The most common presenting symptoms of bone cancer are:
- Pain
- Swelling Besides these, rarely, some may present with:
- An unexplained disability of recent onset - limitation of function or range of movement involving any particular joint.
- Pathological fracture - fracture through the diseased part of the bone.
- Weakness and/or numbness in the extremities in disease involving the spine (backbone).
I will discuss each of these in some detail now.
(1) Pain is the most common first complaint of a patient with bone cancer. This is, most often, of spontaneous onset - without any relatable cause. In some, the pain may be attributed to some injury. However, the pain is often disproportionate to the severity of the injury. Also, unlike the pain following an injury, pain due to cancer does not settle. It persists and will progressively worsen with time. Another feature of bone cancer pain is pain at rest.
The majority of the common pains related to bone and joint conditions are relieved with rest. Even fracture pain becomes tolerable with immobilization and rest. On the other hand, the pain of bone cancer is not affected by rest. It persists with the same intensity even at rest. Rest pain may be quite tolerable in the beginning. However, as cancer grows, it will worsen with time and even affect sleep.
Please do note here that not all patients with bone cancer will have rest pain and not all rest pains are due to bone cancer. Any unexplained pain which is persistent for 2 to 3 weeks, or which is worsening, should not be ignored. You must see your doctor and get investigated. Please do note that in a majority of the cases, the cause of the pain may turn out to be nothing to worry about or some less worrying condition. So, do not get alarmed. But at the same time, do not neglect or ignore any persistent pain.
(2) Swelling is the second common presenting complaint in a patient with bone cancer. This may be a visible and/or palpable (that which can be felt) swelling, depending on the location and size of the growth. This swelling is often of recent onset. It may be preceded or be accompanied by pain. Some swellings are maybe painless in the beginning. Some may be painful to touch and pressure. The swelling may be hard or soft to touch. It could be a long-standing swelling that has recently started showing signs of activity in the form of accelerated growth and/or pain.
The swelling may be small or large in size. In some, there may be no apparent swelling. Any unexplained swelling is clearly an abnormality. You should see your doctor immediately for evaluation and further investigation. At this point, you must know that such swelling can be caused by many benign conditions, tumor-like conditions, infection, etc. Let your doctor evaluate you and help you with the diagnosis and treatment.
(3) Rarely, the only presenting complaint is a disability the patient notices while doing a certain work or movement. This is often noted when the disease affects the bone close to a joint. This may result in a limitation of the range of movement of the affected joint. This restriction may be due to mechanical obstruction of the joint range due to swelling or due to pain.
(4) Sometimes the disease can weaken the bone to such an extent that the bone breaks with trivial force or almost no force at all. This is called a pathological fracture. This is the fracture of the bone through the diseased area where the bone is fragile. It can break with a minor fall or slip and sometimes even while turning in the bed.
Often the patient may have complaints of pain in the region in the days/weeks prior to the incident. Some may not have any such history. Please do note that there are many conditions besides bone cancer that can lead to pathological fracture of a bone. Your doctor will help you with identifying the cause and the treatment for the same.
(5) The backbone is made of multiple bony segments called vertebrae which are stacked on each other to make the vertebral column. Bone cancer can occur in these bones or cancer of other organs can spread to these bones (metastasis). This disease can grow in the vertebrae and weaken them making them vulnerable to fracture. This causes back pain which worsens as it progresses.
As you are aware, the spinal cord passes through the vertebral canal. This is the structure that connects the brain to the rest of the body and is responsible for allowing voluntary movements, bladder and bowel control, and physical sensation.
If a tumor in the vertebra grows and compresses the spinal cord, it will affect the function of the cord and cause weakness and numbness in the body below that level. This needs urgent attention. Again, bone cancer is only one cause for such a presentation. There are many other conditions that can present similarly. See your doctor help you with the diagnosis and treatment.
Patients may present with one or more of these symptoms, either at the same time or over a period of time. Also, there are many other conditions that may have a similar presentation. It's important that you see your doctor for a proper evaluation and advice.
