Bone cancer

Overview

In most cases, cancer spreads to the bones from another part of the body. Primary bone cancer is different because it starts in the bones.

Some bone tumors are benign (non-cancerous), though they can still weaken the bone if they grow and may require treatment. Others are malignant (cancerous) and can spread beyond the bones if not caught early.  

There are several types of malignant tumors:

  • Osteosarcoma - This is the most common type of bone cancer. It typically develops in the arms, legs, knees or pelvis. Osteosarcoma most often affects children and adults between the ages of 10 and 30, but it can affect older adults over 60. 
  • Chondrosarcoma - This cancer can occur anywhere in the body where there is cartilage, though it typically affects the pelvis, legs or arms. It can develop in patients as young as 20, with the risk increasing each year until age 75. 
  • Ewing tumors - This “family” of tumors is typically found in the chest, pelvis, arms or legs. Children and teenagers are more likely to develop an Ewing tumor; diagnoses after age 30 are rare.

Other rare bone cancers include:

  • Malignant Fibrous Histiocytoma (MFH)
  • Fibrosarcoma
  • Giant Cell Tumors
  • Chordoma

Our approach

Bone cancers like osteosarcomas and Ewing tumors are rare. That’s why it is important that a patient chooses a team that has the experience necessary for successful treatment.

The physicians at Northwell Health, including those at Northwell Health Cancer Institute, specialize in limb-sparing surgeries, which allow them to preserve arms and legs affected by bone cancer. The doctor’s expertise allows them to carefully navigate around delicate tendons, nerves and blood vessels to remove tumors and restore bone.

Team members also provide the physical and emotional support that is crucial for treatment, with convenient locations on Long Island.

A Team Approach to Bone Cancer

Effective bone cancer care requires a team of physicians with specialized knowledge working together. The Northwell Health multidisciplinary team brings together different specialties, with members regularly consulting with each other about patient care and meeting regularly to discuss treatment.

Successful bone cancer treatment depends on an accurate diagnosis. The doctors at Northwell Health have the expertise needed to distinguish between a tumor that started in the bone and one that spread there. They use the latest tools and techniques for a thorough analysis of cancer so they can move ahead with each personalized treatment plan.

Risk factors and causes

The cause of most bone cancers is unknown. Some malignant tumors, though, are connected to rare genetic disorders passed down through families. These include:

  • Li-Fraumeni Syndrome - Increases the likelihood of developing malignant bone tumors and other cancers
  • Rothmund-Thomson Syndrome - Causes short stature, rashes and skeletal problems and raises the risk of getting osteosarcoma
  • Retinoblastoma - Causes a rare eye cancer and increases the chances of developing bone cancer
  • Multiple Exostoses (Multiple Osteochondromas) Syndrome - Forms painful nose bumps and increases the risk of getting chondrosarcoma
  • Multiple Enchondromatosis - Causes benign bone tumors to grow but can also increase the risk for chondrosarcoma
  • Tuberous Sclerosis - Increases the risk of developing a chordoma during childhood
  • Additional genetic mutations - Some chordomas appear to run in families but the responsible mutations have not been identified

Other factors may increase someone’s risk of developing bone cancer:

  • Paget Disease - This non-cancerous disease forms abnormal bone tissue and can very rarely lead to bone cancer.
  • Radiation - Exposure to radioactive materials, such as radium, or radiation treatment for other cancers can increase the chances of developing bone cancer. X-rays and exposure from items like microwave ovens do not increase this risk.
  • Chemotherapy - Some chemotherapy drugs may increase the chances of developing bone cancer.
  • Bone Marrow Transplants - Some patients have developed bone cancer after bone marrow transplants.

Symptoms

There are no preventive screening tests for bone cancer, and some patients might not have any symptoms. When a tumor grows, it presses on and damages healthy tissue. That can cause:

  • Pain or swelling in a bone or joint, which can come and go and then turn more severe
  • A lump (sometimes with a soft and warm feel) in the arms, legs, chest or pelvis
  • Fever with no other identified cause
  • Unusual bone break

Just because someone has these symptoms doesn’t necessarily mean they have cancer. See a doctor to determine what is causing symptoms.

Diagnosis

If bone cancer seems possible, a doctor will take all the steps necessary to ensure an accurate diagnosis. This may include recommending several of the following tests:  

  • Physical exam - Gives doctors a chance to feel for lumps and other warning signs
  • Blood tests - Identify high levels of substances associated with bone cancer, such as alkaline phosphatase, lactate dehydrogenase and glucose (chondrosarcoma only)
  • X-ray - Takes an image of the body that allows a physician to see certain structures
  • Bone scan - A radioactive (but safe) substance is injected in the veins and gathers in the bones, where a special camera can then detect damaged areas 
  • CT (CAT) scan - Overlaps X-rays from different angles, with dye sometimes injected into veins or swallowed to allow doctors to see delicate, tiny structures
  • PET scan (Positron Emission Tomography) - Injects glucose (sugar) into the veins and uses a rotating scanner to look for malignant cells throughout the body, not just at the origin site of the cancer (where it first started to grow)
  • MRI (Magnetic Resonance Imaging) - Uses a magnet, radio waves and a computer to take detailed pictures of the inside of the body
  • Biopsy - Typically required to diagnose bone cancer, and uses a needle to remove cells or tissue for examination with a microscope

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