Bone cancer is caused by an abnormal and uncontrolled growth of cells in your bone.
About bone cancer
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.
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:
- fever or night sweats
- weight loss
These symptoms aren't always caused by bone cancer but if you have them, see your GP.
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.
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 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 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 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.
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.
Produced by Stephanie Hughes, Bupa Health Information Team, July 2012.
For answers to frequently asked questions on this topic, see FAQs.
For sources and links to further information, see Resources.