Signs and Symptoms of Bone Cancer

Whether primary or metastatic, cancer in the bones may present with symptoms such as increasing pain, swelling and/or a more sudden intense pain from a pathologic fracture—a fracture that occurs in a bone that has been weakened by the presence of tumor.

Symptoms of bone cancer can be a bit tricky to pin down at first because these types of symptoms are much more commonly caused by noncancerous conditions such as sports injuries or various problems with the joints, including forms of arthritis. Additionally, symptoms of bone cancer vary from person to person and may depend on the location and type of tumor.

bone cancer symptoms
© Verywell, 2018 

Frequent Symptoms

Pain

Overall, pain is the most common sign of the most common bone cancer, osteosarcoma. It most often occurs in the long bones of the body, like those of the arms and legs.

At first, the pain may not be constant. It is often attributed to a physical injury or vigorous physical exercise, both of which are common in the younger population that tends to be affected by osteosarcoma. Symptoms are usually present for several months before a diagnosis is made—about three months, on average.

Pain from bone cancer may be worse at night or when the bone is used. Sings of osteosarcoma are generally a result of the pain, as it begins to encroach on the normal activity level and state of wellbeing:

  • Limping
  • Trouble moving, lifting, or walking
  • Pain, tenderness, and swelling or an enlargement close to a joint
  • Warmth and redness in the affected area
  • A broken bone at the site of the tumor; bone may break with routine, normal movement
  • One may feel sudden, severe pain in a bone that had been sore for weeks or months

About half of all osteosarcomas start in the region around the knee. The most frequent starting point is near the end of the thighbone, or femur, followed by the upper leg bone, or tibia. The arm bone near the shoulder is the third most common location. Involvement of other parts of the skeleton, most commonly the hips, occurs in less than 10 percent of cases in the pediatric osteosarcoma.

Swelling

The painful area of bone may also develop swelling around it, although this may not occur until weeks after the onset of the bone pain. Some people with bone cancer are able to feel a lump or mass if the bone tumor is in a location that can be detected by touch.

With both pain and swelling, these are symptoms that can have a different pattern depending on the type of bone cancer. For instance, in the case of osteosarcoma, the shin, thigh, and upper arm are common tumor sites in children and adolescents. It is in these areas that pain and swelling occur with the disease. Some people may develop a limp if the tumor is in the leg or hipbone.

Pathological Fractures

These fractures wouldn't normally occur in healthy bones. When cancer develops within the bone the bone can be weakened. When a person develops a fracture next to or through a bone tumor, usually he or she describes sudden severe pain in a bone that had been sore for weeks or months.

Osteosarcoma is sometimes discovered when a bone that has been weakened by cancer breaks as a result of a minor fall or accident.

Systemic Symptoms

These symptoms are not directly linked to the bone. Though the cancer may be confined to bone, there can be symptoms that are more general to the whole body, known as systemic symptoms.

People with bone cancer can have weight loss and fatigue, for instance. If the cancer spreads to internal organs such as the lungs, it can cause symptoms at those sights, too—for example, trouble breathing.

Less Common Symptoms

As bone cancer advances, more of the systemic symptoms may arise—that is, some other symptoms may arise that are due to the cancer and its effects on whole-body processes, in addition to the local effects near the bone. These include:

  • Fatigue and sleepiness
  • Fever
  • Unintentional weight loss
  • Low red blood cell count (anemia)

These systemic symptoms occur rarely in the absence of very advanced disease.

Rare Symptoms

In Head and Neck Osteosarcomas

Osteosarcomas of the skull and facial bones are relatively rare and represent less than 10 percent of all osteosarcomas. The male-to-female ratio is close to one. The most commonly affected bones of the head and neck are the jawbone, followed by the upper mouth portion of the skull (maxilla). Osteosarcomas of the other skull bones are extremely rare.

Cancers that develop in the bones of the neck may cause relatively unique symptoms along with swelling. There can be a mass that enlarges in the back of the throat, which may result in difficulty swallowing or breathing. Cancer in the bones of the spine can enlarge to press on nerves, causing numbness and tingling or muscle weakness.

In Parosteal Osteosarcomas

A particular subset of osteosarcoma, parosteal osteosarcoma, has symptoms that differ from typical cases: minimal pain and tenderness over the cancerous site and, if it’s in its characteristic location, worsening limitation in the ability to flex and ultimately extend the knee joint.

The tumor may be present for a long time before it is diagnosed, becoming bigger before pain finally surfacing in the late phases.

Multifocal Sclerosing Osteosarcomas

Another rarity is something called multifocal sclerosing osteosarcoma, in which multiple tumors in the skeleton develop at the same time and are present at diagnosis. Each tumor looks like it’s the original site of disease on the scans, suggesting that the bone tumors developed independently, at the same time, at multiple sites.

Symptoms are similar to more typical osteosarcomas except that they may occur in very young children and are more widespread. It is not known for sure whether such bone cancer arises in multiple sites or if one of the tumors is the true start of the disease and has metastasized rapidly to other skeletal sites without metastasizing to the lungs. Again, this is an uncommon pattern.

Post-Irradiation Osteosarcoma

Post-irradiation osteosarcoma occurs in individuals cured of cancer by radiation therapy. It develops in less than five percent of cases.

Evidence suggests that osteosarcomas occur more frequently in patients who receive higher doses of radiation therapy. Symptoms typically include painful swelling in the area of the body that received the radiation therapy.

Complications

A variety of complications are possible with osteosarcoma and/or its treatment, including the following. The list may feel overwhelming. Remember that all of these complications are just possibilities, and one occurring does not mean that all of them will. In fact, none may occur, and if they do close monitoring and recommendations from your healthcare professional should help you manage and overcome them.

  • Infection
  • Bleeding from surgery
  • Problems after limb-salvage surgery
  • Problems due to chemotherapy:
    • Hair loss, mouth sores, nausea, vomiting, diarrhea, increased infections, easy bruising and bleeding, and feeling tired from chemotherapy
  • Problems due to radiation therapy:
    • Burns, hair loss, nausea, diarrhea, poor bone growth, organ damage, and new cancers from radiation
  • Emotional and physical challenges from amputation
  • Heart and lung problems
  • Problems with growth and development
  • Learning problems
  • Changes in sexual development
  • Problems with fertility
  • Return of the cancer
  • Growth of other cancers

The most frequent site of spread from the bone is the lung. Much less frequently, spread of the cancer is detected in other bones and soft tissues. 

When osteosarcoma has become more widespread, this is more frequently the consequence of recurrence rather than the state of affairs at initial diagnosis. Widespread osteosarcoma can come to involve the central nervous system or gastrointestinal tract.

Death from osteosarcoma is almost always the result of worsening spread to the lungs, with respiratory failure due to widespread disease. This can involve bleeding into the lungs, deflation of one or both lungs, and compression of the great vessels that are near the lungs. Close monitoring by your healthcare professional is necessary.

When to See Your Doctor

Many symptoms of bone cancer, such as pain and swelling, are caused much more commonly by less serious conditions such as traumatic injuries. In addition, leg and arm pain are common in growing boys and girls, and there is often no cause for concern. However, if the pain persists, intensifies, or if other symptoms are present, you should seek medical attention.

If you or a loved one has a cancer-predisposing condition such as retinoblastoma or Li-Fraumeni syndrome, you may want to be particularly vigilant for the signs and symptoms of malignancy.

If you have already been diagnosed with bone cancer, you should speak to your doctor if your symptoms are getting worse, you are having new symptoms, or you are having side effects from treatment.

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