Bone marrow is the spongy, vascular tissue inside the bones, responsible for producing blood cells. Abnormalities and defects in some of the cells can lead to the groups of blood and marrow cancers known as lymphoma, leukemia, and myeloma. Bone cancers can either originate in another part of the body and later spread to the bones through metastasis, or they can originate in bone tissue or inside the marrow (primary bone cancer).
Like other forms of cancer, bone malignancies and sarcomas are treated according to the grade, location, and origin of the tumors. Many sarcomas (also known as soft tissue tumors, which originate in muscle and connective tissue, but can also develop in bones) overwhelmingly affect the arms and legs, especially in children, and therefore limb preservation is a major factor when treating bone cancer. Blood cancers like lymphoma and myeloma cause can cause damage and weaken the bones, often leading to breaks and fractures.
Most Common Forms of Bone Marrow Cancers
The blood is made up primarily of red and white blood cells, which help the body to fight off infections and regulate the immune system, among other functions. Multiple myeloma affects the type of white blood cells known as plasma. Plasma cells are responsible for producing the antibodies that help us to fight off everything from the common cold, to staph infections and other foreign invaders.
When tumors form in the bone marrow, they begin to crowd the healthy cells, disrupting the production of normal blood cells and producing harmful proteins that damage the kidneys and other vital organs (known as M proteins). Some people with myeloma do not experience symptoms or excessive levels of M proteins, and do not require active treatment. The most common signs of cancer in the plasma cells include:
- Bone pain
- Nausea and loss of appetite
- Frequent infections
- Numbness and weakness in the legs
- Confusion and mental fog
- Dehydration/excessive thirst
This type of marrow cancer is diagnosed through blood and urine tests, bone marrow biopsy, and diagnostic imaging tests (X-ray, CAT scan, MRI). Tumor treatment depends on the stage and risk levels of the disease, which is graded from stage 1 – 3 according to severity. If treatment is deemed necessary, the options include:
- Targeted drug therapy – kills myeloma cells by blocking and interfering with the production of harmful proteins
- Biologic therapy – drugs that use the immune system to fight bone cancer cells
- Stem cell transplant
Lymphoma is something of an umbrella term for several forms of cancer that affect the lymphatic system, which includes the bone marrow, lymph nodes/glands, spleen, and thymus gland. The lymphatic system is responsible for healthy immune function in the body. Patients with bone marrow disorders and cancer have trouble fighting off infections, which can lead to frequent infections, and compromise healthy organ function throughout the body.
Categorized as a form of blood cancer, the pathology for the different types of lymphoma are similar to bone sarcomas in that some are more common in children and teenagers, while others tend to occur most frequently in adults over a certain age.
The most common types of lymphoma include:
- Hodgkin Disease – affects white blood cells (lymphocytes)
- Non-Hodgkin Lymphoma – also affects immune system lymphocyte cells in adults
- Non-Hodgkin Lymphoma in Children
- Lymphoma of the Skin (cutaneous lymphoma)
The treatment options and prognosis for this form of cancer vary depending on the type and severity. The most common forms of treatment include:
- Stem cell transplant
Myelodysplastic Syndrome (MDS)
MDS results from a malfunction in the bone marrow that leads to the production of defective blood cells. MDS is often asymptomatic in the earlier stages of the condition, but once symptoms present they can be similar to certain blood and marrow cancers. The most common symptoms of myelodysplastic syndrome include:
- Anemia/pallid skin
- Excessive/easy bruising and bleeding
- Shortness of breath
- Multiple/frequent infections
- Petechiae (tiny red spots caused by bleeding below the skin)
MDS causes the bone marrow to produce defective blood cells that die before or right after entering the bloodstream, and it can affect red or white blood cells, as well as platelets. The condition can sometimes result from earlier radiation treatments, or from unknown causes. It is most common in adults over the age of 60, and earlier treatment with radiation and exposure to industrial chemicals and heavy metals has been known to increase the risk of developing MDS. Treatment varies from medication to stem cell transplant.
Bone Cancer Diagnosis and Treatment in Los Angeles
Daniel C. Allison, MD, FACS, MBA is a board certified orthopedic surgeon and Assistant Director of Orthopedic Oncology, Cedars-Sinai Sam Oschin Cancer Center, with special expertise in musculoskeletal oncology, joint reconstruction, and limb preservation. For more information on the treatment options for marrow tumors, or to obtain a second opinion, contact Dr. Allison at 310-683-4586 to schedule an appointment today.
Next, read about metastatic bone disease.