What is bone cancer?
Bone cancer is a condition in which cells grow abnormally within the bones. There are two types of bone cancer: primary bone cancer, which starts in the bones, and secondary bone cancer, which starts in another part of the body and travels to the bones. Secondary bone cancer is the most common of the two.
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)
- Giant cell tumors
There are no preventive screening tests for bone cancer, and some patients have no symptoms. However, growing tumors can press on and damage healthy tissue and cause a variety of symptoms, including:
- Pain or swelling in a bone or joint, which can come and go and then become more severe
- A lump (sometimes with a soft or warm feel) in the arms, legs, chest or pelvis
- Fever with no other identified cause
- Unusual bone break
If you have one or more these symptoms, it doesn’t necessarily mean you have cancer. Consult with your doctor to determine what is causing your symptoms.
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, including:
- Paget disease—This noncancerous 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 to 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.
How is it diagnosed?
If bone cancer is a possibility, your 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
- 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
Because bone cancer is complex, your treatment team will include specialists in surgical oncology, radiation oncology and orthopaedics who are closely integrated to provide the best outcome. Northwell Health Cancer Institute takes a comprehensive approach to treating bone cancer to provide the best outcome, including maximizing the chance of maintaining a limb impacted by cancer.
There are several types of treatment for bone cancer, including:
- Surgery—Surgery for bone cancer typically involves removing the tumor along with a margin of healthy tissue around it. If the tumor is located in a limb, every effort is used to keep it intact and functional whenever possible.
- Chemotherapy—Surgery alone is rarely sufficient in treating patients with bone cancer. Chemotherapy, administered by a medical oncologist, is often recommended. Chemotherapy can increase the survival rate of many individuals with bone cancer and is sometimes given prior to surgery to treat fast-growing bone cancer.
- Radiation therapy—For bone cancer, radiation therapy is most often used if a tumor cannot be removed with surgery. Radiation therapy may also be recommended prior to surgery to shrink the tumor, or it may be done after surgery to eliminate any remaining cancer cells. Radiation therapy sometimes makes it possible to preserve a limb or to relieve pain for individuals as part of palliative care.