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 the cancer begins determines the type of bone cancer.
Bone cancers are not common. They make up less than 0.2% of cancers in the United States. While they can develop at any age, they are more common in children, teenagers and young adults than in older adults.
Cancers that form in the bone itself are called primary bone cancers. Many tumors 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 tumors. Breast, prostate and lung tumors most commonly metastasize (spread) to the bones.
What are the main types of bone cancer?
There are three main types of bone cancer:
- Osteosarcoma: The most common bone cancer is osteosarcoma. (“Osteo” means bone.) Osteosarcoma develops in the cells where new bone tissue forms. It can begin in any bone, but it usually develops at the ends of large bones such as the legs and arms. Doctors 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 different 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 tissue. 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.
Symptoms and Causes
What causes bone cancer?
Doctors 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.
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. These symptoms may also occur because of other conditions, such as arthritis or Lyme disease which may delay the diagnosis. The most common symptoms of bone cancer include:
- Pain (usually worse at night)
- Unexplained swelling
- Difficulty moving around
- Feeling extra tired (fatigue)
Diagnosis and Tests
How is bone cancer diagnosed?
To diagnose bone cancer, a doctor will often first use X-rays to view images of the bones. Magnetic resonance imaging or MRI and CT scans provide more detailed images of the areas around the bones and are usually obtained before any treatment.
To confirm the diagnosis, the doctor will do 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 doctors know which course of treatment will work best for the specific cancer.
Management and Treatment
How is bone cancer treated?
Treatment for bone cancer depends on the type of cancer, whether it has spread and if so, where. People with bone cancer often work with a team of doctors 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).
Doctors usually combine more than one type of treatment to treat bone cancer. The type and duration of these treatments vary depending on 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 doctors use include:
- Surgery: Removes the tumor and some healthy tissue around it with an operation. Doctors can repair or rebuild affected bones with real or artificial bone grafts. Sometimes, an entire limb must be removed to treat the 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: Shrinks tumors by using high doses of X-rays. Doctors often use radiation before surgery to shrink the tumor so less tissue has to be removed.
- Chemotherapy: Kills cancer cells throughout the body with medicine. People usually receive this medicine by swallowing a pill or having a healthcare professional inject it into a vein. Doctors can use chemotherapy to treat primary bone cancers or bone cancers that have spread.
Outlook / Prognosis
What is the outlook for people with bone cancer?
Doctors can successfully treat many patients with bone cancer. In these cases, the cancer never returns. Sometimes people need multiple surgeries to accomplish this outcome.
Other people with bone cancer might need to continue treatments including radiation and chemotherapy to keep the cancer from spreading. These treatments may go on indefinitely to control the cancer.
It is important to follow up with your doctor regularly to look for signs that the cancer is coming back (recurrent) or spreading. The earlier a recurrence is detected, the sooner doctors can start treating it.