Bone Cancer Symptoms and Signs

Understanding the difference between primary and metastatic cancers

Senior man rubbing Elbow in pain
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Bone cancer is a malignant condition that can affect both children and adults. The term "bone cancer" encompasses several different types of the disease, meaning that bone cancer symptoms can vary. As a whole, bone cancer is categorized based on whether the cancer originated in the bone (primary bone cancer) or whether it spread from another location to the bone (secondary or metastatic bone cancer). Secondary bone cancer, or cancer that has spread to the bone from another part of the body, is much more common than primary bone cancer.

Bone Cancer—Primary and Metastatic

Primary bone cancer is fairly uncommon, but the three most common types include:

Metastatic bone cancer (secondary bone cancer) is much more common than primary bone cancer, as noted above. When there's cancer in your bone from the spread (metastases) of cancer from other regions of the body, it's not called bone cancer. For example, if you have breast cancer that spreads to your bones, it wouldn't be called bone cancer, but rather, "breast cancer metastatic to bones." Many different cancers can spread to the bones. After the lungs and the liver, the bones are the most common area for cancers to spread.

Common Causes of Metastatic Bone Cancer

The cancers most likely to spread to your bones include:

Primary Bone Cancer Signs and Symptoms

Bone cancer symptoms may vary based on the type of bone cancer, but pain is the most commonly experienced symptom. Primary bone cancer most often occurs in the long bones of the body (arms and legs), so these are the most common sites for pain. Keep in mind that not all bone tumors are cancerous; some are benign. Bone pain is more often related to a benign condition, like an injury, than it is to cancer. Other symptoms of bone cancer include:

  • Joint tenderness or inflammation
  • Fractures due to bone weakness. Fractures that occur in a bone that has been weakened by cancer are termed pathologic fractures.

Non-specific symptoms like fever, unintentional weight loss, fatigue, and anemia can also be symptoms of later stage bone cancer, though they're also indicators of other less severe conditions.

Metastatic (Secondary) Bone Cancer Signs and Symptoms

The symptoms of metastatic bone cancer are similar to those of primary bone cancer, namely pain. Yet whereas with primary bone cancer the pain is usually localized to one of the long bones of the body, metastatic cancer to the bones often involves cancer that has spread to multiple bones. The particular bones involved depend on the cancer that has spread. For example, lung cancer often spreads to the spine and ribs. Breast cancer most commonly spreads to the spine and pelvis, the ribs, the skull, and the upper arm and leg bones. Prostate cancer often spreads to the spine and can cause spinal cord compression.

When cancer spreads to your bones, in addition to pain, you may also have an elevated calcium level in your blood due to the breakdown of bone. These symptoms, referred to as hypercalcemia of malignancy, may include muscle weakness, nausea and vomiting, irregular heart rate, and nausea.

What to Do If You Have Bone Cancer Symptoms

If you're experiencing bone pain or think you may have bone cancer, it's important to see your doctor. Express your concern over bone cancer early so the doctor can address these thoughts right away. Keep in mind that bone cancer is not common, so your symptoms are far more likely to be related to a much less serious condition. Your doctor will most likely want to rule out other conditions before attempting to diagnose bone cancer.

If you have cancer already and have bone symptoms, let your doctor know right away as well. Not only are there treatments available to ease the pain associated with bone metastases, but treating these early may help to avoid complications such as pathologic fractures and spinal cord compression. Note that spinal cord compression with bone metastases is a medical emergency. If you have symptoms in your lower back that are worsening, especially if you notice any weakness in your legs or troubles with passing urine or bowel movements, let your doctor know immediately.

Symptoms That May Prompt a Doctor to Investigate Further

Chronic symptoms like bone pain, tenderness, inflammation, or loss of range of motion that does not return may prompt your doctor to seek additional tests to investigate the cause of the symptoms. In the bone cancer diagnostic process, x-rays, MRI, and bone scans are all possible imaging tests that a doctor may order. The findings from these tests are what will make a doctor suspect bone cancer.

Sometimes a bone biopsy will be needed to rule out or confirm the presence of cancer. A bone 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 or surgical procedure.

Doing a biopsy on someone with primary bone cancer can be complex because there's a risk of spreading the cancer during the procedure. The biopsy should be done by a surgeon who has experience performing bone biopsies on those with suspected bone cancer. It's important to note that biopsies can be a common way to worsen these cancers and potentially spread them into other tissues when performed by someone who is inexperienced.

Consider a Second Opinion

If you think you may have bone cancer, consider getting a second opinion. Many people request a second opinion at one of the large national cancer institute-designated cancer centers. These centers often have physicians on staff who specialize in uncommon cancers. Make sure to be your own advocate in your cancer care. This has been found to not only improve your quality of life but may improve your outcomes as well.

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