical and mental health. For more information on taking up a healthier lifestyle, please read: Health promotion.
It is important that you are aware of the possibility of developing bone cancer and that you know the symptoms and signs. If you have any further questions or if the information in this brochure concerns you, please contact your general practitioner or follow-up care specialist.
Healthy lifestyle
- Having a healthy diet
- Drinking less (or no) alcohol
- Exercising regularly
- Quitting smoking (if you smoke)
Your follow-up care specialist or general practitioner may give you additional advice tailored to your individual situation for maintaining a healthy lifestyle. For more information on taking up a healthier lifestyle, please read: Health promotion.
Where can I find more information?
You may find more information about bone cancer online. However, it is important to be aware that this information is not always up to date or accurate.
On this website, you can also find more information related to this topic:
Please note
This PLAIN summary is based on the PanCareFollowUp guideline about “Subsequent neoplasms” [1], which is based on the consensus of different national guidelines.
While the PanCare PLAIN information group strives to provide accurate and complete information that is up-to-date as of the date of publication, you can check with your general practitioner or follow-up care specialist if this summary reflects the most up-to-date information available and whether it is relevant for you.
Please do not rely solely on this information. It is best to also seek the advice of a qualified medical practitioner if you have questions regarding a specific medical condition, disease, diagnosis or symptom.
No warranty or representation, expressed or implied, is made concerning the accuracy, reliability, completeness, relevance, or timeliness of this information. PanCare has produced the English version and PanCare is not responsible for the translated versions of this summary.
The PanCare materials are free to use for anyone aiming to inform about late effects and long-term survivorship care. However, no financial advantage may be achieved. All communication should reference PanCare and link to the PanCare website.
[1] van Kalsbeek, R. et al. (2021) European PANCAREFOLLOWUP recommendations for surveillance of late effects of childhood, adolescent, and Young Adult Cancer, European journal of cancer. Available at: https://www.ejcancer.com/article/S0959-8049(21)00368-3/fulltext.