Your Ultimate Manual for Bone Cancer: Symptoms, Diagnosis, and Treatment

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 cancer begins determines the type of bone cancer.

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 cancers. Breast, prostate and lung tumors most commonly metastasize (spread) to the bones.

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 are more common in children, teenagers and young adults than in older adults.

Where does bone cancer usually start?

It depends on which type of bone cancer you have. There are four types of primary bone cancer:

• Osteosarcoma: The most common type of bone cancer, osteosarcoma develops in the cells where new bone tissue forms. It can start in any bone, but it usually begins at the ends of large bones such as the arms and legs. Providers 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 tissues. 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.
• Chordoma: This rare tumor begins in the bones of the spine — usually at the base of the spine or the base of the skull. Like chondrosarcoma, chordoma occurs most often in older adults. Men are more likely than women to develop this type of bone cancer.

Can a benign bone tumor become cancerous?

Yes, but it’s not common. Even so, people with benign bone tumors may still need treatment to reduce the risk of other issues such as weak bones, joint problems and destruction of healthy bone tissue.

What should I know about bone cancer staging?

Staging is determined by the size and location of the tumor, and whether or not cancer has spread to other areas. Primary bone cancer is categorized into four stages:

• Stage 1: The tumor is low-grade, and the cancer cells are still localized.
• Stage 2: The cancer cells are still localized, 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 had spread from the bone to other areas of the body, such as the lungs or liver.

What are common bone cancer symptoms?

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 signs of bone cancer include:

• Pain (usually worse at night).
• Unexplained swelling.
• Difficulty moving around.
• Feeling extra tired (fatigue).
• Fever.

What causes bone cancer?

Experts 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.

How is bone cancer diagnosed?

To diagnose bone cancer, your healthcare provider will often first use X-rays to view images of your bones. Magnetic resonance imaging (MRI) and CT (computed tomography) scans provide more detailed images of the areas around the bones and are usually obtained before any treatment.

To confirm the diagnosis, your healthcare provider will perform 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 providers know which course of treatment will work best for the specific cancer.

How is bone cancer treated?

Bone cancer treatment depends on the type of cancer, whether it has spread and if so, where. People with bone cancer often work with a team of healthcare providers 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).

Bone cancer treatment typically involves a combination of approaches. The type and duration of these treatments vary depending on several 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 most commonly used include:

• Surgery: Your surgeon removes the tumor and some healthy tissue around it. They can also repair or rebuild affected bones with real or artificial bone grafts. Sometimes, an entire limb must be removed to treat 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 therapy: This treatment shrinks the tumors with high doses of X-rays. Healthcare providers often use radiation before surgery to shrink the tumor so less tissue has to be removed.
• Chemotherapy: This type of treatment kills cancer cells throughout the body with medicine. People usually receive this medicine by swallowing a pill or having it injected into a vein. Your provider can use chemotherapy to treat primary bone cancers or bone cancers that have spread.

Can bone cancer be prevented?

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

What is the outlook for people with bone cancer?

Many cases of bone cancer are successfully treated. In these instances, cancer never returns. Sometimes people need multiple surgeries to accomplish this outcome.

Other people with bone cancer might need to continue treatments including radiation therapy and chemotherapy to keep cancer from spreading. These treatments may go on indefinitely to control cancer.

It is important to follow up with your healthcare provider regularly to look for signs that the cancer is coming back (recurrent) or spreading. The earlier a recurrence is detected, the sooner your provider can start treating it.

Is bone cancer usually fatal?

Not usually. Though some people will die of bone cancer, many others will make a full recovery. The five-year relative survival rate for bone cancer is 66.8%. This means that 66.8% of people with bone cancer are still alive five years after their diagnosis. Keep in mind that survival rates are only estimates based on people who’ve had bone cancer in the past. They can’t predict how long you will live or what to expect in your unique situation. To learn more about bone cancer survival rates, talk to your healthcare provider.

How long can you live with bone cancer?

Many people with bone cancer undergo successful treatment and go on to lead fulfilling lives. Those with early-stage bone cancer have a better chance of full recovery. When bone cancer is detected later on, survival rates decrease.

When should I see my healthcare provider?

Anytime you develop bone pain or swelling, schedule a visit with your healthcare provider. If you’re already undergoing bone cancer treatment, be sure to inform your provider if any new symptoms arise.

What questions should I ask my healthcare provider?

Fully understanding your diagnosis can 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 outlook?

What does bone cancer feel like?

The most common bone cancer symptom is pain, though sometimes these tumors are painless. The pain may be mild or severe. Many people describe it as throbbing, aching or stabbing. Some people develop a lump in the area that may be hard or soft to the touch.

Is there a connection between osteoporosis and bone cancer?

Yes. While osteoporosis isn’t a precursor for bone cancer, many people with bone cancer (or other types of cancer, especially breast or prostate) develop osteoporosis as a result.

A note from Cleveland Clinic

Bone cancer is rare. Being diagnosed with the condition can bring fear, frustration and uncertainty. When detected and treated early, bone cancer can be treated successfully. Talk to your healthcare provider about your treatment options. You may also want to consider joining a support group. Talking with people who are going through the same thing can be beneficial for your mental, emotional and spiritual health.