Overview
The shoulder region is formed by three bones viz. the Humerus (the arm bone), the scapula (the shoulder blade) and the clavicle (the collar bone) and two joints viz, the shoulder joint formed by the upper end of the humerus bone (the ball part of the joint, called the head of the humerus) and the glenoid (the socket of the shoulder joint formed by a part of the scapula), and the acromoiclavicular joint (the AC joint) formed by the lateral end of the clavicle bone and the acromion process which is another part of the scapula.
Like any other bone in the body, bone cancer can affect any of the three bones that form the shoulder joint. In fact, the shoulder region is a relatively common location for bone cancer.
What Is Bone Cancer?
There are three distinct varieties of cancers which can affect bone.
- Primary bone cancers: These are true bone cancers. These are cancers which arise in the tissue of the bone itself. These are called as sarcomas. The most common bone sarcomas are Osteosarcoma, Ewing’s sarcoma and Chondrosarcoma. All of them can affect the shoulder joint.
- Secondary bone cancers: These are cancers of some other organ or tissue that have spread to the bone. These are therefore not considered true bone cancers. These are called as bone metastasis of that particular cancer. The most common cancers that spread to one person are lung cancer, breast cancer, prostate cancer, kidney cancer and thyroid cancer. Bone metastasis represents a stage 4 disease (advanced stage) of that particular cancer. Bone metastasis can occur in any of the bones that form the shoulder joint.
- Bone marrow cancers: These are cancers that arise in the blood forming tissue inside the major bones. This blood forming tissue is called as bone marrow. The cancers that arise due to bone marrow cancer are leukemia (also called as blood cancers) and plasma cell cancers (Plasmacytoma and multiple myeloma). Of these bone marrow cancers, multiple myeloma and plasmacytoma can cause significant damage to the bones including the shoulder joint region.
Symptoms of bone cancer in shoulder
The most common presenting symptoms of bone cancer around the shoulder are Pain in the shoulder region and Swelling around the shoulder. The pain may also cause limitations in the function or rangepatientsvement of the shoulder joint.
Particularly affected are lifting of the arm above the level of the shoulder joint and limitation of rotation of the shoulder joint. Rarely, patients may present with a fracture of the affected bone due to the weakness in the bone caused by the disease. Of the three bones that form the shoulder joint complex, pathological fracture most commonly affects the humerus (arm bone) followed by the clavicle.
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How do you know if you have cancer in your bones?
As already discussed above, the most common presenting symptom in bone cancer is pain. However, there are many other far more common conditions that can cause shoulder pain. Also, other than cancer there are many benign bone tumors that can cause pain. Bone cancer related pain is often progressive in nature; i.e., it progressively increases in intensity, duration and frequency. Eventually, it may become a constant pain which is felt even at rest. If the pain has bothered you for more than a couple of weeks, you should see your doctor.
The other common symptom of bone cancer is the appearance of a swelling. Any unexplained swelling is a matter of concern and you should see your doctor immediately. In most cases, a visible or palpable swelling will be accompanied with pain.
Besides, pain and swelling, any unexplained disability of shoulder function and any fracture of the bones around the shoulder following a trivial injury may indicate the possibility of bone cancer.
However, you should know that all the above symptoms are also likely to happen due to benign bone tumors or sometimes due to other shoulder conditions.
So, the only way to know if you have cancer in your bones is to see your doctor and get appropriately investigated.
What tests are helpful in the diagnosis of bone cancer in the shoulder region?
Besides a good clinical evaluation of your complaints which includes a thorough history of your complaints and a physical examination, the following tests are helpful in the work-up of any patient with a suspected tumor / cancer around the shoulder.
- A good quality of the shoulder area in Antero-posterior and lateral views
- An MRI of the shoulder
- A biopsy of the abnormal tissue
Based on the clinical evaluation, the doctor will decide on the need for any further investigations. When indicated, the imaging studies always starts with a X-ray of the affected area.
Following this an MRI may be advised to study the region in more detail. Finally, after studying the X-ray and MRI findings, depending on what observations are made, the doctor will decide on the need for a biopsy.
Biopsy is sampling of a small part of the abnormal area for further study by a pathologist who examines the tissue under a microscope and issues a histopathology report. Nowadays, most biopsy procedures are done using a biopsy needle.
Conclusion
Primary cancer of the bone is quite rare. Secondary bone cancer is relatively more common. Like all other bones, bones around the shoulder can also be affected by bone cancer. The common presenting symptoms are pain, swelling, disability and pathological fracture. Any progressive pain of more than a couple of weeks duration should be evaluated by a doctor.