Bone cancer

Bone cancer is an uncommon cancer that begins in a bone. Bone cancer can begin in any bone in the body, but it most commonly affects the long bones that make up the arms and legs.

Several types of bone cancer exist. Some types of bone cancer occur primarily in children, while others affect mostly adults.

The term “bone cancer” doesn’t include cancers that begin elsewhere in the body and spread (metastasize) to the bone. Instead, those cancers are named for where they began, such as breast cancer that has metastasized to the bone.

Symptoms and causes

Symptoms

Signs and symptoms of bone cancer include:

• Bone pain
• Swelling and tenderness near the affected area
• Broken bone
• Fatigue
• Unintended weight loss

When to see a doctor

Make an appointment with your doctor if you or your child develops signs and symptoms that worry you.

Causes

It’s not clear what causes most bone cancers. Doctors know bone cancer begins as an error in a cell’s DNA. The error tells the cell to grow and divide in an uncontrolled way. These cells go on living, rather than dying at a set time. The accumulating mutated cells form a mass (tumor) that can invade nearby structures or spread to other areas of the body.

Types of bone cancer

Bone cancers are broken down into separate types based on the type of cell where the cancer began. The most common types of bone cancer include:

• Osteosarcoma. Osteosarcoma begins in the bone cells. Osteosarcoma occurs most often in children and young adults, in the bones of the leg or arm.
• Chondrosarcoma. Chondrosarcoma begins in cartilage cells. It usually occurs in the pelvis, legs or arms in middle-aged and older adults.
• Ewing’s sarcoma. It’s not clear where in bone Ewing’s sarcoma begins, but the tumors most commonly arise in the pelvis, legs or arms of children and young adults.

Risk factors

It’s not clear what causes bone cancer, but doctors have found certain factors are associated with an increased risk, including:

• Inherited genetic syndromes. Certain rare genetic syndromes passed through families increase the risk of bone cancer, including Li-Fraumeni syndrome and hereditary retinoblastoma.
• Paget’s disease of bone. Most commonly occurring in older adults, Paget’s disease of bone can increase the risk of bone cancer developing later.
• Radiation therapy for cancer. Exposure to large doses of radiation, such as those given during radiation therapy for cancer, increases the risk of bone cancer in the future.

Diagnosis

What imaging tests you undergo depends on your situation. Your doctor may recommend one or more imaging tests to evaluate the area of concern, including:

• Bone scan
• Computerized tomography (CT)
• Magnetic resonance imaging (MRI)
• Positron emission tomography (PET)
• X-ray

Removing a sample of tissue for laboratory testing

Your doctor may recommend a procedure to remove a sample of tissue (biopsy) from the tumor for laboratory testing. Testing can tell your doctor whether the tissue is cancerous and, if so, what type of cancer you have. Testing will also reveal the cancer’s grade, which helps doctors understand how aggressive the cancer may be.

Types of biopsy procedures used to diagnose bone cancer include:

• Inserting a needle through your skin and into a tumor. During a needle biopsy, your doctor inserts a thin needle through your skin and guides it into the tumor. The needle is used to remove small pieces of tissue from the tumor.
• Surgery to remove a tissue sample for testing. During a surgical biopsy, your doctor makes an incision through your skin and removes either the entire tumor (excisional biopsy) or a portion of the tumor (incisional biopsy).

Determining the type of biopsy you need and the particulars of how it should be performed requires careful planning by your medical team. Doctors need to perform the biopsy in a way that won’t interfere with future surgery to remove bone cancer. For this reason, ask your doctor for a referral to a team of doctors with extensive experience in treating bone tumors before your biopsy.

Tests to determine the extent (stage) of the bone cancer

Once your doctor diagnoses your bone cancer, he or she works to determine the extent (stage) of your cancer. The cancer’s stage guides your treatment options.

Stages of bone cancer include:

• Stage I. At this stage, bone cancer is limited to the bone and hasn’t spread to other areas of the body. Stage I cancer is low grade, which means the cancer cells are less aggressive.
• Stage II. This stage of bone cancer is also limited to the bone and hasn’t spread to other areas of the body. But Stage II cancer is high grade, which means the cancer cells are more aggressive.
• Stage III. At this stage, bone cancer occurs in two or more places on the same bone. Stage III tumors can be either low or high grade.
• Stage IV. This stage of bone cancer indicates that cancer has spread beyond the bone to other areas of the body, such as other bones or internal organs.

Treatment

The treatment options for your bone cancer are based on the type of cancer you have, the stage of the cancer, your overall health and your preferences. Different bone cancers respond to different treatments, and your doctors can help guide you in what is best for your cancer. For example, some bone cancers are treated with just surgery; some with surgery and chemotherapy; and some with surgery, chemotherapy and radiation therapy.

Surgery

The goal of surgery is to remove the entire bone cancer. In most cases, this involves special techniques to remove the tumor in one single piece, along with a small portion of healthy tissue that surrounds it. Types of surgery used to treat bone cancer include:

• Surgery to remove the cancer but spare the limb. If a bone cancer can be separated from nerves and other tissue, the surgeon may be able to remove the bone cancer and spare the limb. Since some of the bone is removed with the cancer, the surgeon replaces the lost bone with some bone from another area of your body, with material from a bone bank or with a special metal prosthesis.
• Surgery for cancer that doesn’t affect the limbs. If bone cancer occurs in bones other than those of the arms and legs, surgeons may remove the bone and some surrounding tissue, such as in cancer that affects a rib, or may remove the cancer while preserving as much of the bone as possible, such as in cancer that affects the spine. Bone removed during surgery can be replaced with a piece of bone from another area of the body, with material from a bone bank or with a special metal prosthesis.
• Surgery to remove a limb. Bone cancers that are very large or located in a complicated point on the bone may require surgery to remove all or part of a limb (amputation). As other treatments have been developed, this procedure is becoming less common. You’ll likely be fitted with an artificial limb after surgery and go through training to learn to do everyday tasks using your new limb.

Chemotherapy

Chemotherapy is a drug treatment that uses chemicals to kill cancer cells. Chemotherapy is most often given through a vein (intravenously). The chemotherapy medications travel throughout your body.

Chemotherapy may also be used in people with bone cancer that has spread beyond the bone to other areas of the body.

Radiation therapy

Radiation therapy uses high-powered beams of energy, such as X-rays, to kill cancer cells. During radiation therapy, you lie on a table while a special machine moves around you and aims the energy beams at precise points on your body.

Radiation therapy, typically given along with chemotherapy, is often used before an operation. This may increase the possibility that amputation won’t be necessary.

Radiation therapy may also be used in people with bone cancer that can’t be removed with surgery. After surgery, radiation therapy may be used to kill any cancer cells that may be left behind. For people with advanced bone cancer, radiation therapy may help control signs and symptoms, such as pain.

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