Causes

Causes of bone cancer
The exact cause of most bone cancers is not known. But we do know that certain risk factors are linked to this disease. A risk factor is something that affects a person's chance of getting a disease. Some risk factors, such as smoking, can be controlled. Others, like a person's age or race, can't be changed. But having a risk factor, or even several, does not mean that you will get cancer. Most people with bone cancer do not have any known risk factors.

The risk factors for bone cancer are often linked to having had other diseases, treatments for other diseases, or age. The following conditions can slightly increase the risk of bone cancer. If you have any of these, you should ask your doctor for more information.

1. Li-Fraumeni syndrome
2. Rothmund-Thompson syndrome
3. retinoblastoma (a rare eye cancer of children)
4. Paget disease
5. multiple exostoses, also called multiple osteochondromas (an inherited condition that causes many bumps on a person's bones)
6. multiple enchondromatosis (many benign cartilage tumors)

People who have been treated with radiation for an earlier cancer have a higher risk of getting bone cancer later. Being treated at a younger age and/or being treated with high doses of radiation increases the risk of bone cancer. Non-ionizing radiation, such as microwaves, electromagnetic fields from power lines, cell phones, and household appliances, does not increase bone cancer risk.

Bone cancer has been reported in a few people who have had bone marrow (stem cell) transplantation.

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Bone cancer

What is bone cancer

Bone is the supporting framework of the body. Most bones are hollow. The outer part of bones consists of a network of fibrous tissue called matrix onto which calcium salts are laid down. The soft tissue inside hollow bones is called bone marrow. At each end of the bone is a zone of, a softer form of bone-like tissue called cartilage.

Cartilage is made of a fibrous tissue matrix mixed with a gel-like substance that does not contain much calcium. Cartilage is softer than bone but more firm than most tissues.

Most bones start out as cartilage. The body then lays calcium down onto the cartilage to form bone. After the bone is formed, some cartilage may remain at the ends to act as a cushion between bones. This cartilage, along with ligaments and some other tissues connect bones to form a joint. In adults, cartilage is mainly found at the end of some bones as part of a joint. It is also seen at the place in the chest where the ribs meet the sternum (breastbone) and in parts of the face. The trachea (windpipe), larynx (voicebox), and the outer part of the ear are other structures that contain cartilage.

nside hollow bones is a space called the medullary cavity where bone marrow is found. In some bones the marrow is only fatty tissue. The marrow in other bones is a mixture of fat cells and blood-forming cells. The blood-forming cells produce red blood cells, white blood cells, and blood platelets. Other cells in the marrow include plasma cells, fibroblasts, and reticuloendothelial cells.

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Types of liver cancer

Types of liver cancer

Some cancers begin in the cells of the liver itself – these are called primary liver cancer. More commonly, cancers start in cells in other organs of the body but then spread to the liver – this is called secondary liver cancer. Your doctor may use the term ‘liver metastasis’ (which is another way of saying that cancer has spread to the liver). It is possible for there to be several cancer deposits (metastases) in the liver.

There is more than one sort of primary liver cancer. One such type starts within the cells which make up most of the liver tissue – this is known as a hepatoma, or sometimes hepatocellular carcinoma (HCC for short).

Another type begins in the cells which line the tubes (or ducts) that carry the bile out of the liver – this bile duct cancer is known as a cholangiocarcinoma. Hepatomas usually occur in people who have an underlying liver disease, such as scarring of the liver (also known as cirrhosis) and can be a long-term result of chronic hepatitis. There is no association between cirrhosis and the development of cholangiocarcinoma.

However, in the UK, secondary liver cancer is about 30 times more common than these primary liver cancers. Secondary cancer occurs in people who have a primary cancer which has begun elsewhere. The usual sites in the body where primary tumours develop before spreading to the liver include the lung, breast, large bowel,
stomach and pancreas. Cancer cells usually spread to the liver from the primary tumour through the bloodstream.

Other, much less common, types of cancers can occur in the liver. These grow at different speeds. Your doctor will explain if you have one of these sorts of tumour.

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Treatment of liver cancer

Treatment of liver cancer
The treatment options are dictated by the stage of liver cancer and the overall condition of the patient. The only proven cure for liver cancer is liver transplantation for a solitary, small (<3cm) tumor. Now, many physicians may dispute this statement. They may argue that a small tumor can be surgically removed (partial hepatic resection) without the need for a liver transplantation. Moreover, they may claim that the one and three year survival rates for resection are perhaps comparable to those for liver transplantation.

The results of the various medical treatments (chemotherapy, chemoembolization, ablation, and proton beam therapy) remain disappointing. Moreover, for reasons noted earlier (primarily the variability in natural history), there have been no systematic study comparisons of the different treatments. As a result, individual patients will find that the various treatment options available to them depend largely on the local expertise.

How do we know if a particular treatment worked for a particular patient? Well, hopefully, the patient will feel better. However, a clinical response to treatment is usually defined more objectively. Thus, a response is defined as a decrease in the size of the tumor on imaging studies along with a reduction of the alpha-fetoprotein in the blood, if the level was elevated prior to treatment.

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Symptoms of liver

Symptoms of liver cancer

The initial symptoms (the clinical presentations) of liver cancer are variable. In countries where liver cancer is very common, the cancer generally is discovered at a very advanced stage of disease for several reasons.
For one thing, areas where there is a high frequency of liver cancer are generally developing countries where access to healthcare is limited. For another, screening examinations for patients at risk for developing liver cancer are not available in these areas.
In addition, patients from these regions actually have more aggressive liver cancer disease. In other words, the tumor usually reaches an advanced stage and causes symptoms more rapidly. In contrast, patients in areas of low liver cancer frequency tend to have liver cancer tumors that progress more slowly and, therefore, remain without symptoms longer.

In advanced liver cancer, the tumor can spread locally to neighboring tissues or, through the blood vessels, to elsewhere in the body (distant metastasis). Locally, liver cancer can invade the veins that drain the liver (hepatic veins). The tumor can then block these veins, which results in congestion of the liver.

The congestion occurs because the blocked veins cannot drain the blood out of the liver. (Normally, the blood in the hepatic veins leaving the liver flows through the inferior vena ceva which is the largest vein that drains into the heart.) In African patients, the tumor frequently blocks the inferior vena cava.

Blockage of either the hepatic veins or the inferior vena cava results in a very swollen liver and massive formation of ascites. In some patients, as previously mentioned, the tumor can invade the portal vein and lead to the rupture of esophageal varices.

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