Please advise.

Someone in my family has been diagnosed with Leukemia, 3 years ago. she has undergone chemo and is now ok (thank God!). but, starting abt 4-6 months ago, she started to experience sharp, almost constant pain in what seems to be the leg and hip bones. she also says she feels 1000 needles in her heels/soles.

Now the doctor didn't allow any x-ray or CAT scan (for fear of radiation exposure). Her osteoporosis test from a year ago was fine.

What could this be? I'm worried about bone cancer..since I've heard sometime chemo for one can cause another:(

Definition of Bone Cancer
Cancer that begins in the bone is called primary bone cancer. Primary bone cancer is relatively uncommon in comparison with secondary or metastatic cancer (cancer that occurs initially in another organ and then spreads to bone tissue).

Description of Bone Cancer
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). Muscles pull against the bones to make the body move. Bone marrow (the soft, spongy tissue in the center of many bones) makes and stores blood cells.

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.

Primary bone cancers are called often called sarcomas. there are several types of sarcoma. Each type begins in a different kind of bone tissue. The most common are osteosarcoma, Ewing's sarcoma and chondrosarcoma.

Osteosarcoma is the most common type of bone cancer in young people. it usually occurs between the ages of 10 and 25. Males are affected more often than females. Osteosarcoma often starts in the ends of bones, where new bone tissue forms as a young person grows. it usually affects the long bones of the arms or legs.

Ewing's sarcoma usually is found in people between 10 and 25 years of age; teenagers are most often affected. This cancer forms in the middle part (shaft) of large bones. it most often affects the hipbones and the long bones in the thigh and upper arm. it also occurs in the ribs.

Chondrosarcoma is found mainly in adults. This type of tumor forms in cartilage, the rubbery tissue around joints.

Cancers that begin in the bone are quite rare. on the other hand, it is not unusual for cancers to spread to the bones from other parts of the body. When this happens, the disease is not called primary bone cancer. Each type of cancer is named for the organ or the tissue in which it begins. Cancer that spreads is the same disease and has the same name as the original (or primary) cancer.

Treatment for cancer that has spread to the bones depends on where the cancer started and the extent of the spread. about 80 percent of these metastatic lesions are from primary carcinomas, particularly of the breast, prostate, lung, kidney, thyroid, pancreas and stomach.

Symptoms of Bone Cancer
Patients may present with persistent pain, swelling, or tenderness of a bone. They may have unexplained fracture of one or more bones, sometimes without noticeable trauma.

Diagnosis of Bone Cancer
The presenting symptom is usually pain. Pathologic fracture may be present and is more common in the lower than the upper extremity.

The presenting radiologic finding on X-ray is often destruction of bone. In a patient with a known primary malignant tumor presenting with a painful, destructive lesion of bone, a diagnosis of metastatic cancer can be made with some assurance. However, there are individuals in whom the primary cancer is not yet recognized at the time when the early metastatic lesion in bone becomes painful.

A CAT scan, MRI, radionuclide bone scan or a skeletal survey may be done to pinpoint which bones have been affected.

Treatment of Bone Cancer
The treatment of cancer of the bone, especially metastatic cancer, has two goals: management of the neoplasm and management of the symptoms produced by the local lesion. Prognosis is affected by a patient's age, the size of the primary tumor, grade and stage, degree of lymphatic and blood vessel invasion, the duration of symptoms and the location of the tumor on the arm, leg or trunk.
There are two ways bone metastasis is treated. Systemic therapy, aimed at cancer cells that have spread throughout the body, includes chemotherapy, hormone therapy, and immunotherapy. Local therapy, aimed at killing cancer cells in one specific part of the body, includes radiation therapy and surgery.

Surgery often has to be extensive, with a wide margin of tissue around the tumor being removed. Sarcomas involving muscles require removal of the entire affected muscle group.

Radiation therapy is used to prevent local recurrences of radiosensitive tumors and may be given either before or after surgery.

Chemotherapy – a number of drugs have proven to be effective in treating bone and soft tissue sarcomas. The dosages required to provide a good chance for cure often produce significant side effects. Effective single agents may include doxorubicin (Adriamycin), cyclophosphamide, high-dose methotrexate (with leucovorin rescue), ifosfamide, dacarbazine, vincristine, dactinomycin (Actinomycin D), etoposide and investigational agents. Combinations of these drugs are often used.

Hormone therapy is either the removal of the organs which produce hormones which can promote the growth of certain types of cancer (such as testosterone in males and estrogen in females), or drug therapy to keep the hormones from promoting cancer growth.

Biphosphonates are drugs that can be used to reduce bone pain and slow down bone damage in people who have cancer that has spread to their bones.

Even if a bone or soft tissue sarcoma is appears to be localized and could apparently be completely removed, there is still significant risk that tumor cells too small to detect have already spread to other places in the body. Additional treatment with chemotherapy (adjuvant chemotherapy) attempts to eliminate these tumor deposits.

There are also safe and effective ways to treat pain. Medications can allow people to be free of pain so that they can continue the activities that are important to them.

Questions To ask Your Doctor about Bone Cancer
Is it primary or secondary cancer of the bone?

Where has it spread from?

Do you recommend chemotherapy?

What is the prognosis?

Hope this helps! <3 good luck hun!

Could be a number of things such as a bad disk in the back or neck.

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. Cancers that begin in the bone are quite rare. on the other hand, it is not unusual for cancers to spread to the bones from other parts of the body. When this happens, the disease is not called primary bone cancer. Each type of cancer is named for the organ or the tissue in which it begins. Cancer that spreads is the same disease and has the same name as the original (or primary) cancer. any kind of cancer can spread to the bone. This bone metastasis usually occurs late in the disease. Breast, prostate, and lung cancer are the most common types of cancers that spread to the bone. The bones of the spine, pelvis, and ribs are the most commonly affected. The bones of the upper arm and upper leg also may be affected. Multiple myeloma, a type of blood cancer, can affect the bones early in the disease.

What causes bone cancer?
Although scientists are not certain what causes bone cancer, a number of factors may put a person at increased risk. these cancers occur more frequently in children and young adults, particularly those who have had radiation or chemotherapy treatments for other conditions. Adults with Pagets disease, a noncancerous condition characterized by abnormal development of new bone cells, may be at increased risk for osteosarcoma. A small number of bone cancers are due to heredity. For example, children with hereditary retinoblastoma (an uncommon cancer of the eye) are at a higher risk of developing osteosarcoma. The bones support the body and make it possible to move about. Cancers affecting the bone will weaken the bone, and the affected area may break easily. In bone cancer, abnormal cells multiply and spread to form tumors. Healthy bones, nerves, and tissues (including organs) are damaged or destroyed, and the disease can be life threatening. However, successful treatment is often possible, particularly if the cancer is found in its early stages. Chances for successful treatment decrease and the threat to life increases the longer the cancer is untreated. The break can occur for no apparent reason. or, it may be caused by mild trauma that would not normally be expected to cause a bone to break. there may be a genetic link and bones which have been previously fractured or infected may be more susceptible to bone cancer. Excessive exposure to chemicals or radiation may also increase the risk of bone cancer.

What are the symptoms of bone cancer?
Patients may present with persistent pain, swelling, or tenderness of a bone. They may have unexplained fracture of one or more bones, sometimes without noticeable trauma. A fracture in a bone that causes severe pain may be the first sign that cancer has invaded the bone. Sometimes the person will have pain in the area for some time before the fracture occurs. In other cases, there is no pain until the bone breaks. Pain is the most frequent symptom of bone cancer. Sometimes a firm, slightly tender lump on the bone can be felt through the skin. In some cases, bone cancer interferes with normal movements. Bone cancer can also cause bones to break.

How is bone cancer diagnosed?
The presenting symptom is usually pain. Pathologic fracture may be present and is more common in the lower than the upper extremity. The presenting radiologic finding on X-ray is often destruction of bone. In a patient with a known primary malignant tumor presenting with a painful, destructive lesion of bone, a diagnosis of metastatic cancer can be made with some assurance. However, there are individuals in whom the primary cancer is not yet recognized at the time when the early metastatic lesion in bone becomes painful. A CAT scan, MRI, radionuclide bone scan or a skeletal survey may be done to pinpoint which bones have been affected.

What is the treatment for bone cancer?
The treatment of cancer of the bone, especially metastatic cancer, has two goals: management of the neoplasm and management of the symptoms produced by the local lesion. Prognosis is affected by a patient's age, the size of the primary tumor, grade and stage, degree of lymphatic and blood vessel invasion, the duration of symptoms and the location of the tumor on the arm, leg or trunk.

Treatment options depend on the type, size, location, and stage of the cancer, as well as the persons age and general health. Surgery is often the primary treatment. Although amputation of a limb is sometimes necessary, pre- or post-operative chemotherapy has made limb-sparing surgery possible in many cases. When appropriate, surgeons avoid amputation by removing only the cancerous section of the bone and replacing it with an artificial device called a prosthesis.

Chemotherapy and radiation may also be used alone or in combination. because of the tendency for Ewings sarcoma to metastasize rapidly, multidrug chemotherapy is often used, in addition to radiation therapy or surgery on the primary tumor. Radiation therapy is used to treat bone pain in a person who has bone metastasis. Radiation to the affected areas can also prevent further weakening of the bones. The total dose of radiation that can be given is limited, however. Chemotherapy is sometimes used to help control the underlying cancer.

August 11, 2010, 8:51 pm

Life-giving blood is an essential and integral component of the human body. Human blood consists of cellular components known commonly as red cells, white cells and platelets together with a fluid component known as plasma. the red cells contain haemoglobin which is the principal carrier of oxygen and carbon dioxide in the body. there is a highly refined mechanism by which the red cell haemoglobin is empowered to carry out these functions. Red cells are mainly formed within the bone marrow and several different materials are necessary for their formation. These include proper nourishment, particularly proteins, iron, folic acid and several other vitamins. some hormones are also needed for proper production of blood. the integrity and normal functioning of bone marrow which is the soft, spongy tissue inside bones that makes new blood cells, is essential for the production of normal red cells. An adequate and normal amount of blood, both in quantity and adequacy of its essential components, is a mandatory requirement for good health.

When either the number of red cells are reduced or the haemoglobin content of the red cells go down, a state of anaemia is said to be present. Anaemia is one of the more common blood disorders and it can lead to many health problems. Anemia can be caused by several different basic mechanisms. These can be very broadly classified into three separate groups. These are :-

1. Acute or chronic blood loss

2. Inadequate production of red blood cells and / or of haemoglobin

3. Excessive destruction of red blood cells

From another angle, among many other causes, anaemia can also result from inherited disorders, nutritional problems such as an iron or vitamin deficiency, infections, some kinds of cancer or exposure to certain drugs or toxins.

Blood loss can cause anaemia. Blood may be lost acutely due to excessive bleeding secondary to injury, surgery or a problem with the clotting ability of blood which leads to unusual and sustained bleeding from many sites. Slower, long-term blood loss, such as due to intestinal bleeding from hook worm infestations, peptic ulcers or from inflammatory bowel diseases is also known to cause anaemia. it could also be caused by heavy menstrual losses in adolescent girls. A secondary effect of any form of blood loss is an increase in the body’s need for iron, folic acid and other ingredients which are needed to make new red blood cells. If the intake of these nutrients is sub-optimal, then the anaemia due to loss of blood will be potentiated and made worse by the inability of the body to make good the losses and replenish the required amounts of red cells.

Anaemia caused by inadequate production of the required amounts of blood is primarily due to a failure of the bone marrow to function normally. Bone marrow functional disturbances could be produced by certain viral infections, exposure to several toxic chemicals, radiation or medications and in rare cases to a congenital disturbance of the bone marrow. some childhood cancers can also lead to bone marrow problems. In these situations, the marrow is not able to respond to the need to produce more red cells.

Anaemia also occurs when the body is not able to produce enough healthy red cells because of a deficiency of an essential component that is required for the process to be carried out normally. one such important cause is iron deficiency. Iron is essential for haemoglobin production. Poor dietary iron intake or excessive losses of iron from the body can lead to iron deficiency anaemia, which is perhaps the most common cause of anaemia in children. Iron deficiency anaemia can affect children of any age but is most common in those younger than 2 years old. Girls going through puberty also have a particularly high risk for iron deficiency anaemia because of the onset of menstruation, the monthly blood losses increasing the amount of iron they need to consume in their diets.

Anaemia is also known to occur when red blood cells are being destroyed prematurely. These anaemias are collectively referred to as haemolytic anaemia. the normal lifespan of a red blood cell is around 120 days. once they are beyond their useful life, they are destroyed within the body and fresh red cells are produced to replenish the destroyed ones. In all forms of haemolytic anaemias, this life span is shortened, sometimes quite drastically. when such premature destruction occurs, the bone marrow is overwhelmed by the demand to make new red cells and it cannot keep up with the body’s demand for excessive production of red cells. there are several different types of such haemolytic anaemias and the much discussed thalassaemia too falls into this group. Thalassaemia major is a severe form of anaemia in which the red blood cells are rapidly destroyed and iron liberated from this process is deposited in the skin and vital organs. such abnormal depositions of iron are intensely toxic to the tissues in which it is deposited and this leads to damage to many organs of the body. Thalassaemia minor involves only mild anaemia and minimal red blood cell changes. there are other types of anaemias due to shortening of the lifespan of the red cells such as sickle cell anaemia, hereditary spherocytosis and some enzyme deficiencies in the red blood cells. In one particular type of haemolytic anaemia, due to the production of certain types of antibodies, the immune system mistakes red blood cells for foreign invaders and begins destroying them. this can occur acutely and the process can be triggered by many provoking factors. some of these forms of all these haemolytic anaemia could be quite severe with the haemoglobin levels falling to very low levels at regular intervals. the only way to keep the haemoglobin at satisfactory levels is to administer regular blood transfusions.

In certain chronic diseases such as in some forms of chronic arthritis, tuberculosis and other long standing diseases, anaemia may occur as a complication. In many of these cases there is more than one basic cause for the anaemia. Several different mechanisms such as increase in the rate of destruction, poor replenishment of the red cells and a concomitant deficiency of certain nutritional components may all play a part. In such cases, the anaemia is a symptomatic manifestation of the underlying disease and has a multi-faceted origin.

In acute situations where there has been obvious blood loss, symptoms of a sudden reduction in the circulating blood volume may cause shock and collapse. However, if a child has anaemia which has developed over a period of time, depending on the severity, the symptoms may not be all that florid. the first symptoms might be mild skin paleness and decreased pinkness of the lips and nailbeds. These changes may happen gradually and as such they can be difficult to notice. other common signs include irritability, fatigue, dizziness, lightheadedness, and a rapid heartbeat. If the anaemia is caused by excessive destruction of red cells symptoms may include jaundice which is yellowing of the whites of the eyes, an enlarged spleen, and dark plain tea coloured urine. If the haemoglobin falls to very low levels there may be certain features of heart failure as well. In infants and preschoolers, iron deficiency anaemia can result in developmental delays and behavioural disturbances such as decreased motor activity together with problems of social interaction and attention to tasks. Research indicates that such developmental problems may last into and beyond school age if the iron deficiency is not properly treated.

Clinical assessment of anaemia is not all that accurate unless the anaemia is at least moderately severe. However, in very severe anaemias, the heart is called upon to do extra work to get as much of the reduced amounts of blood to the tissues of the body and this may ultimately result in heart failure. In many cases it is often necessary to run quite a few blood tests to ascertain and assess anaemia. These tests are also helpful in categorising the exact type of anaemia. A complete blood count (CBC) provides a number of parameters that could be used to diagnose the type and severity of anaemia. other diagnostic tests may include:

* Blood smear examination: Blood is smeared on a glass slide for microscopic examination of red cells. this can provide certain types of information regarding the size and shape of red cells.

* Iron tests: These include total serum iron and ferritin tests which can help to determine whether anemia is due to iron deficiency.

* Hemoglobin electrophoresis: this test is used to identify various abnormal haemoglobin types in the blood and to diagnose sickle cell anaemia, the thalassaemias, and other inherited forms of anaemia.

* Bone marrow aspiration and biopsy: this test can help determine whether cell production is happening normally in the bone marrow. it is the only way to diagnose certain types of anaemia where the primary problem is in the bone marrow.

* Reticulocyte count: A measure of young red blood cells which helps to determine if the red cell production is at normal levels.

Treatment for anaemia depends on its cause. it is extremely important not to assume various causes and a definitive diagnosis must first be made before starting treatment. the different laboratory tests help to categorise the nature and severity of anaemia. as it often happens, one may have to progressively increase the tests that are being done, depending on the results of the initial basic investigations. more sophisticated tests are necessary in certain cases as the cause may be quite a complicated one or there may be more than one reason for the anaemia.

Depending on the severity of the anaemia, sometimes urgent treatment may be necessary. If the haemoglobin level is very low and into the range that threatens life, an urgent blood transfusion may be necessary. In certain cases, heart failure complicating severe anaemia needs additional treatment. all types of deficiency anaemias would need appropriate treatment with specific substances that are in short supply in the body and are the root cause of the problem. such replenishment therapy may need drugs to be given for a prolonged period of time, possibly for a few months.

Although children often tolerate anaemia much better than adults, they too need special care when they are anaemic. In general, a child with significant anaemia may tire more easily than other kids and therefore need to limit activity levels. it is important for the child’s teachers and other caregivers are aware of the condition. With appropriate treatment, several types of anaemic could be cured but inherited diseases such as thalassaemia do not have a true "cure". whether anaemia can be prevented depends on its cause. currently, there is no way to prevent anaemia due to genetic defects affecting the production of red blood cells or haemoglobin. all types of deficiency anaemias, especially those due to mineral deficiencies can be very effectively prevented by attention to detail about the dietary constituents and by providing a well balanced mixed diet.

The writer would appreciate feedback from the readers. please e-mail him at