An Overview of Bone Cancer

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Bone cancer is a type of malignancy that can affect both children and adults and develop in any bone in your body, though the long bones of the arms and legs are the most common. Cancer can also be spread from another location to the bone, known as secondary bone cancer, but this isn't considered actual bone cancer because it doesn't originate in the bones.

Bone cancer is rare, making up just 1 percent of all kinds of cancer, and noncancerous bone tumors occur far more often than cancerous ones. Surgery is often the go-to treatment, but radiation and/or chemotherapy may also be used.

Types

There are several types of primary bone cancer, meaning cancer originated in the bone, including:

  • Osteosarcoma starts in the bone cells and occurs most often in the arms, legs, and pelvis
  • Chondrosarcoma starts in cartilage and mainly affects the pelvis, legs, and arms
  • Ewing's sarcoma, seen commonly in the chest wall, pelvis, arms, and legs
  • Malignant fibrous histiocytoma, which starts in soft tissue, but can occur in bones, particularly the arms and legs
  • Fibrosarcoma chordoma, which also starts in soft tissue, but can start in the arms, legs, or jaw
  • Giant cell bone tumors are usually benign (not cancerous) but the malignant form can affect the legs, especially near the knees
  • Chordoma is usually seen in the spine and base of the skull

Osteosarcoma, chondrosarcoma, and Ewing's sarcoma are the most common types of bone cancer.

Secondary bone cancer is much more common than primary bone cancer, but it's not considered bone cancer since the cancer has spread from another location to the bone. As a rule, when secondary bone cancer is diagnosed, we refer to the cancer by the site of origin rather than the organ it has affected. For example, a bone cancer caused by a breast cancer that has spread (metastasized) would not be called bone cancer but rather "breast cancer metastatic to the bones."

Secondary bone cancer is considered serious and classified as stage 4 (metastatic) disease since it, by its very nature, involves multiple organs.

Symptoms

Symptoms of bone cancer vary from person to person, but the pain in the bone that's affected is by far the most common sign. Bone cancer most often occurs in the long bones of the body, like those in your arms and legs.

Other symptoms can include:

Causes

Although the exact causes of most bone cancers are unknown, we do know some of the risk factors associated with the disease.

Hereditary Conditions

A small number of bone cancers are caused by hereditary conditions that increase not only the risk of bone cancer but other types of cancers as well. These include:

  • Multiple exostoses, a genetic condition that causes bumps on the bones and increases the risk of developing chondrosarcoma.
  • Rothmund-Thomson syndrome, a genetic disorder characterized by skin rash, sparse hair, malformed bones, and an increased risk of developing cancer, especially osteosarcoma.
  • Retinoblastoma, an inherited form of cancer that affects your retina and can lead to the formation of cancer in soft tissue or bone.
  • Li-Fraumeni syndrome, a genetic disorder that predisposes you to certain types of cancer, including bone cancer.
  • Paget’s disease of the bone, a condition that affects older adults and gradually breaks down bone, can lead to bone cancer, usually osteosarcoma, in 1 percent of people with the disease.

Other Factors

There are other factors that increase your risk of developing bone cancer, including:

  • Previous radiation therapy, particularly if given during childhood. A typical X-ray is not considered dangerous, but higher doses (usually over 60 Gy) can also increase your risk. This typically happens in a child being treated for another form of cancer who receives a course of radiation therapy.
  • Being exposed to radioactive materials like radium and strontium can cause bone cancer because these materials build up in your bones.
  • Having bone marrow transplantation may make you more at risk of developing osteosarcoma.

Diagnosis

If your symptoms along with findings from a physical exam suggest the presence of bone cancer, your doctor will do some additional tests.

Imaging tests like X-rays, magnetic resonance imaging (MRI), and computerized tomography (CT scans), can help identify bone abnormalities not seen by the naked eye. Another specialized imaging tool called a bone scan enables doctors to see the metabolic activity of the bone. By doing so, they can detect new growth or where the bone matter may have broken down.

Ultimately, a bone biopsy will provide the definitive proof of bone cancer. The biopsy involves the removal of a small amount of bone tissue to be examined under a microscope. It usually takes less than an hour and can be done as an outpatient surgical procedure.

Performing a biopsy on someone with bone cancer can be tricky since there is a risk of spreading the cancer from the site of origin. It requires a skilled surgeon who is highly experienced in treating patients with bone cancer.

If cancer is detected, it is then graded and staged by a pathologist. Grading and staging classifications vary based on the type of bone cancer. Ideally, the pathologist examining the sample will be experienced in diagnosing bone cancer.

Treatment

The key to successful treatment is having a medical team that's experienced in primary bone cancer. Your team might include medical oncologists, radiation oncologists, radiologists, surgical oncologists, orthopedic oncologists, and specialized pathologists.

There are three standard forms of treatment for primary bone cancer: surgery, radiation therapy, and chemotherapy. Oftentimes, more than one form of treatment is needed.

  • Surgery: This is the most common treatment for bone cancer. Surgical treatment for non-metastasized bone cancer involves the removal of cancerous bone tissue and a small margin of healthy tissue surrounding it. Radiation or chemotherapy might be performed afterward to clear up any remaining cells.
  • Radiation therapy: High doses of radiation are used to either shrink tumors or eliminate cancer cells following a procedure. It can also be used for palliative purposes to reduce pain. Although radiation therapy can damage nearby healthy cells, those cells tend to be more resilient than cancerous ones and are usually able to recover fully.
  • Chemotherapy: These drugs work by killing rapidly multiplying cells, including both cancer cells and healthy cells that are fast replicating, like hair follicles, bone marrow, and cells lining the gastrointestinal tract. As such, chemotherapy can have considerable side effects.

Coping

Coping with bone cancer means learning to adjust to your diagnosis. Ask for help if you need it. Talk with a trusted friend or a counselor about how you're feeling. Make time for yourself to relax and unwind, and keep open communication with your medical team so you know what to expect from your treatments.

The American Cancer Society has a wide variety of resources to help you understand what's going on, and the National Cancer Institute has resources to help you with coping and survivorship.

A Word From Verywell

If you or a loved one has been diagnosed with bone cancer, it’s natural to feel overwhelmed and frightened. Reach out to family and friends. Talking to others who have been there, whether through social media or in support groups organized by your clinic or community center, can help enormously.

Take it one day at a time and try to learn as much about your disease as you can. By doing so, you can become an advocate for your own care. This will not only help you cope better, it can give you a stronger sense of control and self-determination in a process that can often be overwhelmed by specialists.

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