Bone cancer treatment in Germany: diagnosis, therapy and surgery

Bone cancer treatment in Germany is provided at specialized centers, where the latest technologies to preserve the functionality after surgery are available.

Malignant bone tumors can occur anywhere in the human skeleton.

Depending on the origin, these neoplasms can be primary or secondary (metastases).

Primary malignant bone tumors develop from the cells found in the bone.

Depending on the type of “parent” tissue they are divided into bone, cartilage and bone marrow tumors.

Bone tumors include osteosarcoma and bone marrow tumors include Ewing's sarcoma.

The most common malignant cartilage tumor is chondrosarcoma.

Secondary malignant bone tumors (metastases) occur from tumors in other organs and tissues, especially lung cancer, prostate cancer, kidney cancer, breast cancer, and thyroid cancer. Sometimes these metastases are detected earlier than the primary tumor.

Bone metastases occur predominantly in the second half of life.

How often bone cancer is diagnosed in Germany?

Generally, primary bone cancer is very rare. In Germany, about 800 new patients are diagnosed every year, and the male gender is affected more frequently.

Osteosarcoma is most prevalent with two to three new cases per million people per year. This disease accounts for 40% of all malignant bone tumors, followed by chondrosarcomas with 20%. Ewing's sarcoma is very rare with 0.6 new cases per million inhabitants. In adults, primary bone tumors make up only about 1% of all malignant tumors. By contrast, bone metastases are many times more common.

In children and adolescents, about 5% of all tumors are bone cancer.

About 150 cases of osteosarcoma in children are diagnosed in Germany every year, and the disease affects boys more often than girls.

The tumors of the Ewing’s sarcoma group rank second in children and adolescents. The peak incidence occurs at the age of 10-15 years, and after 20 years the tumor is rare.

Chondrosarcomas occur predominantly in the 4th to 6th decade of life.

Since the causes of bone cancer are unknown, there is no official recommendation for measures to reduce the risk of developing a primary bone tumor. A healthy and balanced lifestyle is usually recommended by German oncologists. You should avoid the known risk factors for cancer, such as smoking and over-consumption of alcohol. It is especially important to consult a doctor in cases of unusual symptoms, since early bone cancer detection provides better survival and functional outcomes.

Warning signs of bone cancer

The symptoms vary depending on the tumor type and place of origin.

Pain is usually the first symptom of bone cancer, whether it is bone metastases or primary bone tumor. In the case of primary bone cancer, swelling usually occurs, which may lead to restriction of mobility (if adjacent joints are involved).

Osteosarcoma mainly affects the long bones of the extremities. Most often, the osteosarcoma is located above or below the knee joint and at the upper end of the humerus. Even mild forces can lead to pathological fractures in the affected areas. Chondrosarcoma is most common in the pelvis, femur and shoulder girdle. Symptoms usually include pain and swelling.

Bone cancer diagnosis in Germany: tests and prices

For bone tumors, the first and most important test is still the X-ray examination in the two projections. If there is suspicion of a malignant tumor, magnetic resonance imaging (MRI) or computed tomography (CT) may be used. Positron emission tomography (CT / PET) is particularly useful in the search for metastases. If bone metastases are suspected, bone scintigraphy provides additional information about the stage of the disease. Scintigraphy is based on studying the metabolism of a radioactive labeled substance in different parts of the skeleton. An increased metabolism is mainly observed in cancer, inflammation and bone fracture healing.

But the main stage of diagnosis is a biopsy, which is necessary to determine the type of malignant cells. It should be performed by an experienced surgeon. The removed tissue is then examined by the pathologist. It will take several days, because different immunohistological studies may be required for a correct diagnosis. On the basis of the histological examination result, the further treatment is planned.

The cost of bone cancer diagnosis in German clinics is significantly lower compared to most Western countries. In particular, MRI in Germany costs about $ 1,500 for one region, and CT scan costs about $ 1,000. Consultation of a highly qualified specialist will cost $ 400 or more. The cost of lab tests also looks very affordable compared to the United States.

Bone cancer treatment options in Germany

Treatment of primary malignant bone tumors should be provided exclusively at specialized centers. Only large university clinics and private centers can provide the necessary technology and clinical experience for optimal therapy and the best functional outcomes. Treatment usually consists of chemotherapy, surgery, and radiation therapy. This is called multimodal therapy, during which specialists from different areas work closely together.

A 2011 study in Germany showed that a tissue sample should be taken only at a clinic that provides further treatment. Otherwise, the frequency of local recurrences of cancer increases and the prognosis worsens dramatically.

In osteosarcoma, due to the high risk of metastasis, neoadjuvant chemotherapy is carried out to reduce the size of the tumor and eliminate any malignant cells in the blood and other organs.

The cost of chemotherapy for bone cancer can reach $ 3,000 or more. After a successful course of chemotherapy, the tumor is surgically removed. In specialized centers, more than 80% of patients can be operated on for a short and long term.

The resulting bone defect can be repaired using a tumor endoprosthesis, and in some cases also with the help of the body's own bone tissue (the so-called osteoplasty).



The cost of intervention varies greatly, depending on the location and size of the tumor, as well as on the technical complexity of the specific procedure and subsequent treatment. After removal of osteosarcoma, another chemotherapy may be prescribed to improve outcomes (according to EUROBOSS protocol for patients 40-65 years).

Ewing's sarcoma tends to quickly form metastases in distant parts of the body, especially in the lungs and other bones. Therefore, before the surgery, doctors recommend chemotherapy. For the primary tumors, radiation therapy or a combination of both methods is used.

The cost of radiation therapy for bone cancer in Germany starts from $ 12,000.

After surgery, chemotherapy is considered (EWING 2008 protocol).

Chondrosarcomas are almost exclusively treated surgically. Chemotherapy and radiation therapy play no role in this disease, with the exception of undifferentiated osteosarcoma. The treatment of bone metastases is usually carried out by several specialists from different fields of medicine. In case of bone fracture due to metastasis, as well as in case of a high risk of fracture, surgical stabilization is necessary. Other effective treatments for pain include radiotherapy and the administration of bisphosphonates or the monoclonal antibody denosumab (Prolia, XVEGA).

The decision to conduct hormone therapy and chemotherapy depends on the current clinical situation and the origin of the primary tumor. Prognosis for patients with bone metastases is also determined by the primary tumor.

Bone cancer treatment in Germany in most cases provides excellent results thanks to advanced surgical technology, innovative drugs and clinical experience. Local doctors always try to preserve the independence and high quality of life of patients, offering a personalized approach in each case. This makes German oncology the best.

© Analytical reviews and oncology news by K. Mokanov: clinical pharmacist and professional medical translator