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Bone cancer

Bone cancer is caused by an abnormal and uncontrolled growth of cells in your bone.

There are around 200 bones in your body. These bones form your skeleton – the rigid internal structure that supports your body. Bone is made up of the mineral calcium and different types of cells. These cells continuously break down and form new bone.

Primary bone cancer starts in your bone, whereas the more common secondary bone cancer spreads to your bone from somewhere else in your body. This factsheet covers primary bone cancer only.

Primary bone cancer is very rare – about 600 people in the UK get it each year. Mostly teenagers and young adults are affected.

Types of primary bone cancer

There are different types of primary bone cancer. The main types are listed below.

  • Osteosarcoma is the most common type of bone cancer and affects about 150 people each year in the UK. It’s more common in teenagers and young adults, but it can occur at any age. It usually develops in your lower thighs, shins or upper arms.
  • Ewing's sarcoma affects about 75 people each year in the UK and is most common in teenagers. It usually develops in your pelvis, thighs or shins but it can also occur in the soft tissues of your body.
  • Chondrosarcoma affects about 75 people each year in the UK and is most common in adults over 40. It starts in the cartilage cells in your joints. It usually develops in the bones of your thighs, pelvis, ribs, upper arm or shoulder blades.
  • Spindle cell sarcoma is similar to osteosarcoma but is rarer and more common in adults over 40. It usually develops in your lower thighs, shins, knees or arms. There are several types of spindle cell sarcoma including undifferentiated sarcoma of the bone, malignant fibrous histiocytoma, fibrosarcoma and leiomyosarcoma.
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How cancer develops
Cells begin to grow in an uncontrolled way

Details

  • Symptoms Symptoms of bone cancer

    Symptoms of bone cancer can vary depending on where the cancer develops and how severe it is. Common symptoms include the following.

    • Pain. Bone cancer often causes pain and tenderness in the affected area. In children, this can be mistaken for growing pains. The pain is often worse at night or after exercise.
    • Swelling around your bone. As the cancer grows it can cause swelling around the affected area. Depending on the where the cancer is, you may be able to feel a lump. If it’s near a joint, it may make movement in your joint difficult. If the cancer is in your spine, it may press on nerves and cause weakness or numbness and tingling in your arms and legs.
    • Fractures (breaks). The cancer may weaken the bone it grows in and can cause the bone to break.

    Less common symptoms include:

    • tiredness
    • fever or night sweats
    • weight loss

    These symptoms aren't always caused by bone cancer but if you have them, see your GP.

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  • Diagnosis Diagnosis of bone cancer

    Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history.

    Your GP may refer you to a hospital to have an X-ray of your bone. If the X-ray shows anything abnormal, your GP may refer you to a bone specialist (an orthopaedic doctor) or an oncologist (a doctor who specialises in cancer care) for further tests to confirm your diagnosis.

    If you're found to have bone cancer, you may need to have other tests to check if the cancer has spread. The process of finding out the stage of a cancer is called staging. These tests may include the following.

    • Scans. You may have an MRI or CT scan. These will check the bones, muscles, organs and tissues in your body and can show how much of the bone is affected.
    • Bone scans. These are more sensitive at checking for bone cancer than a simple X-ray. A small amount of harmless radioactive dye will be injected into your vein. This will collect in areas of your bone that may have cancer, and will be picked up by the scan.
    • Positron emission tomography (PET) scan. A small amount of harmless radioactive material is injected into your vein and can be seen by a special camera to show the areas affected by cancer.
    • Biopsy. Your doctor may take a biopsy (a small sample of tissue) from your bone. This will be sent to a laboratory for testing to determine the type of cells and if these are benign (not cancerous) or cancerous. The procedure is called a core needle biopsy and will be done under local anaesthesia. Sometimes doctors do an operation called a surgical or open biopsy under general anaesthesia.
  • Treatment Treatment of bone cancer

    Your treatment for bone cancer will depend on the type of bone cancer you have, how far it has spread, your age and your general health. Your doctor will discuss your treatment options with you. There are three main treatments for bone cancer: surgery, radiotherapy or chemotherapy.

    Surgery

    Surgery is the main treatment for bone cancer. The type of surgery you have will depend on how far the cancer has spread. Chondrosarcoma is usually treated with surgery alone. However, osteosarcoma or Ewings sarcoma is usually treated with chemotherapy before and after surgery to help shrink the tumour as much as possible.

    Surgery is sometimes followed by radiotherapy treatment to make sure all the cancer cells are destroyed. There are different types of surgery, which include the following.

    • Resection. Your surgeon will remove part or all of your affected bone. You may have this type of surgery if you have cancer in your rib or calf bone (fibula). The bone will be removed along with a surrounding area of healthy tissue.
    • Limb-sparing surgery. This is resection of a bone in your arm or leg. Your surgeon will remove the area of bone or joint affected by the cancer and replace it with either a metal prosthesis (an artificial replacement part) or a piece of healthy bone, which will be taken from another part of your body (a bone graft). Advances in technology mean that limb-sparing surgery is becoming more common. See our frequently asked questions for more information.
    • Amputation of your arm or leg. This may be necessary if the cancer has spread into your surrounding tissues and blood vessels. This may be the only way to get rid of the cancer. See our frequently asked questions for more information.

    Non-surgical treatments

    Non-surgical treatments are an important part of the treatment of primary bone tumours and include the following.

    • Chemotherapy uses medicines to destroy cancer cells. They are usually injected into a vein. It's effective for osteosarcoma and in particular Ewing's sarcoma. Chemotherapy is often given before surgery to shrink the cancer to make it easier to remove and after surgery to destroy any remaining cancer cells. Your doctor will discuss the possible side-effects with you.
    • Radiotherapy uses radiation to destroy cancer cells. A beam of radiation is targeted on the cancerous cells, which shrinks the tumour. Radiotherapy is especially useful if the cancer is in a difficult area to treat with surgery. Radiotherapy is sometimes used after surgery to destroy any remaining cancer cells.
    • Mifamurtide is a medicine that encourages your immune system to produce specialised cells that can kill cancerous cells. It can be used after surgery in combination with chemotherapy.

    After treatment for bone cancer, you will have regular check-ups with your doctor to monitor how well the treatment has worked for you and if there is any evidence that the cancer has returned. See our frequently asked questions for more information.

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  • Causes Causes of bone cancer

    The exact reasons why you may develop bone cancer aren't fully understood at present. However, certain factors make bone cancer more likely, which include the following.

    • Age. Bone cancer is most common in teenagers and young adults, when bones are growing.
    • Radiotherapy. Treatment with radiotherapy in the past can increase your risk of getting bone cancer in that area.
    • Paget's disease. This disease can make your bones brittle, which can cause pain and fractures. It mainly affects people over 60 and can slightly increase your risk of bone cancer.
    • Ollier's disease (also called enchondromatosis). This is a bone condition that can increase your risk of developing a chondrosarcoma.
    • A previous benign (non-cancerous) bone tumour. If you have had a benign type of bone tumour, you're more likely to develop chondrosarcoma.
    • Inherited conditions. Having a rare inherited condition, such as Li-Fraumeni syndrome, retinoblastoma or Rothmund Thompson syndrome, makes you more likely to develop bone cancer.
  • Help and support Help and support

    Being diagnosed with cancer can be distressing for you and your family. An important part of cancer treatment is having support to deal with the emotional aspects as well as the physical symptoms. Specialist cancer doctors and nurses are experts in providing the support you need, and may also visit you at home. If you have more advanced cancer, further support is available to you in hospices or at home and this is called palliative care.

  • FAQs FAQs

    How is limb sparing surgery to treat bone cancer going to affect my day-to-day life?

    Answer

    Surgery usually works well and many people recover almost full use of their limb. Physiotherapy treatment and rehabilitation can help you to make as full a recovery as possible, although it’s possible you may have some issues, such as limited movement, which may affect your day-to-day life.

    Explanation

    Around eight out of 10 people who have osteosarcoma bone cancer in an arm or a leg have limb-sparing surgery to remove the cancer from your bone. You will need physiotherapy to help get back as much power and flexibility in your arm or leg as possible. An occupational therapist can also help you become independent.

    However, certain issues may affect your life, such as the following.

    • You may have a slight limp if you had surgery to your leg. If you try to compensate for the limp, it can sometimes cause pain in other areas. Speak to your surgeon or physiotherapist if this happens.
    • You may need further surgery in the future to replace loosened or worn artificial joints.
    • If you’re treated as a child, you may need operations to extend (lengthen) your bone as your body grows. Some artificial bones are designed to expand and can be lengthened using a strong magnet without an operation.
    • You may not be able to take part in contact sports, such as football or rugby, as it may damage or loosen the artificial bone or joint.
    • If you had your shoulder joint replaced, you may not be able to lift your arm above your shoulder.
    • You will have surgical scars.
    • Surgery and radiotherapy can cause a build up of fluid that causes swelling in your arm or leg (lymphoedema). This can be well controlled if treated early.

    What will life be like if I need an amputation to treat bone cancer?

    Answer

    Amputation of a limb is a major life change and can affect people in different ways. However, many people go on to lead a full and active life and are able to work, drive and play sport.

    Explanation

    Life after amputation is different for everyone. The kind of amputation you have and how much of your limb is removed will affect your recovery and how much you’re able to do.

    Recovery from amputation isn't easy and you will need to be committed and determined. A team of health professionals will help you make as full a recovery as possible.

    A few days after your operation, a physiotherapist (a health professional who specialises in maintaining and improving movement and mobility) will start to help you to strengthen the muscles around the site of your operation. Once your wound has healed, you can be measured for your artificial limb. Your limb will be made specifically for you to make sure it fits as well as possible. New technology and materials now mean that artificial limbs are very effective.

    Rehabilitation can be frustrating. You may need to learn how to walk and balance again or how to write, eat and get dressed. An occupational therapist can help make changes to your home and workplace. He or she can also give you aids to make life easier.

    It commonly takes about a year for people to get back to their usual lifestyle and to wear their artificial limb regularly.

    Problems after having an amputation can include the following.

    • Phantom limb pain. Up to seven in 10 people who have a leg or arm amputated will have phantom limb pain at some time (pain in the area of the amputated arm or leg). This feeling usually disappears gradually over a few months but it can last a year or more. Massage, elevating your existing limb, rest and distraction can all help to reduce phantom limb pain. Your doctor may also prescribe you painkillers or mild antidepressants to relieve the pain. Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.
    • Feelings of anger, frustration or shock. It can be difficult to deal with the change in the way you look. Support groups and talking to your family, friends and health professionals may help overcome these feelings.

    Will I still need to see my doctor after my treatment for bone cancer finishes?

    Answer

    You will need to visit your doctor regularly after your treatment finishes to check for any signs that the cancer has come back or spread, and to see how well you’re recovering. It's important to go to your appointments to make sure you have the best chance of getting early treatment and making a good recovery if the cancer returns.

    Explanation

    After you have finished your treatment, you will have follow-up appointments with your doctor. How often these will be depends on your individual circumstances. For the first two years after your treatment finishes, you will probably see your doctor every three months. If everything goes well, these appointments will then be less frequent – every six months and then once a year. The gaps between your appointments get longer as time goes on because the chance of the cancer coming back gets less as time passes. If you notice any new symptoms or you’re worried that the cancer has come back in between these appointments, arrange to see your doctor straight away.

    You will have regular follow-up appointments with your doctor for several reasons.

    • To spot any early signs that the cancer has come back – this means you can have any further treatment quickly so you have the best chance of a good recovery.
    • To check for any long-term complications of your treatment and see how you’re progressing.
    • To give you an opportunity to ask questions or talk about your worries.

    At every appointment, your doctor will examine you. He or she may also ask you to have blood tests and X-rays, including chest X-rays. This is because some types of cancer can tend to spread to the lungs. If the cancer does spread to your lungs, it can be successfully treated if it's spotted early.

    For many people with bone cancer, treatment is successful. Overall, more than 40 out of every 100 men and over half of women will live for more than five years after they are diagnosed and treated for bone cancer. The prognosis is related to a number of factors which your doctor will speak to you about. However, for some people, the cancer does come back or spread to other areas, which is why follow-up appointments are so important.

  • Resources Resources

    Further information


    Sources

    • Bone cancer. CancerHelp UK (Cancer Research UK). http://cancerhelp.cancerresearchuk.org, published 6 October 2011
    • Bone sarcoma – suspected. Map of Medicine. www.mapofmedicine.com, published 21 July 2011
    • Primary bone cancer. Macmillan Cancer Support. www.macmillan.org.uk, accessed May 2012
    • Bone cancer overview. American Cancer Society. www.cancer.org, accessed May 2012
    • Bone sarcoma – investigations. Map of Medicine. www.mapofmedicine.com, published 21 July 2011
    • Suspected cancer in primary care: guidelines for investigation, referral and reducing ethnic disparities. New Zealand Guidelines Group. www.nzgg.org.nz, published June 2009
    • Osteosarcoma treatment. Map of Medicine. www.mapofmedicine.com, published 21 July 2011
    • Mifamurtide for the treatment of osteosarcoma. National Institute for Health and Clinical Excellence (NICE), 2011. www.nice.org.uk
    • Joint Formulary Committee. British National Formulary. 64th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain; 2012
    • Types and causes of cancer pain. CancerHelp UK (Cancer Research UK). http://cancerhelp.cancerresearchuk.org, published 25 November 2011
    • Statistics and outlook for bone cancer. CancerHelp (Cancer Research UK). http://cancerhelp.cancerresearchuk.org, published 9 September 2011
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    Produced by Stephanie Hughes, Bupa Health Information Team, July 2012.

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