How do lifestyle factors or environmental exposures contribute to the risk of developing bone cancer, specifically Ewing sarcoma and Osteosarcoma?
Written by: Mikal Kidane, Chantal Li, Samuel Lin, & Karen Oei
Discussion
Bone Cancer is known to be one of the least common cancer forms with only 0.2% of the United States population diagnosed with it alone. Due to its rareness, it has been made abundantly clear that professionals have struggled when it comes to studying this form of cancer. The rarity of this specific branch of cancer makes it so that it doesn’t receive the same level of attention or focus as the more prominent types of cancer, i.e. lung cancer and brain cancer.
The lack of focus on bone cancer means that there hasn’t been as much advancement regarding treatment affecting the lives of those who have been diagnosed.
We as a group, collectively, decided to further our understanding regarding bone cancer and raise more awareness through this research paper. Bone cancer’s underrepresentation should be no more, encouraging us to provide a better understanding of this rare kind of cancer and emphasize the necessity for ongoing study and specialist care.
Abstract
Our curiosity and eagerness to provide a better understanding of bone cancer is why we chose to focus our research on this specific type of cancer. Our research paper focuses on the influence of lifestyle variables and environmental exposures on the risk of getting bone cancer, primarily osteosarcoma and Ewing sarcoma. Despite its rarity in comparison to other cancer types, the impact bone cancer has on patients highlights the necessity of recognizing its risk factors. We will look at how different lifestyle choices, such as exercise, substance use, and nutrition will lead to bone cancer risk. In addition, we will look at environmental exposures such as radiation and chemicals to understand how they may contribute to bone cancer growth. This paper will ultimately provide a detailed summary of how these factors contribute to the origin of bone cancer.
Introduction
When you hear the word “cancer,” what is the first type of cancer disease you think of? Did you think of breast cancer, lung cancer, or even colorectal cancer? To be candid, neither of these guesses are incorrect. These are all the most common types of cancers affecting individuals all around the world with more than 4,600,000 diagnoses of these cancers alone. However, frequently, people tend to forget that there are several other types of cancer affecting kids, teens, and adults all around the globe. These types of cancer mentioned earlier, garner a lot of attention because of their high occurrence and the extensive study into understanding and treating them. This widespread focus promotes breakthroughs in treatment and patient care. However, people frequently forget that numerous types of cancer affect children, adolescents, and adults worldwide that simply don't receive as much awareness. A prime example of this is bone cancer. Despite its low rate of diagnosis, bone cancer poses unique obstacles that demand specialist study and therapy specifically for children and adults.
Before diving into what exactly bone cancer is, it is imperative to understand the fundamentals of broad-term cancer. Often, people hear the word “cancer”, but aren’t fully aware of the term's definition. Cancer is a type of disease that causes some parts of the body's cells to grow uncontrollably and spread to other parts of the body. It is one of the most prominent genetic diseases in the world due to individuals' lack of nutrition, exercise, and an immense drinking problem. Of course, these are common leading factors, varying depending on which type of cancer is being discussed, but these are still the most evident factors seen in those who are diagnosed with cancer. That being said, it is important to be aware of your health and go down a healthy lifestyle to avoid certain diseases and complications.
Now that we can grasp what the definition of cancer is, let us take a deeper dive into what bone cancer is. So what is bone cancer? Bone cancer occurs when the bone cells grow extremely out of control and go on to create a lump of tissues known as a tumor. The build then becomes too intense and continuously spreads towards other parts of the body causing it to become cancerous. Fortunately, the majority of the bone tumors that occur, aren't cancerous or concerning as they don’t go on to the further stages. To fully understand what bone cancer is, there are the 3 main primary bone cancers we must cover.
Primary bone cancer, also referred to as bone ‘sarcoma’, is when these tumors start to grow from your bones making It the most serious form of bone cancer. The difference between primary bone cancer and secondary bone cancer is that secondary bone cancer begins in a different part of your body, such as your heart or lungs, and continues to spread to the bones. Whereas, primary bone cancer originates from your bones.
In the Penn Medicine article: Bone Sarcoma, it stated, “Bone sarcomas that are cancerous are quite uncommon, accounting for less than 1 percent of all diagnosed cancers”. This makes it so that cancerous bone sarcomas are quite uncommon, accounting for less than 1 percent of all diagnosed cancers. Eventually, as these tumors grow within the bone, they can destroy the bone and go on to affect the rest of your body.
There are three main types of primary bone cancer: Ewing's Sarcoma, Osteosarcoma, and Chondrosarcoma. Ewing sarcoma is when the pelvis, upper arm, leg, and ribs are the breeders of bone cancer. It typically attacks young individuals between the ages of 5-20. Osteosarcoma is typically found in teens or young adults because of how they experience rapid growth and puberty, making it the most common primary type of bone cancer. Oftentimes osteosarcoma begins in your humorous (upper arm) or knee (femur, tibia, and patella). The final type of primary bone cancer is known as Chondrosarcoma. The people often diagnosed with this form of primary bone cancer are individuals between the ages of 50-70. Chondrosarcoma occurs in the cartilage cells, which is often the least common type of primary cancer there is.
Although bone cancer is a sporadic form of cancer type, it poses immense challenges in diagnosis and treatment. To thoroughly understand its origins and proposals on how to better navigate this life-changing experience, we must ask the question: How do lifestyle factors or environmental exposures contribute to the risk of developing bone cancer? Although there is no way to avoid it, there are possibilities of helping the process. This way, we can question what contributes to bone cancer and the best ways to better the chances of winning against bone cancer.
Lifestyle Factors
There are several contributing lifestyle factors that can lead to cancer. Examples of these different lifestyle choices include exercise, substance use, and nutrition will lead to bone cancer risk.
Lack of exercise doesn’t directly cause bone cancer, but it can indirectly increase risk factors. Inactivity reduces bone density and contributes to obesity, which is linked to higher cancer risk due to chronic inflammation and hormonal changes. Partaking in regular exercise with up to 30 minutes to 1 hour is great for reducing your chances of being diagnosed with bone cancer.
Regular exercise helps maintain bone health and manage inflammation, potentially lowering overall cancer risk. While bone cancer itself is not directly caused by inactivity, staying active is important for overall health.
The use of substances such as cocaine, heroin, tobacco, and others are commonly known as negative substances for your body. They contribute to negative and unhealthy lifestyles harming your body in regards to sleep, mental health, behavioral health, and several other health issues. Summing up, substance use does more harm than any kind of good to your body, making it a kind of contributing factor.
Substance use and drug addictions have a strong correlation in leading to cancer, but what about bone cancer in particular? The risk of developing bone cancer when using substances such as tobacco and cocaine is extreme and can also do other damage to your health. As mentioned in the Journal of Bone Oncology, tobacco use negatively impacts the bone's health by making them more prone to osteoporosis. This means that this may lead to other health implications within the bones and can later on develop into a form of cancer. That is why individuals should stay away from substance use due to its immense negative impacts on the human body.
Nutrition also plays a significant role when it comes to cancer. It became evident that the lack of nutrition in the United States, alone, has resulted in severe health complications such as cancer, resulting in more than half a million deaths per year.
In the article, Cancer and Food by Better Health, it states, “High-fat, low-fiber diets may increase the risk of many cancers including bowel, lung, prostate and uterine cancers.” This analysis represents that lack of proper nutrition in the body ultimately leads to complicated health problems, often cancer. Although this may not be a direct contributing factor in regards to bone cancer, it can still make the diagnosis of bone cancer worse if there is a lack of nutrition.
Ultimately, unhealthy lifestyles do impose an impact on the human body's health, specifically in contributing to bone cancer. In general, keeping up with a good, healthy lifestyle with limited substance use, a strong sense of nutrition, and exercise can ease the process of dealing with primary bone cancer.
Environmental Exposures
Environmental exposures such as radiation and chemicals increase the chance of getting bone cancer, but they don't directly cause the disease.
High-energy radiation, often used in cancer therapy, can damage DNA in bone cells, increasing the risk of bone cancer later in life. Too much radiation, especially when you're a kid, can lead to a higher chance of getting bone cancer later on.
Heavy metals and benzene are types of chemicals that can eventually strengthen your odds of receiving bone cancer. These chemicals tend to cause inflammation and stress, which can harm bone health and make you more likely to get cancer. Being around these chemicals for a long time can weaken your bones and make it easier for cancer to start. Also, the Environmental Protection Agency notes that pollution in the environment can make cancer risks worse by causing inflammation and genetic harm.
Although these environmental factors won’t automatically contribute to bone cancer, they can make conditions significantly more difficult and pose a chance of being impacted by bone cancer. That is why it is super important for individuals to understand and be cautious when it comes to their environment as certain things can lead to health complications.
Diagnosis
There are several ways to diagnose bone cancer. This includes an MRI Scan, CT Scan, Bone Scan, and X-rays; the most common way is a task known as biopsy. Due to bone cancer rarity, it is often tough to find facilities or clinics that can provide treatment and how to go about the diagnosis.
An MRI scan uses magnets and radio waves to create detailed images of internal organs in issues to see where the cancer is. A bone scan uses small amounts of radioactive material and then resting images to diagnose if the cancer has spread or not. An X-ray is a medical test that takes pictures of the inside of your body, like your bones, lungs, or teeth with the use of special radiation. It helps doctors see if you have any injuries, infections, or other health problems. A biopsy is a medical procedure where a doctor removes a small sample of tissue or cells from your body, usually with a needle or during surgery. The sample is then examined under a microscope to check for diseases, like bone cancer, or other conditions.
There are many ways to know whether you have bone cancer. Bone cancer symptoms include pain, swelling, or redness in the affected bone or joint, weakness, fatigue, limited mobility, unexplained weight loss, and numbness or tingling. Pain may worsen at night or with activity, and fractures can occur without significant injury. Other symptoms may include swelling, lumps, warmth, loss of appetite, nausea, vomiting, paralysis, weakness, or numbness. It is imperative to go to a doctor and check out these symptoms.
Medical Profession
Two main types of medical professions often deal with primary bone cancer and secondary bone cancer. These are known as pediatric oncologists and orthopedic surgical oncologists.
To become a pediatric oncologist, you need to finish medical school, which takes four years. After that, you must complete a residency lasting three years. Then, you have to do a fellowship for two to three years. As a pediatric oncologist, you'll come up with treatment plans for people who have Ewing sarcoma. You also have to put them into action. These plans include chemotherapy, radiation therapy, and surgery. Your expected salary is between $250,000 and $400,000 a year.
Becoming an orthopedic surgical oncologist takes a lot of time and dedication. You'll need to complete four years of medical school followed by a residency that lasts about six years. After that, you'll spend one to two years in a fellowship program. Once you're trained, your job involves removing osteosarcoma tumors through surgery and rebuilding affected limbs. You'll team up with other medical professionals to create an all-around treatment plan for patients. Your expected salary is between $400,000 and $600,000 each year.
Treatments
Now that we have a good understanding of Ewing sarcoma and osteosarcoma, you might be wondering how doctors can help patients cure these types of cancers. Unfortunately, there is no standard treatment for Ewing sarcoma because treatment varies from patient to patient. This is because Ewing sarcoma affects various bones and soft tissues and treatment must be tailored to the specific characteristics of each patient. For example, treatment depends on the patient’s overall health, age, and disease history.
Before patients undergo chemotherapy or surgery for Ewing sarcoma, pictures of bones and soft tissues help to diagnose Ewing sarcoma. These photos can also show that the cancer cells have spread within bones and tissues. One such machine to detect Ewing sarcoma is an MRI (magnetic resonance imaging) that uses radio waves to make a detailed picture of the inside of the body.
Once Ewing sarcoma is confirmed, treatment is commonly done by chemotherapy, radiation therapy, surgery, or a combination of these treatments. First of all, chemotherapy is used to kill fast-growing cancerous cells in your body that could be causing Ewing sarcoma. Chemotherapy is a long process and takes various steps. Vincristine is used followed by doxorubicin and cyclophosphamide to slow the growth of cancer cells by blocking an enzyme called topoisomerase-2. For most patients, chemotherapy will last at least 9 weeks before an actual surgery or radiation therapy takes place if needed. Most patients with Ewing sarcoma undergo around 14-15 stages of chemotherapy that could span 6 months.
Another way to cure Ewing sarcoma is radiation therapy. This is only used when the tumor cannot be removed by surgery or when the surgery will affect other important body functions. In other words, think of radiation therapy as the last resort to cure Ewing sarcoma. Nonetheless, how it works is that Ewing sarcoma cells are highly sensitive to radiation, so radiation therapy can help to kill the cells and treat this cancer.
Finally, surgery could also be used to remove a small portion of bone and surrounding tissue if needed. Usually, it takes place after chemotherapy or radiation therapy.
As for how to avoid Ewing sarcoma, according to Penn Medicine, professionals do not know for sure how to avoid it. This can be due to the rarity of the disease, leading to limited research and data available. Typically, Ewing sarcoma involves genetic mutations which is something we can not control. Despite this, you could avoid Ewing sarcoma by doing things such as genetic counseling to better understand your family’s genetics and health monitoring to regularly check up on your body.
Now diving into osteosarcoma, similar to Ewing sarcoma, both cancers use similar treatment methods as they are both genetic cancers that affect bone and soft tissues.
First, cells and tissues are removed during a biopsy so that they can be viewed to check for signs of cancer. Doctors will either do a core biopsy or an incisional biopsy. A core biopsy is when tissues are removed if needed an incisional biopsy is when a tissue or lump is removed because it doesn’t look normal.
After the diagnosis, patients with osteosarcoma can be treated with surgery. One type of surgery is limb-sparing surgery to remove cancer from the leg, arm, hip, or shoulder. This surgery removes the cancer from the body part without actually removing the body part. The tissue and bone with cancer are removed and replaced with a graft using tissue and bone taken from another part of the patient’s body or with an implant such as an artificial bone. Other than a graft, patients may use an artificial limb.
After surgery, chemotherapy is commonly used to kill any cancer cells left in the area the tumor was removed. One type of chemotherapy is combination chemotherapy which is used because some tumors require more than one medication at a time to treat cancer.
Finally, just like Ewing sarcoma, there is no known way to prevent osteosarcoma because it is not caused by lifestyle or environmental factors but rather by genetics.
Statistics
Ewing Sarcoma:
· Approximately 250-300 cases diagnosed each year in the United States
· Accounts for about 2% of all childhood cancers
· Most commonly affects children and young adults between the ages of 10 and 20
· Peak age range is 15-17 years old
· Slightly more common in males than females
· About 30% of cases occur in children under the age of 10
· Rarely occurs in adults over the age of 30
Osteosarcoma:
· About 400-500 cases diagnosed each year in the United States
· Accounts for about 5% of all childhood cancers
· Most commonly affects children and young adults between the ages of 10 and 25
· Peak age range is 15-19 years old
· Slightly more common in males than females
· About 20% of cases occur in children under the age of 10
· Can also occur in adults, especially those over the age of 50
Impacts
Bone cancer in children and young adults has a significant impact on various aspects of their lives and their families, starting from physical, emotional, social, and long-term implications.
Although both osteosarcoma and Ewing sarcoma target people 10 to 30 years old, these two cancers occur in different parts of the bones. Osteosarcoma occurs at the end of long bones of the arms and legs, where new tissues form during growth. It can also occur in the soft tissue outside the bones, however this is a very rare condition. On the other hand, Ewing sarcoma occurs in the shaft of the bone, mainly on the hips, ribs, upper arms, and thigh.
Cancer has a physical impact on people. People with bone cancer experience persistent pain in their bones and joints. Pain, swelling, and fractures can lead to difficulties in movement and daily activities. It is recommended to check with a doctor regarding constant pain. Medical imaging is usually required to detect cancers.
People diagnosed with cancer require regular testing and examinations to be done. A change of lifestyle habits - such as adopting a healthier diet, frequent exercising, stopping smoking, and no alcohol - is important to improve overall health. When cancerous cells are present, treatment may be required to keep the cancerous cells under control or even to remove it.
Chemotherapy, radiation, and surgery are common treatments to remove cancerous cells. These can cause side effects to patients, such as nausea, fatigue, hair loss, and many more. Patients, especially children and young adults, who undergo treatment have to experience not just the pain in their bones and joints, but also the effects of treatment.
During cancer treatment, partial remission and cancer progression can be difficult for a patient to be treated. Partial remission is when the cancer partly responds to a treatment, yet does not go away. Progression is when the cancer grows and gets worse after treatment. Both obstacles require a different treatment, which might give different side effects.
Furthermore, surgical procedures can be done to remove cancerous cells, but it may result in amputation and prosthetics being worn, which will impact movement, mobility, and daily activities. Physical therapy and rehabilitation are needed to promote recovery, reduce swelling, and regain strength.
Aside from physical impacts, cancer emotionally and psychologically affects children and young adults. Just the thought of having cancer can cause anxiety, depression, and fear in children and even their families. Cancer changes the appearance of a person drastically, such as intense weight loss and hair loss, and this affects a child’s confidence and self-image. Mental health support - for example, counseling and support groups - is highly recommended to aid the emotional distress. Frequent hospital visits for chemotherapy or other treatments interrupt a child’s social life. It can lead to the feeling of loneliness and isolation.
All children are expected to attend school; however, regular hospital visits and treatment will interrupt a child’s schooling life - including academic performance and social interactions with their friends. Children and young adults keen on sports and actively playing may have to stop their training, as bone cancer affects their limbs. Interruption in education and potential physical limitations can affect future career opportunities.
The diagnosis of cancer in a child affects the entire family. Requiring significant time and emotional investments can strain parents and siblings. Fitting cancer treatment into their schedule and making treatment part of their everyday life is like making the world revolve around cancer. Cancer comes with intense financial pressure. Constant treatment, surgery, and hospital bills make it difficult for some families.
Bone cancer survivors may face long-term health problems. They have a higher risk of infertility due to treatment, getting other types of cancer - secondary cancer - and other types of bone cancer, such as soft tissue sarcoma, lung cancer, esophagus cancer, stomach cancer, colorectal cancer, liver cancer, pancreas cancer, and acute myeloid leukemia. Recurrence or getting the cancer again after it has been removed years later can be very discouraging for people. They not only have to carry the burden associated with cancer treatment but they might also be treated with different treatments since cancerous cells can be resistant to the previous treatment. This is an evolutionary race between cancerous cells and current treatments. Getting diagnosed with secondary leukemia can be correlated with the treatment of chemotherapy, due to the treatment changing your DNA or affecting blood cells.
The impacts of bone cancer in children and young adults are profound. The correct treatment and support are required to accommodate the needs of affected children and their families.
Conclusion
Ultimately, bone cancer has little to no correlation with lifestyle and environment. Cancer occurs when the body cell replicates and divides uncontrollably, forming a mass of tumors. Although most bone tumors are not cancerous, there is always a slight chance of it being cancerous. Inherited genetic disorders increase the risk of bone cancer. It can occur at any age, but two of the most common types - Ewing sarcoma and osteosarcoma - occur primarily in children and young adults. Males are more susceptible to getting diagnosed with bone cancer, due to the hormone testosterone that promotes cell growth.
Early warning signs of bone cancer include pain in bones and joints, swelling, and constant tiredness. A biopsy may be required to find out for sure that a person has bone cancer. Children and young adults with bone cancer, whether it is Ewing sarcoma or osteosarcoma, both require similar treatments. Chemotherapy, radiation, and surgery are treatments that can be done to shrink or remove the cancerous cells. However, the side effects of cancer treatment can be even more painful to some.
Children and young adults diagnosed with bone cancer will experience a huge change in their physical, emotional, and social life. Cancer will also burden these children's families. They have to sacrifice time and money for their children's treatment.
Medical professionals, usually pediatric oncologists and surgeons, develop treatment plans for children and young adults with cancer. Together with the help of psychologists, bone cancer in children and young adults can be tackled successfully. Physical support and emotional support is needed for everyone with cancer.
By understanding the importance of cancer symptoms, addressing fears faced by young people, and fully supporting those who need it most, we can promote cancer awareness. Bone cancer cannot be prevented, but reducing the risks and minimizing the pain will help children and young adults.
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