Bone cancer

Cancer that starts in the bone is known as primary bone cancer. Primary bone cancer is very rare; about 500 people in the UK get it each year and is most common in teenagers and young adults. Primary bone cancer is usually treated with surgery, radiotherapy or chemotherapy.
 
How cancer develops
About bone cancer
Symptoms of bone cancer
Causes of bone cancer
Diagnosis of bone cancer
Treatment of bone cancer
Living with bone cancer

How cancer develops

The information on the video provided does not constitute advice on diagnosis or the treatment for heart disease and such advice should always be sought from a doctor or another suitably qualified health professional.

About bone cancer

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

Cancer is caused by an uncontrolled growth of cells. Primary bone cancer is cancer that starts in the bone. Secondary bone cancer is cancer that spreads to the bone from another organ. This factsheet is only about primary bone cancer.
 

Types of primary bone cancer

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

• Osteosarcoma – this is the most common type of bone cancer and it affects about 150 people each year in the UK. It is most frequent in teenagers and young adults, but it can occur at any age. It usually develops in the lower thighs, shins or upper arms.
• Ewing’s sarcoma – this affects about 100 people each year in the UK and is most common in teenagers. It usually develops in the pelvis, thighs or shins but it can also occur in the soft tissues of the body.
• Chondrosarcoma – this affects about 80 people each year in the UK and is most common in adults over 40. It starts in the cartilage cells in joints. It usually develops in the bones of the thighs, pelvis, ribs, upper arm or shoulder blades.
• Spindle cell sarcoma – there are four types: undifferentiated sarcoma of the bone, malignant fibrous histiocytoma, fibrosarcoma and leiomyosarcoma. They all behave like osteosarcoma but are more common in adults over 40. This type of cancer usually develops in the lower thighs, shins, knees or arms. 

Symptoms of bone cancer

Symptoms vary depending on where the bone cancer develops and how severe it is.

Bone cancer often causes pain and tenderness in the affected area. In children, this can be mistaken for growing pains, in adults it can be mistaken for arthritis. The pain is often worse at night. As the cancer grows it can also cause swelling in the affected area. If it is near a joint, it may make movement in the joint difficult.

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, visit your GP.
 

Causes of bone cancer

Doctors don’t fully understand why bone cancer develops. However, certain factors make bone cancer more likely.

• Age – bone cancer is most common in teenagers and young adults, when bones are growing.
• Radiotherapy – past treatment with radiotherapy increases the risk of having bone cancer in that area.
• Chemotherapy – this depends on the type and dose of anti-cancer drugs used.
• Paget’s disease – this disease affects the bones, making them brittle and causing pain and fractures. About one in 10 people with Paget’s disease develop bone cancer.
• Past benign bone tumour – if you have had a benign (non-spreading) type of bone tumour, you’re more likely to develop chondrosarcoma.
• Genetics – having a rare inherited condition, such as Li-Fraumeni syndrome,  retinoblastoma or Rothmund Thompson syndrome, makes you more likely to develop osteosarcoma.

Diagnosis of bone cancer

 
Your GP will ask about any symptoms and examine you. You may have the following tests to confirm diagnosis.
 

• Bone X-ray – this can be the simplest way of finding out which bones are affected.

• Scans – these may include ultrasound, MRI or CT scans. These are done to check the bones, muscles, organs and tissues in your body. MRI and CT scans can show how much of the bone is affected.
   
• Bone scans – this is more sensitive at checking for bone cancer than a simple X-ray.  A small amount of harmless radioactive dye is injected into a vein. This collects in areas of the bone that may have cancer, and is picked up by the scan.
   
• Biopsy – a sample of cells or tissue is removed from the bone and sent to a laboratory for diagnosis. The procedure is called a core needle biopsy and is done under local anaesthesia. Sometimes doctors do an operation called a surgical or open biopsy under general anaesthesia.

Treatment of bone cancer

Treatment depends on the type of bone cancer, 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

The type of surgery you have depends on how far the cancer has spread. Surgery is sometimes followed by chemotherapy or radiotherapy treatment to make sure all the cancer cells are destroyed.

• Limb-sparing surgery – this involves removing the area of bone or joint affected by the cancer and replacing it with either a metal prosthesis (an artificial replacement part) or a piece of healthy bone taken from another part of your body (a bone graft). Advances in technology mean that limb-sparing surgery is becoming more common.
• Amputation of affected limb – if the cancer has spread into surrounding tissues and blood vessels, amputating the limb may be the only way to get rid of the cancer.

Non-surgical treatments

• Chemotherapy – anti-cancer drugs are used to destroy cancer cells. They are usually injected into a vein but sometimes you may be given tablets. It’s effective for some types of osteosarcoma and Ewing’s sarcoma. Chemotherapy is often given before surgery to shrink the cancer to make it easier to remove.
• Radiotherapy – radiation is used to kill cancer cells. Radiotherapy is especially useful if the cancer is in a difficult area to operate on.

Living with bone cancer

After treatment for bone cancer, you will have regular check ups with your doctor to see if there is any evidence of the cancer returning. If the cancer has already spread, you will be seen regularly by doctors or specialist nurses for treatments to deal with any symptoms.

Being diagnosed with cancer can be distressing for you and your family. Specialist cancer doctors and nurses are experts in providing the care and support you need. There are support groups where you can meet people who may have similar experiences to you. Ask your doctor for advice.