Prognosis and survival for bone cancer

A prognosis is the doctor's best estimate of how cancer will affect you and how it will respond to treatment. Survival is the percentage of people with a disease who are alive at some point in time after their diagnosis. Prognosis and survival depend on many factors.

The doctor will look at certain aspects of the cancer as well as characteristics of the person (such as their age or performance status) . These are called prognostic factors. The doctor will also look at predictive factors, which influence how a cancer will respond to a certain treatment and how likely it is that the cancer will come back after treatment.

Prognostic and predictive factors are often discussed together. They both play a part in deciding on a prognosis and a treatment plan just for you. Only a doctor familiar with your medical history, the type and stage and other features of the cancer, the treatments chosen and the response to treatment can put all of this information together with survival statistics to arrive at a prognosis and chances of survival.

The following are prognostic factors for bone cancer.

Cancer can spread from the place where it started to other parts of the body. This spread is called metastasis. Whether or not the cancer has already spread when it is diagnosed is the most important prognostic factor for bone cancer. Cancer that has spread has a worse prognosis than cancer that is localized.

Where the cancer has spread is also an important prognostic factor. Bone cancer that has spread only to the lungs has a better prognosis than metastasis to other parts of the body.

Tumours found in the bones of a leg or arm are considered appendicular skeleton tumours. Tumours found in the bones of the pelvis (hip), chest, skull or spine are considered axial skeleton tumours.

Appendicular skeleton tumours have a better prognosis than axial skeleton tumours. This may be because tumours in the arms and legs are easier to completely remove with surgery. Tumours in the chest, pelvis or spine are usually found later, are often larger and are closer to important organs. Those factors make it harder to remove them completely with surgery.

Low-grade tumours have a better prognosis than high-grade tumours.

Osteosarcomas that are smaller than 9 cm have a better prognosis than larger tumours. Osteosarcomas that grow less than one-third into the bone have a better prognosis than larger tumours that grow into more than one-third of the bone.

Women diagnosed with bone cancer have a better prognosis than men diagnosed with bone cancer.

We need more research and can’t say at this time what the prognosis is for transgender, non-binary and gender-diverse people.

People who are younger than 40 when they are diagnosed with bone cancer have a better prognosis than people over age 40.

Chemotherapy given before surgery is called neoadjuvant chemotherapy. It is used for osteosarcomas and Ewing sarcomas.

Whether chemotherapy can shrink or stop the tumour from growing affects the prognosis. Tumours that respond well to chemotherapy have a better prognosis than tumours that don’t respond very well to chemotherapy.

When osteosarcoma causes a bone to break, it is called a pathological fracture. People with a pathological fracture may have a worse prognosis than people who have not had a fracture.

People with bone cancer who have higher levels of alkaline phosphatase( ALP) and lactate dehydrogenase( LDH) have a worse prognosis. A higher level of ALP and LDH is a sign of a larger tumour.