What is bone cancer?

Bone cancer is the term for several different cancers that develop in the bones. When cancer cells grow in a bone, it can harm normal bone tissue. The type of cell and tissue where cancer begins determines the type of bone cancer.

Cancers that form in the bone itself are called primary bone cancers. Many tumours that begin in organs or other parts of the body can spread to the bones, as well as other body parts. These growths are called secondary or metastatic bone cancers. Breast, prostate, and lung tumours most commonly metastasize (spread) to the bones.

While they can develop at any age, they are more common in children, teenagers and young adults than in older adults.

Stage of primary bone cancer

Staging is determined by the size and location of the tumour, and whether, or not, cancer has spread to other areas. Primary bone cancer is categorized into four stages:

Stage 1: The tumor is low-grade, and the cancer cells are still localized.
Stage 2: The cancer cells are still localized, but the tumor is high-grade.
Stage 3: The tumor is high-grade and cancer has spread to other areas within the same bone.
Stage 4: Cancer had spread from the bone to other areas of the body, such as the lungs or liver.

Primary bone cancer is a rare type of cancer that begins in the bones

This is a separate condition from secondary bone cancer, which is cancer that spreads to the bones after developing in another part of the body. Tumours that begin in organs or other parts of the body can also spread to the bones. Treatments include surgery, radiation therapy and chemotherapy.

Outlook and prognosis

The outlook for bone cancer depends on factors such as your age, the type of bone cancer you have, how far the cancer has spread (the stage), and how likely it is to spread further (the grade). Generally, bone cancer is much easier to cure in otherwise healthy people whose cancer hasn’t spread.

Overall, around 6 in every 10 people with bone cancer will live for at least 5 years from the time of their diagnosis, and many of these may be cured completely.

What is the outlook for people with bone cancer?

Many cases of bone cancer are successfully treated. In these instances, cancer never returns. Sometimes people need multiple surgeries to accomplish this outcome.

Other people with bone cancer might need to continue treatments including radiation therapy and chemotherapy to keep cancer from spreading. These treatments may go on indefinitely to control cancer.

It is important to follow up with your healthcare provider regularly to look for signs that the cancer is coming back (recurrent) or spreading. The earlier a recurrence is detected, the sooner your provider can start treating it.

Signs and symptoms of bone cancer

Bone cancer can affect any bone, but most cases develop in the long bones of the legs or upper arms.

The main symptoms include:

persistent bone pain that gets worse over time and continues into the night
swelling and redness (inflammation) over a bone, which can make movement difficult if the affected bone is near a joint
a noticeable lump over a bone
a weak bone that breaks (fractures) more easily than normal
problems moving around – for example, walking with a limp

Types of bone cancer

It depends on which type of bone cancer you have. There are four types of primary bone cancer. Some of the main types of bone cancer are:

Osteosarcoma – the most common type, which mostly affects children and young adults under 20
Ewing sarcoma – which most commonly affects people aged between 10 and 20
Chondrosarcoma – which tends to affect adults aged over 40

Young people can be affected because the rapid growth spurts that occur during puberty may make bone tumours develop. The above types of bone cancer affect different types of cell. The treatment and outlook will depend on the type of bone cancer you have.

Osteosarcoma: The most common type of bone cancer, osteosarcoma develops in the cells where new bone tissue forms. It can start in any bone, but it usually begins at the ends of large bones such as the arms and legs. Providers most commonly diagnose osteosarcoma in children and teenagers.
Ewing sarcoma: Named for the doctor who first described this type of bone cancer, Ewing sarcoma includes many tumors that have similar qualities and are believed to begin in the same types of cells. These tumors can form in the bones and in surrounding soft tissues. Ewing sarcoma most commonly grows in the hips, ribs and shoulder blades, or on long bones such as the legs.
Chondrosarcoma: Chondrosarcoma begins in tissue called cartilage. Cartilage is a soft connective tissue that allows movement between bones and joints. Some cartilage becomes bone when the body adds calcium to it. This cancer typically forms in the arm, leg, or pelvis bones. Unlike osteosarcoma and Ewing sarcoma, chondrosarcoma occurs more frequently in adults than in younger people.
Chordoma: This rare tumor begins in the bones of the spine — usually at the base of the spine or the base of the skull. Like chondrosarcoma, chordoma occurs most often in older adults. Men are more likely than women to develop this type of bone cancer.

What causes bone cancer

In most cases, it’s not known why a person develops bone cancer. You’re more at risk of developing it if you:

have had previous exposure to radiation during radiotherapy
have a condition known as Paget’s disease of the bone – however, only a very small number of people with Paget’s disease will actually develop bone cancer
have a rare genetic condition called Li-Fraumeni syndrome – people with this condition have a faulty version of a gene that normally helps stop the growth of cancerous cells

How bone cancer is treated

Treatment for bone cancer depends on the type of bone cancer you have and how far it has spread. Most people have a combination of:

surgery to remove the section of cancerous bone – it’s often possible to reconstruct or replace the bone that’s been removed, but amputation is sometimes necessary
chemotherapy – treatment with powerful cancer-killing medicine
radiotherapy – where radiation is used to destroy cancerous cells

Management and treatment

How is bone cancer treated?

Bone cancer treatment depends on the type of cancer, whether it has spread and if so, where. People with bone cancer often work with a team of healthcare providers to treat the condition. This group includes doctors who specialize in cancer (oncologists and radiation oncologists) and doctors who specialize in bones and joints (orthopaedic surgeons).

Bone cancer treatment typically involves a combination of approaches. The type and duration of these treatments vary depending on several factors, including the type of bone cancer, the size of the tumor and whether it has spread to other parts of the body. The treatments most commonly used include:

Surgery: Your surgeon removes the tumor and some healthy tissue around it. They can also repair or rebuild affected bones with real or artificial bone grafts. Sometimes, an entire limb must be removed to treat cancer. In this case, an artificial limb (prosthetic) can be used. Sometimes repeat surgery is needed if all of the cancer cells were not removed the first time around.
Radiation therapy: This treatment shrinks the tumors with high doses of X-rays. Healthcare providers often use radiation before surgery to shrink the tumor so less tissue has to be removed.
Chemotherapy: This type of treatment kills cancer cells throughout the body with medicine. People usually receive this medicine by swallowing a pill or having it injected into a vein. Your provider can use chemotherapy to treat primary bone cancers or bone cancers that have spread.

Symptoms and causes

What are common bone cancer symptoms?

Some people with bone cancer have no symptoms other than feeling a painless lump. For others, a variety of symptoms can develop. These symptoms may also occur because of other conditions, such as arthritis or Lyme disease, which may delay the diagnosis. The most common signs of bone cancer include:

Pain (usually worse at night).
Unexplained swelling.
Difficulty moving around.
Feeling extra tired (fatigue).
Fever.

What causes bone cancer?

Experts are not certain what causes bone cancer, but they have found links between bone cancer and other factors. The most important factor is being exposed to radiation or drugs during treatment for other cancers. Some bone cancers occur due to conditions that are passed down in families (hereditary), although this is not usually the case.

Diagnosis and tests

How is bone cancer diagnosed?

To diagnose bone cancer, your healthcare provider will often first use X-rays to view images of your bones. Magnetic resonance imaging (MRI) and CT (computed tomography) scans provide more detailed images of the areas around the bones and are usually obtained before any treatment.

To confirm the diagnosis, your healthcare provider will perform a biopsy, where a small piece of tissue is removed from the bone to be examined under a microscope. A biopsy provides specific information about the cancer, including where it formed. Having this information helps providers know which course of treatment will work best for the specific cancer.

Prevention

Can bone cancer be prevented?

Since experts don’t really know what causes bone cancer, there is currently no known way to prevent it. And because radiation therapy (another known cause of bone cancer) is necessary for treating other types of cancer, it can’t be avoided altogether.

Is bone cancer usually fatal?

Not usually. Though some people will die of bone cancer, many others will make a full recovery. The five-year relative survival rate for bone cancer is 66.8%. This means that 66.8% of people with bone cancer are still alive five years after their diagnosis. Keep in mind that survival rates are only estimates based on people who’ve had bone cancer in the past. They can’t predict how long you will live or what to expect in your unique situation. To learn more about bone cancer survival rates, talk to your healthcare provider.

Many people with bone cancer undergo successful treatment and go on to lead fulfilling lives. Those with early-stage bone cancer have a better chance of full recovery. When bone cancer is detected later on, survival rates decrease.

Living with bone cancer

Anytime you develop bone pain or swelling, schedule a visit with your healthcare provider. If you’re already undergoing bone cancer treatment, be sure to inform your provider if any new symptoms arise.

Fully understanding your diagnosis can empower you to make the best decisions regarding your health. Here are some questions you may want to ask your healthcare provider:

What type of bone cancer do I have?
Has it spread?
What tests do I need?
What are my treatment options?
What is my outlook?

What does bone cancer feel like?

The most common bone cancer symptom is pain, though sometimes these tumors are painless. The pain may be mild or severe. Many people describe it as throbbing, aching, or stabbing. Some people develop a lump in the area that may be hard or soft to the touch.