Bone cancer is a rare form of cancer that is more commonly diagnosed in children and young adults. Types of bone cancer include osteosarcoma, chondrosarcoma and Ewing’s sarcoma. Fast and accurate diagnosis is crucial for successful treatment involving surgery, chemotherapy and radiation therapy. Risk factors, such as one’s genetics, and radiation exposure, can increase the likelihood of developing bone cancer.In this article, we explore the types of bone cancer, stages, causes, symptoms, treatment options, and address frequently asked questions surrounding the condition.
Types of bone cancer
Bone tumours can be classified as either benign or malignant. Benign tumours do not pose a life-threatening risk and do not spread to other parts of the body.1 In contrast, malignant tumours have the ability to metastasise and spread cancer cells throughout the body.1 Common types of cancer that frequently metastasise to the bone include breast, lung, thyroid, renal, and prostate cancer.2 Regardless of whether a tumour is benign or malignant, its growth can lead to the destruction of surrounding healthy tissue and increase the risk of bone fractures.2
The most commonly diagnosed primary bone cancer is osteosarcoma, accounting for 35.1% of cases.1 It is followed by chondrosarcoma at 25.8%, Ewing's sarcoma at 16.0%, chordoma at 8.4%, and malignant fibrous histiocytoma (including fibrosarcoma) at 5.6%.3 The treatment and prognosis for bone cancer depend on the specific type diagnosed.4
Osteosarcoma, being the most common type, is frequently found in the long bones of the arms and legs, primarily affecting children and adolescents.1,3 Osteosarcoma commonly emerges around the age of 12 for girls and 16 for boys, often developing around the knee in the femur or tibia.1,5
Ewing's sarcoma typically affects patients between the ages of 5 and 20, commonly involving the upper and lower legs, pelvis, upper arms, and ribs.4,5
Chondrosarcoma, a malignant tumour of cartilage-producing cells, is most frequently observed in individuals aged 40 to 70, commonly affecting the hip, pelvis, or shoulder area. In the population over the age of 50, chondrosarcoma is the most frequently diagnosed bone tumour.3 Surgery is typically the primary treatment for chondrosarcoma.4,5
In summary, bone cancer encompasses various types, with osteosarcoma being the most common and predominantly affecting children and young adults.3
Stages of bone cancer
The staging of bone cancer is crucial for determining its extent and spread. The stages range from localised cancer (stage I) to cancer that has spread to distant sites (stage IV). Evaluations include imaging tests, biopsies, and assessing tumour size, location, and involvement of nearby tissues or lymph nodes. The presence of metastasis significantly impacts the prognosis of osteosarcoma and Ewing’s sarcoma, leading to lower survival rates.1 Staging and grading play a critical role in understanding the progression and prognosis of bone cancer.4
In the UK, the commonly used staging system consists of three primary stages.4 Stage 1 indicates low-grade cancer confined to the bone, stage 2 represents high-grade cancer localised within the bone, and stage 3 signifies cancer that has spread to other parts of the body, such as the lungs.4 Most stage 1 bone cancers and some stage 2 bone cancers have a favourable prognosis and a good chance of being cured.4 However, stage 3 bone cancer presents greater challenges for treatment and cure, although various treatment options are available.4
Causes of bone cancer
Bone cancer is influenced by various factors. The global incidence of cancer has been increasing, with projections estimating a rise from 12.7 million cases and 7.6 million deaths in 2008, to a predicted 22.2 million cases and 13.2 million deaths by 2030.6 Incidence rates of cancer are relatively stable or slightly declining in developed nations, but they are increasing in developing countries due to factors such as smoking and obesity.6
The exact causes of bone cancer remain unclear, but certain risk factors have been identified. These include genetic predisposition, previous radiation therapy, and specific inherited conditions like Li-Fraumeni syndrome and hereditary retinoblastoma.1 It is important to note that most cases of bone cancer occur sporadically without a known cause.1
Osteosarcoma is commonly associated with genetic syndromes and radiation exposure, while Ewing’s sarcoma and chondrosarcoma have fewer identified risk factors and are not linked to familial cancer syndromes or radiation exposure.1
Signs and symptoms of bone cancer
Bone cancer can manifest with various symptoms depending on its location and stage. Common signs include persistent bone pain, swelling or a lump in the affected area, fractures without significant trauma, fatigue, unexplained weight loss, and, in some cases, neurological symptoms.1 These symptoms may resemble musculoskeletal injuries and often occur after minor trauma.1 Other typical signs include soft tissue swelling, unexplained fevers, and recurrent fevers in the case of Ewing’s sarcoma.1
Bone cancer primarily affects the long bones of the legs or upper arms with key symptoms including persistent worsening bone pain, swelling, redness, and inflammation around the affected bone, and increased vulnerability to fractures.4 Difficulty in mobility, such as walking with a limp, may also be observed.4
Management and treatment for bone cancer
Bone cancer is managed through a series of diagnostic tests, including imaging and biopsies.1 Prompt referral to a specialised cancer centre and skilled surgeons are crucial for accurate biopsies and limb preservation.1 Treatment involves tailored approaches such as adjuvant chemotherapy, surgical excision and radiation therapy if necessary.1 The combined use of chemotherapy and surgery has improved survival rates and reduced the need for limb amputation.1
Treatment for bone cancer is personalised based on the type, stage, and overall health of the individual.4 Specialised multidisciplinary teams in cancer centres manage the treatment, which may include surgery to remove the affected bone section, limb-sparing surgery with reconstruction, chemotherapy, radiotherapy, and sometimes mifamurtide for osteosarcoma.4 Rehabilitation after surgery and regular follow-up appointments are important for monitoring and detecting potential recurrence.4
Pain management in bone cancer can be challenging. Current options include chemotherapy, radiation, surgery, and strong pain medications.7 External beam radiation provides initial pain relief for most patients, but pain may return in a significant number of cases.7 Bisphosphonates and surgical stabilisation techniques help reduce bone loss and manage pain.7 Medications like anti-inflammatories and opioids are used when other treatments are ineffective, although high doses may be required, and breakthrough pain episodes can still occur.7
Psychosocial adaptation is generally positive for bone cancer patients, with most experiencing minor issues but adapting well to new circumstances.8 Some differences may be observed in areas such as marital status, independent living, and parenthood compared to control subjects.8 Overall, bone cancer survivors can lead active, independent lives without significant long-term emotional or social problems, although study limitations should be considered.8
Diagnosis of bone cancer
The diagnosis of bone cancer involves a series of tests and procedures to accurately identify the disease.1,4,5,8,9 These tests may include imaging techniques like X-rays, CT scans, MRI scans, and bone scans, with plain radiography being the preferred method for diagnosing bone tumours and determining their spread.1,4,5,9 Imaging plays a vital role in diagnosing and managing bone tumours, allowing for the classification of lesions as aggressive or non-aggressive.9
Biopsy, either through a core needle or open procedure, is performed to examine a tissue sample under a microscope and confirm the presence of cancer cells.1,4,5 Timely diagnosis can be challenging due to bone cancer’s late presentation, non-specific symptoms, and low suspicion by physicians.1 Specialised centres with expertise in bone cancer diagnosis are often recommended due to its rarity.4 Overall, a comprehensive medical history, physical examination, imaging tests, and biopsy are essential for the accurate diagnosis of bone tumours.2
The exact cause of bone cancer is largely unknown, however, several risk factors have been identified.4 Individuals who have undergone radiation therapy in the past have a higher risk, as well as those with Paget's disease of the bone, although the risk for most people with this condition is low.4 Additionally, a rare genetic disorder called Li-Fraumeni syndrome, characterised by a mutated tumour-suppressor gene, is associated with an increased risk of bone cancer.4
Can bone cancer be prevented?
While the exact prevention methods for bone cancer are unknown, maintaining a healthy lifestyle, avoiding radiation exposure, and managing genetic conditions can help reduce the risk. Prompt evaluation of persistent bone pain, immediate referral to a cancer centre, and biopsies by experienced surgeons are recommended.1
How common is bone cancer?
Bone cancer is considered a rare form of cancer, accounting for less than 1% of all cancers.10 It primarily affects the bones and is known as primary bone cancer or bone sarcoma.1 In the UK, approximately 600 cases of bone cancer are diagnosed each year.10 It can occur in people of any age, although it is slightly more prevalent in men than women.
When should I see a doctor?
If you experience persistent bone pain, unexplained swelling or lumps, fractures without significant trauma, or any other concerning symptoms, it is important to consult a healthcare professional for a proper evaluation and diagnosis.
Bone cancer is a relatively rare type of cancer that affects the cells of the bones, with osteosarcoma being the most common form. Diagnosing bone cancer involves imaging tests and a biopsy to confirm the presence of cancer cells. Treatment options for bone cancer include surgery, chemotherapy, radiation therapy, and targeted therapy, depending on the specific type and stage of the cancer. While there are no established prevention methods, it is important to understand the risk factors associated with bone cancer and recognise early symptoms to facilitate timely diagnosis and treatment. By raising awareness and promoting early detection, we can improve outcomes for individuals affected by this disease.
- Ferguson JL, Turner SP. Bone Cancer: Diagnosis and Treatment Principles. American Family Physician [Internet]. 2018 Aug 15;98(4):205–13. Available from: https://www.aafp.org/pubs/afp/issues/2018/0815/p205.html
- Bone Tumor - Types and Treatments - OrthoInfo - AAOS [Internet]. Aaos.org. 2015. Available from: https://orthoinfo.aaos.org/en/diseases--conditions/bone-tumor/
- Dorfman HD, Czerniak B. Bone cancers. Cancer. 1995 Jan 1;75(S1):203–10. Available from: https://pubmed.ncbi.nlm.nih.gov/8000997/
- NHS Choices. Overview - Bone cancer [Internet]. NHS. 2019. Available from: https://www.nhs.uk/conditions/bone-cancer/
- Felder-Puig R, Formann AK, Mildner A, Bretschneider W, Bucher B, Windhager R, et al. Quality of life and psychosocial adjustment of young patients after treatment of bone cancer. Cancer. 1998 Jul 1;83(1):69–75. Available from: https://pubmed.ncbi.nlm.nih.gov/9655295/
- Mantyh P. Bone cancer pain: Causes, consequences, and therapeutic opportunities. Pain. 2013 Dec;154:S54–62. Available from: https://pubmed.ncbi.nlm.nih.gov/23916671/
- Clohisy DR, Mantyh PW. Bone cancer pain. Cancer. 2003 Jan 23;97(S3):866–73. Available from: https://pubmed.ncbi.nlm.nih.gov/14600620/
- Goyal S, Roscoe J, Ryder WDJ, Gattamaneni HR, Eden TOB. Symptom interval in young people with bone cancer. European Journal of Cancer [Internet]. 2004 Oct 1 [cited 2023 Jul 11];40(15):2280–6. Available from: https://www.sciencedirect.com/science/article/abs/pii/S0959804904004459
- Costelloe CM, Madewell JE. Radiography in the Initial Diagnosis of Primary Bone Tumors. American Journal of Roentgenology. 2013 Jan;200(1):3–7. Available from: https://pubmed.ncbi.nlm.nih.gov/23255735/
- Bone cancer - Macmillan Cancer Support [Internet]. www.macmillan.org.uk. Available from: https://www.macmillan.org.uk/cancer-information-and-support/bone-cancer