Large B Cell Primary Bone
Non-Hodgkin's Lymphoma - that was my diagnosis. I thought there was just
one Non-Hodgkin's Lymphoma - how wrong can you be. Someone told me there
are 36 variations of NHL, and yesterday I read that there are 72 - so I
don't know how many there are to be honest. Perhaps this should be a new
section within the Furry Monkey..... how many variations are there really?
After my diagnosis, I was told that Primary Bone
NHL is very rare. I've since checked it out and it appears to only happen
in 1% to 3% of people diagnosed with NHL. So this is indeed, rare. Trust
me to have an unusual cancer, as John said "you couldn't have a normal
one could you?!".
I've tried to find out more about it, but information
is limited. I've put the following information together from various sources.
I hope that you find it useful.
Find out all about Primary Bone Cancer
Normal Bone Tissue
What is primary bone
What is Primary non-Hodgkin's Lymphoma of Bone?
So what is secondary bone cancer?
What's the difference between primary and secondary
What symptoms can you get with bone cancer?
How are bone tumours diagnosed?
What bones can be affected by cancer?
What treatment is available for bone cancer?
What is the chance of recovery?
What is normal
Bone is the supporting framework of the body. Most
bones are hollow. The outer part of bones consists of fibrous tissue called
matrix onto which calcium salts are deposited. At each end of the bone is
a zone of cartilage, a softer form of bone-like tissue. Cartilage consists
of a fibrous tissue matrix mixed with a gel-like substance. Unlike bone,
cartilage does not contain calcium. Cartilage acts as a cushion between
bones and, together with ligaments and some other tissues, forms the joints
between bones. The bone itself is very hard and strong. Some bone is able
to support as much as 12,000 pounds per square inch. It takes as much as
1200 to 1800 pounds of pressure to break a femur (thigh bone).
The outside of the bone is covered with a layer
of fibrous tissue called periosteum. The bone itself contains two kinds
of cells. The osteoblast is the cell responsible for forming bone and the
osteoclast is the cell responsible for dissolving bone. Although bone looks
to be a very unchanging organ, the truth is that it is very active. New
bone is constantly forming, and old bone dissolving.
Bone marrow is the soft tissue inside the hollow
bones. The marrow of some bones consists only of fatty tissue. The marrow
of other bones is a mixture of fat cells and hematopoietic (blood- forming)
cells. These blood-forming cells produce red blood cells, white blood cells,
and blood platelets. There are some other cells in the marrow such as plasma
cells, fibroblasts, and reticuloendothelial cells.
What is primary
Primary bone cancer refers to cancers which start in the bone. These
cancers are totally different to secondary cancers which start in other
parts of the body and then spread to the bones. Bone cancers are tumours
which have the potential to spread to other parts of the body.
These are different to benign (non-cancerous) bone
tumours which do not spread. Benign bone tumours are more common than malignant
(cancerous) bone tumours.
There are several different types of bone tumors.
Their names are based on the area of bone or surrounding tissue that is
affected, and the kind of cells forming the tumor. Some primary bone tumors
are benign (not cancerous) and others are malignant (cancerous). Most bone
cancers are called sarcomas. Sarcomas are cancers that mostly develop from
bone, cartilage, muscle, fibrous tissue, fatty tissue, or nerve tissue.
is Primary non-Hodgkin's Lymphoma of Bone?
Primary non-Hodgkin's lymphoma of bone (PLB) is a rare type of cancer
starting in bone, it accounts for about 1% to 3% (that I've found so
far!) of all primary bone tumours. This was my diagnosis for NHL.
Lymphomas can arise from almost any lymphatic tissue
(lymph nodes, spleen, thymus, mucosa associated lymphoid tissue (MALT)).
It is hard to believe but the bones are an important part of the lymphatic
process: the "B" in white b-cell is for cell maturation in the bone marrow.
Non-Hodgkin's lymphoma (NHL) usually starts in the
lymph nodes and lymph glands (part of the immune system). PLB, however,
starts in the bone. This is distinct from NHL which started in the lymph
notes and then spread to the bones (bone metastases).
The peak age of people diagnosed with PLB is in the
50-60 yr age group, the disease is slightly more common in men than in women.
Symptoms are usually bone pain and sometimes swelling. The majority of people
with PLB are diagnosed with a single localised tumour. PLB has higher survival
rates compared to other types of Non-Hodgkin's Lymphoma.
is secondary bone cancer?
Secondary bone cancer is where malignant cells have
spread to the bones from other parts of the body. This is totally different
to cancers that have started in the bones (primary bone cancer). Virtually
all types of cancer can spread to bone. Bone metastases are particularly
common in people with breast, lung or prostate cancer. Bone metastases are
usually multiple, and they can cause pain and can lead to other symptoms
such as hypercalcemia (abnormally high levels of calcium in the blood).
the difference between primary and secondary bone cancer?
There are really two main types of bone
cancer. Primary bone cancer is a cancer that starts in the bone. It's less
common than secondary bone cancer, which starts somewhere else in the body
and then spreads to the bone. Secondary bone cancer is more common.
Any type of cancer can spread to the bone but bone
metastases (spreading of cancerous cells to the bone) is most common among
persons with breast, lung, or prostate cancer.
can you get with bone cancer?
The symptoms of bone cancer vary from person to person
and depend on the location and size of the tumour. Two people with the same
type of bone cancer can have very different symptoms.
The most common symptoms of cancer are pain and swelling
or tenderness in the affected area. You may see or feel a hard lump on the
surface of the affected bone. Sometimes bone cancer can interfere with movement
and can weaken the bones, occasionally leading to a fracture (this is
what they first suspected I had in my leg). Other symptoms of cancer
may include tiredness, fever, weight loss, and anaemia.
With NHL some of the more well known symptoms are:
None of these symptoms is a sure sign of cancer;
if you suspect you have a health problem please consult your doctor.
bone tumours diagnosed?
If a bone tumour is suspected the doctor will do a
complete medical examination. This may include a blood test as bone tumours
can be associated with increased levels of certain proteins in the blood.
The doctor may also recommend X-rays and other scans of the bone(s).
If the results of the x-rays and scans suggest that
a tumour may be present then a biopsy (removal of a sample of tissue) will
be performed. A pathologist will then examine the cells to determisent then a biopsy (removal of a sample of tissue) will
be performed. A pathologist will then examine the cells to determine whether
it is cancerous, and if so what type of cancer it is that you have.
can be affected by cancer?
In total there are over 200 bones in the human body,
any of these can be affected by cancer. However, certain types of bone cancer
are more common in specific bones.
Osteosarcoma is most commonly found in the bones
around the knee. Ewing's sarcoma is more common in the upper leg, pelvis
and other bones of the trunk. The pelvis is the most frequent location for
chondrosarcoma. My NHL is in both my left and right leg. The tibia (below
the knee) in the left leg and above the knee in the right leg.
Nevertheless, it is possible for these cancers to
affect any bone in the body.
the treatment for bone cancer?
Everyone's treatment depends on their own cancer.
For example the type of cancer it is, whether it has spread or not, and
the size and location of the main (primary) tumour. Treatment of bone cancers
is complex and involves a team of different specialists usually within an
institution that is experienced in treating these types of cancers.
There are 3 main types of therapy used to treat bone
surgery (to take out the tumour in an operation)
radiotherapy (using high-dose x-rays to kill
chemotherapy (using drugs to kill cancer cells)
Surgery is often used to remove the primary tumour.
For tumours of the arms and legs an amputation of the limb is sometimes
necessary, however, limb-sparing surgery may be possible in many cases where
only the cancerous part of the bone is removed and it is replaced by a bone
graft or metal prosthesis.
Radiotherapy may also be given as well as or instead
of surgery to destroy the cancer cells. Chemotherapy may also be given to
kill malignant cells that may be circulating around the body.
It was decided I was to have the first option,
surgery, to remove the tumour in my leg and then replace part of my tibia
and my knee with metal implants. However at my next appointment it was then
decided to go with the chemotherapy/radiotherapy route instead and see what
happens. Thankfully no surgery has been required - although they have told
me not to rule this out in the future.
What is the
chance of recovery?
Overall, the chance of recovery (prognosis) for bone
cancers has improved significantly since the development of modern chemotherapy.
However the chance of recovery will depend on a variety
of influences; if the cancer has spread, the type of bone cancer, the size
of the tumour, location, the person's general health and other individual
factors. Also important is how much of the main tumour can be removed/destroyed
by surgery and/or radiotherapy and chemotherapy, and how the tumour responds
Your consultant should be able to give you a rough
idea of the prognosis for your type of cancer.
As I said earlier, all diagnosis and future treatment
of any cancer, not just Primary Bone NHL is determined by your consultant
and/or doctor. They will have all the results of your tests and scans and
will be able to advise you.
However please note that not all consultants are
keen on answering questions as I have found!