Overview of Bone Cancer in Teenagers and Young Adults
Bone cancer in teenagers and young adults is a rare but serious malignancy that originates in the bones or surrounding connective tissues. Unlike cancers that spread (metastasize) to the bones from other organs, primary bone cancers start within the bone itself. They most commonly occur during periods of rapid growth, which explains their prevalence in adolescents and young adults.
The two most common types in this age group are:
- Osteosarcoma: Usually develops in the long bones of the arms or legs, particularly near growth plates around the knee or shoulder.
- Ewing sarcoma: Can arise in any bone or soft tissue but often affects the pelvis, femur, or chest wall.
Early detection is vital, as bone cancer can spread quickly — especially to the lungs — but advances in surgery, chemotherapy, and targeted therapies have significantly improved survival rates.
Commonly Associated with Bone Cancer in Teenagers and Young Adults
Several risk factors and conditions are associated with primary bone cancer in this age group:
- Rapid bone growth: Adolescents experiencing growth spurts are at higher risk.
- Previous radiation therapy: Prior exposure, especially at a young age, increases risk.
- Inherited genetic syndromes: Such as Li-Fraumeni syndrome, hereditary retinoblastoma, or Rothmund-Thomson syndrome.
- Bone diseases: Conditions like Paget’s disease (rare in youth) can predispose to cancer.
- Family history: Although rare, genetic predisposition plays a role in some cases.
- Previous chemotherapy: Certain cancer treatments increase future risk of bone tumors.
Causes of Bone Cancer in Teenagers and Young Adults
The exact cause is not always clear, but bone cancer typically results from genetic mutations in bone-forming cells that lead to uncontrolled growth and tumor formation. Factors include:
- Genetic alterations: Spontaneous or inherited mutations in tumor suppressor genes (e.g., RB1, TP53).
- Rapid bone growth: Rapidly dividing bone cells during adolescence are more prone to mutations.
- Radiation exposure: DNA damage from previous radiation therapy can trigger malignant transformation.
- Environmental and chemical exposure: Rarely, toxins and chemicals may contribute.
These changes disrupt the normal cycle of bone remodeling, causing abnormal bone tissue to form tumors.
Symptoms of Bone Cancer in Teenagers and Young Adults
Symptoms often resemble those of sports injuries or growing pains, which can delay diagnosis. Persistent or worsening symptoms should always be evaluated.
Common signs and symptoms include:
- Persistent bone pain: Often worse at night or during activity.
- Swelling or lump: Near the affected bone, sometimes tender or warm to touch.
- Limited joint movement: If the tumor is near a joint.
- Fractures: Bones weakened by the tumor may break easily.
- Fatigue, weight loss, or fever: Possible in advanced disease.
- Shortness of breath or cough: If the cancer spreads to the lungs.
In teenagers, pain is often dismissed as growth-related, so early medical evaluation is essential if symptoms persist longer than 2–3 weeks.
Exams & Tests for Bone Cancer
Diagnosis involves a combination of imaging, laboratory tests, and tissue analysis:
- Medical history and physical examination: Assess pain characteristics, swelling, and functional limitations.
Imaging tests:
- X-rays: Often the first test, showing abnormal bone structure or masses.
- MRI: Provides detailed images of tumor size, local spread, and soft tissue involvement.
- CT scan: Evaluates tumor extension and checks for lung metastasis.
- Bone scan or PET-CT: Detects additional lesions or metastases.
Biopsy (definitive diagnosis):
- Core needle or open biopsy: Essential for identifying tumor type and grade.
Laboratory tests:
- Blood tests: May show elevated alkaline phosphatase or lactate dehydrogenase (LDH), indicating increased bone activity or tumor burden.
Staging is based on tumor size, grade, and spread (localized vs. metastatic).
Treatment of Bone Cancer in Teenagers and Young Adults
Treatment depends on the tumor type, size, location, and stage, as well as the patient’s overall health. A multidisciplinary team approach is essential.
1. Surgery (Mainstay of Treatment):
- Limb-sparing surgery: Most common approach — removes the tumor while preserving the limb using bone grafts or prosthetics.
- Amputation: Rarely required today but may be necessary for extensive or complex tumors.
- Rotationplasty: In certain cases, especially in children, part of the limb is removed and reattached to allow for prosthetic fitting.
2. Chemotherapy:
- Used before surgery (neoadjuvant) to shrink the tumor and after surgery (adjuvant) to kill remaining cancer cells.
- Standard regimens for osteosarcoma include methotrexate, doxorubicin, and cisplatin (MAP).
- Ewing sarcoma often requires multi-drug therapy (e.g., vincristine, ifosfamide, doxorubicin, etoposide).
3. Radiation Therapy:
- More commonly used in Ewing sarcoma (radiation-sensitive) or when surgery is not possible.
- May also be used postoperatively to target residual cancer cells.
4. Targeted Therapy & Immunotherapy:
- Drugs targeting specific genetic changes (e.g., FGFR, IGF-1R inhibitors) are under investigation.
- Immunotherapies are emerging as options in clinical trials.
5. Rehabilitation and Supportive Care:
- Physical therapy to restore strength and mobility.
- Psychological support to address emotional challenges.
- Long-term follow-up for recurrence monitoring and managing late treatment effects.
Prognosis:
- Localized osteosarcoma: 5-year survival rate ~65–75%.
- Localized Ewing sarcoma: 5-year survival rate ~70–80%.
- Metastatic disease: Prognosis drops to ~20–40%, emphasizing early detection and treatment.
Source
- Whelan J, et al. “Primary bone tumours in adolescents and young adults.” Lancet Oncol 2022; 23(8):e347–e359.
- Bielack SS, et al. “Osteosarcoma and Ewing sarcoma: clinical features and management.” J Clin Oncol 2021; 39(30):3431–3444.
- National Comprehensive Cancer Network (NCCN). “Bone Cancer (Version 1.2024) Clinical Practice Guidelines.”
