Bone Cancer

What is bone cancer?

“Bone cancer” is the term for several different cancers that develop in your bones. When cancer cells grow in a bone, they can harm normal bone tissue. Bone cancers can start in any bone, but they more commonly form in your thigh bone, shin bone or upper arm.

Cancers that form in the bone itself are called primary bone cancers or bone sarcomas. Many cancerous tumors that begin in organs or other parts of your body can spread to your bones, as well as other body parts. These growths are called “bony metastases.” Breast, prostate and lung tumors are the cancers most likely to metastasize (spread) to your bones.

Bone cancers are serious and require prompt treatment. The good news is that there are things healthcare providers can do to treat bone cancers and, in some cases, even cure them.

Types of bone cancer

There are three main types of primary bone cancer. The type of cell and tissue where cancer starts determines the type of bone cancer:

• Osteosarcoma. The most common type of bone cancer, osteosarcoma develops in the cells where new bone tissue forms. It’s most common in teenagers but may also affect young adults and children.
• Ewing sarcoma. These tumors can form in your bones and in surrounding soft tissues. They’re most common in children and teenagers but may also affect some young adults.
• Chondrosarcoma. These tumors begin in the soft connective tissue that allows movement between joints and bones (cartilage). They occur more frequently in adults.

Rarer types of bone cancer include:

• Chordoma. These tumors form in your spine or the base of your skull.
• Fibrosarcoma. These tumors start in the fibrous, connective tissue at the end of your bones.
• Giant cell tumor. These benign (noncancerous) tumors may become cancerous in rare cases.
• Undifferentiated pleomorphic sarcoma. These aggressive tumors start in soft tissue and bone.

How common is bone cancer?

Bone cancers are rare. They make up less than 1% of cancers in the United States. While they can develop at any age, they’re more common in children, teenagers and young adults than in older adults.

Tumors that form in your bones are much more likely to be benign. Unlike bone cancers, benign bone tumors don’t spread throughout your body.

What are the symptoms of bone cancer?

Some people with bone cancer have no symptoms other than feeling a painless lump. For others, a variety of symptoms can develop. Providers can easily mistake some symptoms for those of other conditions, like “growing pains,” sports injuries, arthritis or Lyme disease. Narrowing it down may delay the diagnosis.

The most common signs of bone cancer include:

• Bone pain that gradually becomes more persistent (usually worse at night and may feel throbbing, aching or stabbing)
• A lump in the affected area that may be hard or soft to the touch
• Unexplained swelling around the affected area of the bone
• Difficulty moving around (if swelling is near a joint)
• Fatigue
• Fever

What causes bone cancers?

Experts aren’t certain what causes bone cancers. But as with other cancers, bone tumors form when problems with cell DNA cause cells to grow out of control. Eventually, they form a mass that damages the surrounding healthy tissue. Without treatment, bone cancers can spread to other parts of your body.

Risk factors

Researchers have found links between bone cancers and other factors that may increase your risk. Risk factors for bone cancers include:

• Previous cancer treatment. Radiation therapy and some chemotherapy drugs to treat other cancers may increase your risk of developing bone cancer in the future.
• Genetic factors. Some rare inherited genetic disorders, like Li-Fraumeni syndrome, may increase your risk of bone cancer. Inheriting the genetic mutation (change) that causes retinoblastoma also increases your risk.
• Benign bone conditions. In extremely rare cases, benign bone conditions progress to cancer. For instance, having Paget disease of the bone or multiple enchondromas may increase your risk.

Still, most people who develop bone cancers don’t have any risk factors. It usually happens without cause.

What are the complications of this condition?

Bone cancers weaken the bones that they form in, and sometimes, people can develop bone fractures through the tumor. These are called “pathologic fractures.” Sometimes, healthcare providers find bone cancers while investigating a fracture.

How are bone cancers diagnosed?

To diagnose a bone cancer, your healthcare provider will often first use X-rays to view your bones. Magnetic resonance imaging (MRI) and CT (computed tomography) scans provide more detailed images of the areas around your bones. You’ll likely need them before treatment.

To confirm the diagnosis, your provider will also do a biopsy. They’ll remove a small piece of tissue from your bone, so a disease specialist (pathologist) can examine it under a microscope. A biopsy provides specific information about the cancer type. Having this information helps providers know which treatments will work best.

Bone cancer staging

Cancer staging allows healthcare providers to determine whether the cancer is only in one place (localized) or if it’s already spread throughout your body (metastasized). They also consider how likely it is to spread if it hasn’t already. The tumor’s grade, or how abnormal the cancer cells look, provides clues about how likely it is that cancer will spread. There are two systems providers may use to stage bone cancers.

The Musculoskeletal Tumor Society, or Enneking system, uses the following staging guidelines:

• Stage 1: Tumors are low-grade and haven’t spread.
• Stage 2: Tumors are high-grade and haven’t spread.
• Stage 3: The cancer has spread.

The American Joint Committee on Cancer (AJCC) uses the following system:

• Stage 1: The tumor is low-grade and the cancer hasn’t spread.
• Stage 2: The cancer hasn’t spread, 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 has spread from the bone to other areas of your body, like your lungs or liver.

How are bone cancers treated?

The most common treatment for bone cancers is surgery to remove the cancer. Limb-sparing surgery, where your surgeon only removes the tumor and some healthy tissue around it (but leaves your arm or leg intact), is the most common type of surgery. They can repair or rebuild affected bones with real or artificial bone grafts.

Sometimes, your surgeon will need to remove an entire limb to treat cancer. In this case, a healthcare provider will fit you with an artificial limb (prosthesis) after surgery. These devices are highly sophisticated and allow people to carry on with their routines in much the same way they did before surgery.

Other treatments include:

• Radiation therapy to shrink tumors before surgery or to destroy any remaining cancer cells after surgery. In certain bone cancers, radiation can be used instead of surgery.
• Chemotherapy to treat the primary cancer, any metastases and any cancer cells floating around in your body. Chemotherapy is typically given before surgery to help control the spread of the cancer and possibly shrink the tumors. After surgery, chemo “cleans up” any remaining cancer cells in your body and helps prevent bone cancers from coming back.

How soon after treatment will I feel better?

Pain related to bone cancers often improves soon after treatment starts. But the treatments can cause some side effects and require recovery.

It may take up to six months of rehabilitation and physical therapy to get used to a prosthesis. With limb-sparing surgery, it may take up to a year to feel completely comfortable with the changes in your bones.

Ultimately, your recovery time depends on the cancer type, stage and the combination of treatments you need. Your healthcare provider will let you know what to expect so you can decide which treatments work best for you.

Can bone cancers be prevented?

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

Still, you can see a healthcare provider if you’re noticing unusual changes in your bones, like a lump or increasing bone pain. These symptoms don’t usually mean cancer. But only a provider can diagnose what’s causing the issue.

What can I expect if I have a bone cancer?

Treatment for bone cancers is often successful. In many instances, the cancer never returns. You may need one or more surgeries to accomplish this outcome.

People with more aggressive forms of bone cancer might need to continue treatments like radiation therapy and chemotherapy to keep cancer from spreading. These treatments may go on for a long time to manage the cancer.

Ultimately, every case is different, and there isn’t one outcome that applies to everyone with a bone cancer. Your healthcare provider can explain your prognosis (outlook) based on the type of cancer, its stage, location and response to treatment.

What is the survival rate for bone cancer?

Though bone cancers can be fatal, many people make a full recovery. The five-year relative survival rate for bone cancer is 68.2%. This means that 68.2% of people with bone cancer are still alive five years after their diagnosis. Those with lower-stage bone cancers have a better chance of a full recovery. For people with higher-stage bone cancers, where it’s already spread, the chances of the cancer coming back increase.

Keep in mind that survival rates are only estimates based on people who’ve had bone cancers in the past. They can’t predict how long you’ll live or what to expect in your unique situation. To learn more about bone cancer survival rates, talk to your healthcare provider.

When should I see my healthcare provider?

Schedule a visit with a healthcare provider anytime you develop unexplained bone pain or swelling. Contact your child’s provider if they have a lump or swelling that doesn’t go away. If you’re already receiving bone cancer treatment, be sure to inform your provider if any new symptoms arise.

After treatment, make sure to attend all follow-up appointments. Within the first two years, you may need to see your provider as often as every three to six months, with check-ins becoming less frequent after that. The frequency allows your provider to catch cancer recurrence early, when treatment is most effective.

What questions should I ask my healthcare provider?

Fully understanding your diagnosis can help 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 prognosis?