Bone Cancer

“Bone cancer” refers to several different cancers that start in your bones. Healthcare providers also call them primary bone cancers or bone sarcomas.

Cancer can affect any bone, but it usually starts in your thigh bone, shin bone or upper arm. Primary bone cancers can affect anyone, but they’re most common in children, teens and young adults.

It’s extremely rare for cancer to start in bone. It’s more common for cancerous tumors that form in other parts of your body to spread to bone. These growths are called “bony metastases.” Breast, prostate and lung cancers are the ones most likely to metastasize (spread) to bone.

When cancer cells grow in a bone, they can harm normal bone tissue. They can also spread and harm other parts of your body. 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. They vary based on the type of cell and tissue where cancer starts:

• Osteosarcoma: This type is most common. It develops in the cells that make new bone tissue, usually in your arms or legs. It’s most common in teenagers, but it can also affect children and young adults.
• Ewing sarcoma: These tumors form in bone and soft tissue, like muscles, tendons and ligaments. They’re most common among people aged 10 to 20.
• Chondrosarcoma: These tumors begin in cartilage and are more common in adults over 50.

Rarer types of bone cancer include:

• Chordoma: Forms in your spine or the base of your skull
• Fibrosarcoma: Starts in the fibrous connective tissue at the end of your bones
• Giant cell tumor: Noncancerous growths that may become cancerous in rare cases
• Undifferentiated pleomorphic sarcoma: Aggressive tumors that start in soft tissue and bone

Symptoms of bone cancer

The most common symptoms are:

• Bone pain that gradually becomes worse (usually more intense at night and often feels like a throbbing, aching or deep pain)
• A painless lump in the affected area that may feel warm to the touch
• Swelling or limited movement in a joint near the growth
• Numbness or tingling (if the tumor presses on a nerve)
• Extreme tiredness
• Losing weight without trying
• Bones that break easily (rare)

Remember: Lots of conditions can cause these symptoms, and most don’t mean cancer. But seeing a healthcare provider is the only way to know for sure what’s going on. If you or your child has a new lump or persistent bone pain that doesn’t get better within two weeks, it’s time to see a provider.

Bone cancer causes

Bone tumors form when problems with cell DNA cause cells to grow out of control. Most tumors that form in bone are benign (not cancerous).

Unlike benign bone tumors, bone cancers can spread throughout your body. They can cause damage in new tissue when the cells grow and form tumors.

Risk factors

Healthcare providers haven’t found a single cause that triggers the cell changes that lead to bone cancers. But they’ve found factors that can increase a person’s risk, like:

• Previous cancer therapy: This includes past radiation therapy or chemotherapy treatments.
• Genetic conditions: Some rare genetic disorders, like Li-Fraumeni syndrome, may increase your risk of bone cancer. Inheriting the abnormal gene that causes retinoblastoma does, too.
• Noncancerous bone conditions: Bone conditions that aren’t cancer sometimes become cancer. This can happen if you have Paget’s disease of bone or several enchondromas. This is very rare.
• Fast bone growth: Some bone cancers tend to happen when kids go through growth spurts. It’s possible that DNA errors that lead to bone cancer are more likely to happen at these times.
• Reduced blood flow to bone tissue: Injuries or conditions that reduce the blood supply to the affected bone may increase the chance that cancer forms there.

Complications of this condition

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

How doctors diagnose this condition

Your healthcare provider will ask about your symptoms. They’ll order imaging scans to view your bones and the surrounding tissue. Imaging scans may include an:

• X-ray
• MRI
• CT scan
• PET-scan

Your provider will need to do a biopsy to test the tumor for cancer cells.

Bone cancer staging

Cancer staging helps healthcare providers determine whether the cancer is only in one place (localized) or if it has spread throughout your body (metastasized). They also consider the grade, or how abnormal the cancer cells look. High-grade tumors have more abnormal-looking cells and are more likely to spread. There are two systems that providers use to stage this condition.

The Musculoskeletal Tumor Society, or Enneking system, uses three stages:

• 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. At this stage, it’s called metastatic bone cancer.

The American Joint Committee on Cancer (AJCC) uses four stages:

• 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 parts of your body, like your lungs or liver (metastatic bone cancer).

How is it treated?

The most common treatment is limb-salvage surgery. Your surgeon will remove the tumor and some healthy tissue around it. They can rebuild affected bones with real or artificial bone grafts.

Sometimes, surgeons may need to remove the entire limb. In that case, you may need a prosthesis after surgery. The artificial limbs that surgeons use today are highly sophisticated. They can often allow people to carry on with their routines much as before surgery.

Other treatments include:

• Radiation therapy: This treatment can shrink tumors before surgery or destroy any remaining cancer cells after surgery. Sometimes, radiation replaces surgery as the main treatment.
• Chemotherapy: Chemo shrinks tumors before surgery. After surgery, it “cleans up” any remaining cancer cells in your body and helps prevent bone cancers from coming back.

Recovery time

Pain related to bone cancers often improves soon after treatment. With limb-sparing surgery, it may take up to a year to feel completely comfortable with the changes in your bones. It may take up to six months of rehabilitation and physical therapy to get used to a prosthesis.

Treatments like radiation and chemotherapy may cause side effects that also require recovery.

Many factors will affect how long it takes to feel better. Your healthcare provider will let you know what to expect in your specific situation.

When should I see my healthcare provider?

After treatment, make sure to attend all follow-up visits. These visits allow your provider to detect cancer recurrence early, when treatment is most effective.

Within the first two years, you may need to see your provider as often as every three to six months. If there are no signs that the cancer has come back, check-ins may become less frequent. But you’ll still likely need them for the rest of your life.

What is the bone cancer survival rate?

Though bone cancers can be fatal, many people make a full recovery. The five-year survival rate for all primary bone cancers is 68%. This means that nearly 7 out of 10 people with bone cancers are still alive five years after their diagnosis.

The five-year mark is important because many cancers that don’t come back within this period stay in remission. Remission means there are no signs or symptoms of cancer. In general, those with early-stage disease have a better chance of a full recovery.

It’s important to remember that every case is different. There isn’t one result that applies to everyone. Things like life expectancy vary based on your diagnosis. Your healthcare provider can explain your prognosis (outlook) based on the type of cancer, its stage, location and your response to treatment.