Bone Tumors

When your bone cells grow unchecked and out of control within or near your skeleton, they form a lump or mass (tumor). They can grow in any of the bones in your body — arms, legs, hips, spine, ribs, pelvis, even your fingers or toes. Since the lump is in your bone, you might not be able to feel it. But it can damage your healthy bone tissue, make your bones weak and cause problems with your joints.

Benign bone tumors in adults

Many tumors that start in your bones aren’t cancerous. In benign bone tumors, the abnormal cell growth usually stays where it started, instead of spreading to other parts of your body. Providers usually see these kinds of tumors in young adults. There are several types of benign tumors. Some of the more common ones found in adults are:

• Enchondromas: These tumors form cartilage in the center of your bones.
• Osteoid osteomas and osteoblastomas: These tumors are most often found in the long bones in your body, like your shins (tibia) or thighs (femur). They’re more common in people assigned male at birth (AMAB).
• Giant cell tumors: These tumors grow near the end of one of your bones — often near your knee, at the bottom of your thigh or at the top of your shin.

Malignant bone tumors in adults

Cancerous tumors that start in your skeleton are called sarcomas. They’re different from cancers that start somewhere else, like in your lung or breast, and spread (metastasize) to your skeleton. Sarcomas are rare and can spread to other parts of your body. Depending on how big the tumor is, where it is and if it’s spread, your provider will give it a stage.

Some of the most common types of malignant bone tumors are:

• Osteosarcomas: These are the most common types of bone cancer. These tumors usually form at the ends of long bones in your arms and legs. They’re most common in children and teens. But adults can get them, too, especially if you have another health condition, like Paget’s disease.
• Chondrosarcoma: These tumors form cartilage and usually happen in the pelvis, ribs and axial skeleton (spine and base of skull) of middle-aged to older adults.
• Chordoma: This is a rare cancerous bone tumor that begins in the base of your spine or skull. It’s most often seen in older adults and people assigned male at birth (AMAB).

Diagnosing Bone Tumors at Cleveland Clinic

It’s important to remember that not every bump or lump is a tumor, or cancer. Many other conditions can be mistaken for bone tumors, including infections and injuries/trauma.

And if it’s a bone tumor, that doesn’t mean you have cancer, either. Many of the most common ones are benign. That’s why it’s important to work with healthcare providers, like the ones at Cleveland Clinic, who are familiar with the different types of bone tumors. You can have peace of mind knowing our skilled pathologists will give you a correct diagnosis, and our expert oncologists will provide personalized and compassionate treatment based on that diagnosis.

What to expect at your first visit

When you first come to see us, your provider will spend time getting to know you. They’ll ask about your symptoms and how long you’ve had them. If you’ve already had X-rays or other imaging or tests, they’ll look at those and go over the results with you. They’ll also want to know about other health conditions you and your family may have. And if any of your family members have or have had any type of bone tumors.

Sharing this information is an important first step to confirming your diagnosis and helps our team rule out other conditions. At this visit, you’ll also have a physical exam, and your provider may order some tests, like:

• X-rays.
• CT scans (computed tomography scans).
• MRI (magnetic resonance imaging).
• PET scan (positron emission tomography scan).
• Bone scan.
• Blood tests.
• Biopsy.

Second Opinions for Bone Tumors

When you hear you may have cancer, you probably have a lot on your mind. But one thing is certain — you want to be sure you have the correct diagnosis. Knowing what’s going on can make it easier to take the next step. That’s why we encourage second opinions. Because sarcomas are rare, a second opinion from providers experienced in treating them is important.

When you reach out to Cleveland Clinic for a second opinion, we work to schedule an appointment as quickly as possible. And when you meet with our team of expert providers, we’ll listen to your concerns, go over your test results and help you understand what to expect from treatment, recovery and follow-up. We want you to feel in control of your care from the moment you connect with us — so you feel confident about moving forward.

Meet Our Bone Tumor Team

Our providers work together across various specialties to give you the most personalized care. This means we’ll carefully select a team of healthcare providers based on your needs. These experts work together to plan your care and guide you through treatment. Depending on if your bone tumor is cancerous or not, your team may include:

• Anesthesiologists.
• General surgery.
• Head and Neck surgery.
• Intracranial neurosurgery.
• Medical oncologists.
• Nurse practitioners.
• Occupational therapists.
• Orthopaedic oncologists.
• Palliative care specialists.
• Pathologists.
• Physical therapists.
• Plastic surgery.
• Psychologists/Psychiatrists.
• Radiation oncologists (cancer specialists that treat you with radiation therapy).
• Radiologists.
• Social workers.
• Surgical oncologists (cancer specialists that perform surgeries).
• Thoracic surgery.

Depending on the type of bone tumor you have and if it’s benign or cancerous, your care team will recommend a plan of action unique to your treatment experience.

Treating benign bone tumors

Treating benign bone tumors depends on many things — what kind it is, where it is, how big it is and if it’s damaged your bone. Your provider may recommend:

• Watchful waiting (observation): You’ll have regular appointments and testing to make sure there aren’t any changes. Some benign bone tumors go away without treatment, although it could take years. Many don’t go away but will never cause problems or need any specific treatment.
• Medications: Your provider may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen (Advil^® or Motrin^®) or naproxen sodium (Aleve^®) to help with pain and shrink the tumor.
• Surgery: If your provider feels it’s best to remove your benign bone tumor with surgery, we’ll take it out and preserve your healthy bone as much as possible. We may also need to stabilize your bone with plates, screws or rods. And we might need to fill in the area where the tumor used to be with a bone graft, bone substitute or bone cement. Benign bone tumors that are taken out with surgery usually don’t come back (recur).

Treating malignant bone tumors

Once your care team looks over your test results and medical history, they’ll meet with your team of sarcoma providers at the Sarcoma Tumor Board to build your treatment plan. This plan usually includes a combination of surgery and chemotherapy or, more rarely, radiation therapy.

Finding orthopaedic oncologists and surgeons with experience in treating sarcomas is crucial for taking care of these rare cancerous bone tumors. To make sure they don’t come back, bone tumors need to be delicately removed, all in one piece. Most of the time, your surgery team will be able to build back your bone using metal implants, bone grafts or other techniques during limb salvage efforts.

We often do what we call “neo-adjuvant therapy” before surgery to help increase the chances of getting rid of the tumor for good. This means we’ll try to shrink the tumor and kill off cancer cells wherever they are in your body before you go into the operating room. We usually use chemotherapy to do this. Rarely, we may use radiation therapy before surgery. For some bone cancers, surgery to remove the tumor is the only treatment you’ll need.

Some types of malignant bone tumors (and many benign ones) may also respond to other treatments like:

• Brachytherapy.
• Immunotherapy.
• Targeted therapy.
• Cryotherapy.
• Radiofrequency ablation.
• Bisphosphonates.

In rare cases, the tumor may have damaged your bone and surrounding tissue too much to build it back. If that happens, we may have to remove (amputate) part or all of the limb. If you need amputation, we use the latest techniques to maximize function and durability and minimize pain.

We can help you learn to use a highly customized artificial (prosthetic) limb after surgery. We work with leading researchers and prosthetists to get you back to your activities as quickly as possible.

We know that this can be hard not just physically, but also emotionally. We make sure you have the support you need to move ahead with this treatment, like:

• Physical therapy.
• Occupational therapy.
• Support groups.
• Counseling (psychotherapy).

Life After Bone Tumors Treatment

No matter what type of bone tumor you have, you’ll need time to recover after treatment. Our team will guide you through every step of this process, which will include regular follow-up appointments and testing to make sure the tumor isn’t growing back.

Your provider will go over how long you’ll need to rest before going back to your activities. They’ll also talk with you about rehab, like physical or occupational therapy, and can suggest other support you may need.

Taking the Next Step

If you’ve been told you have a bone tumor, a quick diagnosis and early treatment can help limit bone damage. We can also help you to better manage any pain you might have. While bone tumors are rare, they aren’t to us. Our experienced orthopaedic oncologists and surgeons know how to care for all kinds of bone tumors — both benign and malignant. They’re ready to help you find your way on this new journey and keep living a full and productive life after treatment.