Cancer that starts in bone is rare. Bone cancer can be hard to treat and can spread to other parts of the body. It’s important to find out how far the cancer has spread, which doctors call staging.
Researchers aren’t sure what causes bone cancer. But it can happen more often in people who have had radiation or chemotherapy for another type of cancer.
The adult human skeleton has 206 bones that form groups and give shape to the body. Bone cancer develops in these bones and can cause pain, stiffness and weakness. The symptoms vary depending on the type and location of the tumour. The most common types of bone cancer are osteosarcoma, chondrosarcoma and Ewing sarcoma. These are found most often in the bones of the legs or arms. Another rare bone cancer is called chordoma, which occurs most often in the bones of the spine or skull.
The first symptom of bone cancer is usually pain in the area of the tumour. The pain may be constant or it may get worse with activity. It may also cause a lump or mass in the bone. If the tumour is near a joint, it can interfere with movement and lead to pain, swelling or even break a bone. It is important to see a doctor if you have any of these symptoms.
Other symptoms that can be caused by bone cancer include a fever, fatigue and weight loss. If the cancer has spread to the lungs, it can cause problems with breathing. In some cases, the cancer can spread to other parts of the body, such as the intestines or brain. These are called secondary bone cancers.
X-rays or other imaging tests can show a bone tumor. Your doctor can then use other tests to find out if the tumour is cancer or not. These tests include magnetic resonance imaging, also called MRI; computerised tomography, or CT scan; and positron emission tomography, also called PET scan. These tests can help doctors decide how the tumour should be treated.
Some types of bone cancer have a clear cause, such as certain inherited conditions like Li-Fraumeni syndrome and an eye disease called retinoblastoma. Bone cancer can also happen when a normal bone cell becomes a mutated one. Other causes of primary bone cancer include radiation to the area or treatment with certain chemotherapy drugs.
Cancer that starts in a bone but then spreads to other areas of the body is called secondary bone cancer. The cancer cells in the new site can grow and spread faster than the cells in the bone where the tumor started.
If your doctor suspects that you have bone cancer, he or she will order imaging tests to find out more about the tumor and how far it has spread. These include X-rays, computed tomography (CT) scans and magnetic resonance imaging (MRI).
Your doctor may also use a special type of MRI called diffusion tensor imaging, which measures how much the bones in your body move when you take certain positions or movements. These results can help your doctor know which area of the bone is most affected by the cancer.
The doctor will need to know which type of bone cancer you have, so a biopsy is done. The doctor will use a needle or a surgical biopsy to remove a sample of the bone cancer for testing. The type of biopsy you have depends on whether the doctor thinks your bone cancer is benign (not cancer) or malignant (cancer). It also depends on what type of surgery you have later to remove the cancer.
Some types of bone cancer, such as chordoma, grow slowly and don’t spread to other areas of the body. Others, such as osteosarcoma and ewing sarcoma, grow faster and are more likely to spread. The cancer cells in your bone are divided into stages based on how they look under a microscope. The lower the stage, the more likely you are to be cured.
A grading system also helps doctors decide how to treat the cancer. The grading is based on how similar the cancer cells look to normal bones. The higher the grade, the more atypical the cells appear and the more likely they are to spread.
Your doctor will determine if your cancer has spread to other parts of the body by checking your lymph nodes and lungs. He or she will also check for other health problems that can happen with this cancer, such as metastasis. Your doctor will also give you a number called your survival rate. This tells how likely it is that you will live for at least 5 years after your diagnosis.
The treatment options for bone cancer depend on the type and stage of the disease. The main treatments are surgery, chemotherapy and radiation. If your cancer is found early, it is likely that you will only need one of these treatments. You will be treated in a specialist centre and cared for by a team of different health professionals called a multidisciplinary team (MDT). This team will include an orthopaedic surgeon, a specialist oncologist and a clinical nurse specialist.
Bone cancer develops when cells in or near a bone have changes in their DNA, which gives them instructions about how fast to grow and die. The DNA changes cause the cells to grow and multiply more quickly than normal, forming a tumour. The tumour may also spread to other parts of the body, such as the lungs or liver.
Your doctor will examine you, and depending on the area of your body where the tumor is located, will order a number of tests to confirm the diagnosis and check for other conditions. These may include blood and urine tests, an MRI scan or CT scan, a needle biopsy or an open biopsy. In a needle biopsy, your doctor inserts a needle into the tumor and removes some of the tissue. In an open biopsy, your doctor surgically removes part or all of the tumor.
X-rays can help your doctor determine the size of the tumor and whether it is growing or spreading. Your doctor will also ask you about your symptoms and overall health, as well as any previous treatment you have received for another condition. This will help them decide on the best treatment for you.
For bone cancers that haven’t spread, your doctor can often cure you with surgery and chemotherapy. You may also have radiation or other treatments, such as targeted therapy.
The most common types of bone cancer are sarcoma and osteosarcoma. These usually begin in the bones of your arms or legs, but they can also form in other parts of the body, such as the skull or pelvis. Other types of bone cancer, such as metastatic bone cancer, start in the bones after cancer has spread from somewhere else in your body, such as from your lungs or breasts.
The follow-up care necessary for bone cancer patients depends on what type of bone cancer you have and whether it spreads. Some types of cancer, like osteosarcoma and undifferentiated pleomorphic sarcoma (UPS), are more likely to return after treatment than others. If your cancer has spread, tests are done to see if the cancer has reached other parts of your body. This is called staging.
UC San Diego Health surgeons are experienced in advanced surgeries that can prevent the need to amputate an arm or leg. We also perform image-guided biopsies to get a more accurate diagnosis of the tumor.
Our specialists have a wide range of treatments for bone cancer, including chemotherapy and radiation therapy. We also offer targeted therapy and immunotherapy, which use drugs to help your body fight the cancer or stop it from growing.
Radiation therapy uses high-energy rays to destroy the cancer cells and reduce the chance that the tumor will come back. We have a state-of-the-art proton beam therapy center, which gives us the ability to target the radiation directly at your tumor, sparing surrounding tissues and vital organs.
Chemotherapy is a common treatment for some types of bone cancer, and it can be used before surgery to shrink a tumor or after surgery to destroy any cancer cells left behind. We can also combine chemotherapy with immunotherapy or targeted therapy to improve your chances of survival.
Immunotherapy and targeted therapy are newer methods of treating cancer that work by using your body’s natural defense systems to fight the cancer or stopping it from spreading. We have one of the largest programs in the country for these emerging treatments.
The risk of a bone cancer coming back increases in the first few years after treatment, so you will need to have follow-up visits with your doctors. During these visits, your doctor will ask you about how you are feeling and do a physical exam. You may also have a blood test or a scan to check your progress. We will work with you to find a follow-up schedule that works for your lifestyle.
Many cancers that start in bone can spread to other parts of the body. This is called secondary cancer. These types of cancer don’t feature in this fact sheet.
Doctors diagnose bone tumors by taking X-rays and other tests. They can also use MRI and CT scans to see the inside of your bones. They may also take a sample of your tumor to check for cancer cells. This is known as a biopsy.
Pain is the most common symptom of bone cancer. It usually starts as a nagging, persistent ache that gets worse over time. Sometimes the ache is so strong that it stops you from doing normal activities. Occasionally, it may also cause you to feel tired and weak. The type of pain you have depends on the location and size of your tumor. The ache might come and go or it may be constant, especially at night. The ache might be felt as a dull, sharp, or burning sensation. It might get more severe as the cancer spreads.
If the cancer has spread to a bone in the spine, you might feel numbness or weakness in that area. This is called bone metastasis. Bone metastasis happens when cancer cells break off from their original site and travel to other parts of the body, where they grow into new tumours.
Most of the time, bone tumors aren’t cancerous (benign). They might be hard to remove completely, though. If they’re located in the bones of the spine, for example, surgery might not be possible without affecting the spinal cord and nerves.
For some types of bone cancer, like chordomas and chondrosarcoma, doctors use drugs to stop their growth. These drugs are known as kinase inhibitors and work by blocking certain proteins in the cell that normally relay signals to the cell to grow. These drugs are taken as pills and can be given alone or with radiation therapy.
Doctors don’t know what causes bone cancer. But it is believed that there are some risk factors for the disease. These include being exposed to radiation or certain drugs, such as corticosteroids, as well as having a genetic predisposition.
There are also some things you can do to lower your risk of getting bone cancer, such as having regular screenings, living a healthy lifestyle, and avoiding smoking. Talk to your healthcare provider about the best ways to prevent bone cancer for you. This PDQ cancer information summary has current information about the treatment of osteosarcoma and undifferentiated pleomorphic sarcoma of bone (UPS). It is provided by the National Cancer Institute (NCI). This PDQ cancer information summary does not replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you might have with your provider.
Bone cancer causes pain, swelling and, in some cases, fractures. The exact symptoms depend on the type of bone cancer you have and where it starts. It can affect bones in the arms, legs, hips, pelvis, rib cage and spine. Pain is the earliest symptom and might come and go, or get worse at night. A tumor might cause a visible lump and may grow rapidly, especially in the case of a rare form of bone cancer called chordoma (which usually occurs in the neck or spine).
When a tumour grows in a bone, it can weaken it, and sometimes breaks (fractures) easily, for example, after a minor injury. Bone cancer may also spread to the bones from another part of the body, which is called secondary or metastatic bone cancer. The signs and symptoms of metastatic bone cancer are different from primary bone cancer, and they may be more general, such as fatigue or weight loss.
The most common symptom of bone cancer is pain at the site of the tumour. It may come and go, or it might be present all the time. The pain might be felt in the area where the tumor is, or it might feel like a pressure or a burning sensation. Bone cancer in the spine can sometimes lead to a spinal cord compression, which can lead to numbness and weakness.
It isn’t certain what causes bone cancer, but it is thought that changes in the DNA of cells in or near a bone are the cause. These changes mean that the cancerous cells keep growing and multiplying, while healthy cells stop or die at a set rate.
People who have had previous radiation therapy to treat other cancers are at higher risk of developing primary bone cancer than those who haven’t. Other conditions that can occur in the bones, such as Paget’s disease of bone and fibrous dysplasia, also increase a person’s risk of bone cancer.
Any change in your bones should be investigated by a doctor. Although it is very unlikely that you have bone cancer, it’s important to see your GP and get any symptoms checked out.
Pain is the main symptom of bone cancer, but some people experience other symptoms. The pain may come and go or it might be constant. It is often worse at night and when resting. It can cause problems with mobility and range of motion. It can also be felt in other parts of the body, such as the chest or lungs, and this is called referred pain.
Bone pain caused by cancer is usually a dull ache or sharp, and it can get worse with activity. In some cases, it might feel more like a muscle cramp than a bone pain. It can develop in any bone, but it is most common in long bones such as the legs and arms. It is sometimes mistaken for arthritis in adults or growing pains in children and teens.
Sometimes, a tumor can weaken a bone so that it breaks easily, which can be very painful. This is more likely if the cancer is in a bone near a joint. It might also happen when a cancer spreads to the bone from another part of the body, although this is very rare.
X-rays can show the location, size and shape of a bone tumour. They might also suggest that it is cancerous and recommend further tests such as a biopsy or a bone scan.
The results of these tests will determine the stage of the cancer. A biopsy involves taking cells from the tumour and looking at them under a microscope. This can tell doctors how similar or different the cells are to normal bone cells, and this helps them decide what treatment is best. A cancer is assigned a number between 1 and 3, depending on how much it looks like typical cells and whether or not it has spread.
Symptoms of bone cancer are usually mild and might not be noticeable, but it is important to visit your GP if you have persistent or severe pain, especially if it gets worse or you notice a lump in the affected area. Your GP can examine you and refer you to a specialist for further tests, if necessary.
Fatigue is an important symptom of bone cancer. It is a feeling of tiredness that makes it hard to get through the day and do activities with your family and friends. The cause of fatigue may vary, but it might be caused by a condition that affects your breathing (chronic obstructive pulmonary disease), heart disease, liver disease, an infection or other health problems. Talk to your doctor if you have a problem with fatigue. They might be able to recommend ways to help with the fatigue or refer you to a specialist.
The most common symptom of bone cancer is pain. This symptom may come and go or it may be a constant pain. Bone cancer pain is more likely to happen if the tumor is in a long bone, such as a leg or arm bone. It is also more likely to happen if the cancer has spread from another part of the body to the bone.
If a tumor is causing a lot of pain, it might cause the bone to break. The bone might also feel swollen or tender. Sometimes a bone tumor can be mistaken for other conditions, such as arthritis or sports injuries. X-rays can often help diagnose bone cancer. They can show the size of the tumor and whether it has spread from the bone where it started.
Most bone cancers are not fatal, but they can be serious. If you have a type of bone cancer that is spreading to other parts of the body, your survival chances are much lower. The types of bone cancer that are most likely to spread include osteosarcoma and ewing sarcoma.
The type of treatment you have for your bone cancer will depend on the type and stage of your cancer. Treatments might include surgery, radiation or chemotherapy. Some people with bone cancer need a combination of treatments.
Treatment for bone cancer aims to control the tumour, relieve pain and prevent it spreading. You may have surgery, chemotherapy, radiation therapy or drug treatment.
Your doctor will examine you and might order X-rays or other tests. They will ask about your general health and what medicines you take.
A cancer that forms in bone, osteosarcoma usually affects the long bones of the arms and legs. It most often happens in teenagers during a growth spurt and it’s more common in boys than girls. It can also happen in older adults. The exact cause is not known. But it is thought that changes in a person’s DNA increase the risk of getting osteosarcoma.
A biopsy is the only way to know for sure if you have osteosarcoma. During the biopsy, doctors take out a small piece of tissue from the tumor to look at under a microscope. It’s best to have the biopsy done by doctors who treat bone tumors. Then the same doctors can remove the tumor later. The type of surgery used depends on where the tumor is and whether it has spread.
Staging is a process that uses imaging tests and other tests to find out how far the cancer has spread. It helps doctors plan the best treatment.
The most common treatments for osteosarcoma are chemotherapy and surgery. Doctors can also use radiation.
Chemotherapy is a treatment that uses drugs to kill cancer cells. These drugs can damage other healthy cells, so you may have side effects. Some of the most common side effects of chemotherapy include nausea, vomiting, low appetite, and tiredness.
Your doctor will give you a medicine called a steroid to help prevent nausea and vomiting. You’ll get it as a shot or in a vein (IV). It may be given with other medicines, such as steroids or antibiotics.
Surgery is the main treatment for most osteosarcomas. It can be done in a way that saves the limb. This is called limb-sparing surgery.
If the tumor is in a large bone, doctors may need to break it into pieces or remove part of the limb. If it’s in a smaller bone, they might remove just the tumor itself. Sometimes doctors can replace the lost bone and tissue with a graft of tissue from another area of your body or with artificial bones.
If the tumor hasn’t spread, you may not need further treatment. But you’ll need to follow up with your doctor regularly. This will include blood tests and imaging tests to check for complications and to see if the cancer comes back or spreads.
The treatment for undifferentiated pleomorphic sarcoma depends on where the cancer is located and how large it is. When possible, doctors try to remove the sarcoma completely with surgery. They aim to remove the tumor and a margin of healthy tissue around it with as little impact on surrounding structures as possible. If the cancer affects the arms and legs, surgeons may prefer to use limb-sparing operations. However, in some cases it may be necessary to amputate the affected limb. Radiation therapy is also used in combination with surgery or on its own. This type of radiation comes from a machine that moves around you as you lie on a table and directs the beam to precise points on your body.
Chemotherapy is usually used to treat undifferentiated pleomorphic cancer that comes back after treatment or spreads to other parts of the body. It can be given before surgery to shrink the tumor or on its own after surgery to kill any remaining cancer cells. This type of chemotherapy targets specific abnormalities present in cancer cells, which can cause them to die. Targeted drug treatments are often used in conjunction with chemotherapy to increase the effectiveness of the treatment.
Undifferentiated pleomorphic relapsed sarcoma can be difficult to diagnose because it can mimic other types of soft-tissue tumors. Therefore, it is important to get a complete medical history and perform a physical exam before making a diagnosis. Your doctor will look for any signs of lumps or swelling in the affected area and may recommend imaging tests such as X-rays, CT scans and magnetic resonance imaging (MRI) to take detailed pictures of the affected area.
X-rays and other imaging tests can help to determine the size of the tumor, whether it is in a bone or deep within the tissues. The doctor will then order a biopsy to obtain a sample of the tumor for laboratory testing. The biopsy will be examined to confirm the diagnosis and rule out other conditions. The results of the biopsy will help determine your treatment options.
Fibrosarcoma is an extremely rare, aggressive bone cancer that mainly affects young people in the second decade of life (ages 10 – 19). It has a more limited age distribution than osteosarcoma and is less common than osteoblastic osteosarcoma. Its radiographic appearance varies, depending on whether it is lytic (destructive) or blastic. It is often confused with osteosarcoma, especially the telangiectatic form of the disease. The diagnosis of fibrosarcoma requires the expertise of a specialist in bone tumors. A familiarity with the work-up of these lesions is important to minimize unnecessary tests, as well as ensuring that required studies are performed in an efficient manner. This can be accomplished by involving an orthopaedic oncologist early in the case, if possible. The MSTS maintains a database of such specialists, and your own orthopaedic oncologist should be able to direct you to someone he or she often refers these cases to.
Histologically, fibrosarcoma of bone looks very similar to other bone sarcomas such as malignant fibrous histiocytoma, myxofibrosarcoma and undifferentiated pleomorphic sarcoma. It is important to have these lesions examined by pathologists who are familiar with the different types of sarcomas, as they require careful examination and sophisticated microscopic techniques in order to be distinguished from other benign or malignant bone tumors.
Depending on the stage of the tumor, a patient may require pre- or post-operative chemotherapy. The goal of chemotherapy is to kill the large tumor mass as well as any circulating cancer cells that are not visible on imaging.
Once a patient has undergone surgical resection, his or her prognosis depends on the histologic grade and the presence of metastatic spread to the lungs. Unfortunately, metastasis is not uncommon for bone sarcoma, especially in patients with lower grade tumors.
Although these cancers are rare, they can be very difficult to treat effectively. Because they tend to infiltrate and destroy bones quickly, it is important that a specialist in bone tumors be involved in the diagnosis and management of these lesions. The prognosis depends on the size, grade and staging of the tumor, as well as other factors such as the patient’s general health, age and comorbidities.
Giant cell tumor is a noncancerous (benign) bone cancer that usually grows near a joint. It is more common in the ends of the long bones in the legs and arms. It most often occurs in adults between ages 20 and 40. It may cause pain, swelling, and limited range of motion. Giant cell tumor of bone is usually diagnosed with a physical examination and X-rays. Other diagnostic tests may include a blood test, CT scan, MRI, or a bone scan.
A giant cell tumor is a slow-growing disease that does not spread to other parts of the body. The treatment goal is to remove the tumor, relieve symptoms, and restore function. Your doctor may recommend surgery, radiation therapy, or a combination of treatments.
Symptoms of giant cell tumors include pain, a lump or mass, and a limited range of motion in the affected area. Most often, the pain comes from damage to bone tissue by the tumor. Giant cell tumors also can erode or destroy adjacent tissue, and they may form soft tissue masses.
In rare cases, giant cell tumors can spread to the lungs. If this happens, surgical removal of the tumor and the lung is necessary.
The surgical procedure most commonly used to treat giant cell tumors is curettage. During this procedure, your doctor uses special instruments to scrape the tumor from the bone. It is typically followed by packing the site with cement.
Although GCTs are not generally considered to be cancerous, they tend to recur after surgical removal. Complete surgical removal is the best way to prevent recurrence, and it is the treatment of choice for GCTs in locations that are amenable to surgery.
Radiation therapy can help control and destroy tumors that cannot be removed surgically. It is typically followed by chemotherapy to prevent recurrence of the cancer. Giant cell tumors can recur, so your doctor will likely recommend follow-up visits for several years after the initial treatment. These visits will include X-rays of the affected area and chest X-rays. The X-rays will help determine whether the tumor has recurred or if it has spread to other areas of the body.
