Bone cancer is a rare disease in which cancerous cells develop in the bone tissue.
Bone cancer occurs when cells in the bone grow uncontrollably, forming a tumor. It can start directly in the bone (primary bone cancer) or spread to the bone from another part of the body (secondary or metastatic bone cancer). Different types of bone cancer exist, and each one affects the body in varying ways, so treatment approaches differ based on your specific needs and cancer type. AHN Bone Cancer specialists are highly trained, compassionate health care providers who see you and your unique needs — especially with this rarer diagnosis.
Bone cancer is relatively uncommon in the U.S., accounting for less than 1% of all cancers. It’s more frequently diagnosed in children and young adults, though some types are more common in older adults. Certain genetic conditions and prior radiation exposure can increase the risk of developing bone cancer.
Some forms of bone cancer grow quickly and can spread to other parts of your body. Other times, the tumor is not cancerous and grows slowly. Any tumor can destroy healthy tissue, weakening your bones and increasing your risk for fracture (broken bone). Common forms of bone cancer include:
- Chondrosarcoma
- Ewing sarcoma
- Multiple myeloma
- Osteosarcoma
AHN Sarcoma Center of Excellence
The AHN Sarcoma Center of Excellence is made up of a team of multiple health care experts walking you through every step of your cancer diagnosis and treatment. The AHN Orthopaedic Institute is home to one of the few orthopaedic surgeons in the country dedicated to treating bone cancer, Dr. Lisa B. Ercolano, MD. Our expert completed specialized training (fellowship) in treatments for cancers affecting the bones, joints, and soft tissue.
Diagnosis and treatment will usually begin with an appointment with our orthopaedic oncology team. The team works closely with providers amongst different medical specialties including:
- Surgeons
- Medical oncology
- Radiation oncology
- Pathology
- Physical therapy
- Occupational therapy
- Plastic surgery
- Nurse Navigators
Our goal at AHN is to deliver coordinated care that uses the latest in treatment options, while minimizing any unnecessary discomfort. AHN manages appointment scheduling, imaging planning, and other aspects of your care so you can focus on healing and recovery.
Bone cancer symptoms and signs
Bone cancer signs and symptoms are varied. Some people experience noticeable symptoms, while others have no symptoms at all. Some common signs and symptoms those with bone cancer may experience include:
- Bone pain: This is the most common symptom, often starting as a dull ache that worsens over time, especially at night.
- Swelling: You might notice swelling around the affected bone, which can make the area look larger or feel tender.
- Fractures: Bone cancer weakens the bone, making it more susceptible to fractures, even from minor injuries.
- Reduced range of motion: Pain and swelling around a joint can limit its movement and flexibility.
- Fatigue and weakness: You might feel unusually tired and lack energy.
- Unexplained weight loss: This is a general symptom associated with various cancers, including bone cancer.
- Other symptoms: Depending on the tumor's location and size, you might experience additional symptoms like numbness, tingling, or weakness in a limb if the tumor compresses nerves or blood vessels.
It's important to remember that experiencing these symptoms doesn't necessarily mean you have bone cancer, as they can also indicate other medical conditions.
Causes and risk factors
The exact causes of bone cancer are largely unknown. There are some potential risk factors that have been associated with developing bone cancer. Those include:
- Genetic conditions: Certain inherited genetic syndromes — such as Li-Fraumeni syndrome, hereditary retinoblastoma, and Rothmund-Thomson syndrome — increase the risk.
- Prior radiation therapy: Having received radiation therapy for a previous cancer significantly raises the risk of developing bone cancer later in life, particularly osteosarcoma.
- Paget's disease of bone: This noncancerous bone condition, which causes abnormal bone turnover, can sometimes lead to osteosarcoma, especially in older adults.
- Certain bone conditions: Some noncancerous bone conditions like enchondromas (a type of cartilage tumor) may slightly increase the risk of developing chondrosarcoma.
- Age: While bone cancer can occur at any age, certain types are more common in specific age groups. For example, osteosarcoma is more prevalent in children and young adults, while chondrosarcoma is more often diagnosed in older adults.
- Family history: Having a family history of bone cancer or related genetic syndromes may increase the risk, although many bone cancers occur in people with no family history.
Bone cancer screening and diagnosis
There isn’t a routine screening test for bone cancer in the general population. It's usually diagnosed when someone experiences symptoms or if an abnormality is detected during tests for other medical issues. Here's what usually happens:
Physical exam
It’s essential to remember that early detection plays a vital role in improving treatment outcomes. If you experience persistent bone pain, especially if accompanied by other symptoms like swelling or unexplained weight loss, don't hesitate to seek prompt medical attention. A physician will review your medical history and physical examination, paying close attention to the area of concern, looking for tenderness, swelling, limited range of motion, or other abnormalities.
Imaging
To get a full picture of the bone cancer and determine an appropriate treatment option, your AHN bone cancer specialist will most often order imaging. This allows your AHN Care Team to get an in-depth look at the bone cancer. Imaging tests may include:
- X-ray: This is usually the first step to visualize the bone structure and look for any irregularities.
- CT scan: A CT scan provides more detailed images of the bones and surrounding tissues, helping to determine the tumor's size and location.
- MRI scan: An MRI is very sensitive in detecting bone tumors and can also assess their involvement with nearby tissues and organs.
- Bone scan: This imaging test uses a small amount of radioactive material to identify areas of increased bone activity, which could indicate a tumor or other bone conditions.
Biopsy
This is the definitive way to diagnose bone cancer. It involves taking a small sample of the suspicious tissue and examining it under a microscope to confirm the presence of cancer cells, determine the tumor type, and assess its aggressiveness (grade). There are two main types of biopsies:
- Needle biopsy: A thin needle is inserted into the tumor to extract a tissue sample.
- Surgical biopsy: This involves a minor surgical procedure to remove a larger tissue sample or even the entire tumor.
Additional testing
Once a diagnosis of bone cancer is made, further tests help determine the stage of the cancer:
- Blood tests: Though not diagnostic for bone cancer itself, they provide information about your overall health and organ function. Some blood tests might look for specific tumor markers associated with bone cancers.
- Other imaging: Additional imaging tests, such as PET scans, can help determine if the cancer has spread to other parts of the body.
Types and stages of bone cancer
Bone cancers are broadly categorized into two main groups. They can be secondary bone cancers that have spread (metastasized) to the bone from another part of the body. Common cancers that spread to bone include:
- Breast cancer
- Lung cancer
- Prostate cancer
- Multiple myeloma (a cancer of the plasma cells in bone marrow)
Primary bone cancers are a diverse group of malignant tumors that originate within the bone itself.
Osteosarcoma
This is the most common type of primary bone cancer but it is still considered a rare disease. Osteosarcoma is most often found in the long bones of the arms and legs, particularly around the knee, but it can occur in any bone. This type of cancer is most common in children and adolescents, with a second peak incidence in older adults. Treatment typically involves a combination of chemotherapy and surgery, and the prognosis varies depending on factors such as the stage of the cancer at diagnosis and the patient's overall health.
Chondrosarcoma
Chondrosarcoma is a relatively rare type of bone cancer that develops in cartilage cells. Common symptoms include pain (often worsening over time), a palpable mass, and sometimes limited joint movement. It most often affects the pelvis, femur (thigh bone), humerus (upper arm bone), and ribs.
Treatment typically involves surgical removal of the tumor, and radiation or chemotherapy may be used in certain situations or for more aggressive types. The specific approach depends on the tumor’s grade, size, and location.
Ewing sarcoma
Ewing sarcoma is a rare type of cancer that primarily occurs in bone or soft tissue surrounding bone, most often affecting children and young adults. Common symptoms include bone pain (often worse at night), swelling, fever, and sometimes a palpable mass or fracture. It frequently arises in the bones of the legs, pelvis, arms, or chest wall.
Treatment for Ewing sarcoma typically involves a combination of chemotherapy, surgery (to remove the tumor when possible), and radiation therapy. This multimodal approach aims to eradicate the cancer cells and prevent recurrence.
Chordoma
Chordoma is a rare type of bone cancer that arises from remnants of the notochord, a structure present during embryonic development. Common symptoms depend on the tumor’s location but can include pain, numbness, weakness, bowel or bladder dysfunction, and vision problems. It most often occurs in the skull base and spine, particularly the sacrum (base of the spine).
The primary treatment for chordoma is surgical resection to remove as much of the tumor as possible, followed by radiation therapy to target any remaining cancer cells. Proton beam therapy is often preferred for radiation due to its precision in targeting the tumor while minimizing damage to surrounding tissues.
Giant cell tumor of bone
Giant cell tumor of bone (GCTB) is a relatively rare, typically benign (noncancerous) bone tumor, although it can sometimes behave aggressively or recur. Common symptoms include pain, swelling, and limited range of motion in the affected joint, and it often occurs near the ends of long bones, especially around the knee. GCTB most frequently affects young adults between the ages of 20 and 40.
The primary treatment for GCTB is surgery to remove the tumor, often with curettage (scraping out the tumor) and bone grafting or bone cement to fill the cavity. In some cases, medication like denosumab may be used to shrink the tumor before surgery or to treat recurrent or unresectable tumors.
Malignant fibrous histiocytoma of bone
Malignant Fibrous Histiocytoma (MFH) of Bone, which is also known as Undifferentiated Pleomorphic Sarcoma (UPS) of Bone, is a rare and aggressive type of bone cancer that arises from connective tissue cells within the bone. Common symptoms include pain, swelling, and sometimes a palpable mass or fracture, and it typically affects the long bones of the extremities, such as the femur (thigh bone) and tibia (shin bone). It's more common in older adults.
Treatment for UPS of bone usually involves a combination of surgery to remove the tumor, chemotherapy to kill cancer cells throughout the body, and sometimes radiation therapy to target any remaining cancer cells in the affected area. The specific approach depends on the tumor's size, location, and stage.
Bone cancer treatment
Bone cancer treatment at AHN uses the latest technological and surgical advancements to help our patients experience improved health outcomes. This, combined with our patient-focused, compassionate care creates a holistic and tailored experience that aims to deliver focused, effective treatment.
Surgery
We deliver a broad range of surgical treatments for bone cancer, including:
- Curettage: We remove the tumor without removing large sections of bone tissue. To prevent cancer from coming back, we apply certain substances, including cold gas (cryotherapy) or bone cement, to kill any remaining cancer cells.
- Limb-sparing surgery: This treatment gets rid of larger tumors while preserving function in your arm or leg. We remove sections of cancerous bone and a small amount of nearby healthy tissue.
- Limb reconstruction: Reconstructive surgery maximizes your ability to use the limb after you recover. We may transplant a section of bone from another area of the body. If we need to remove the lower part of your arm or leg, we may change the positioning of your elbow or knee to help you use an artificial limb (prosthesis).
- Amputation: We make every effort to avoid amputation, a procedure to surgically remove a limb. Amputation is sometimes necessary if the cancer is near nerves or blood vessels, and we are not able to preserve limb function. If we determine together that amputation is the most effective treatment option for you, our expert team will be with you every step of the way. We help you retain as much healthy leg or arm tissue as possible so you can live a good quality of life.
Radiation therapy
Radiation oncologists use high-energy rays to destroy cancer cells. They can do this using:
- Neoadjuvant (before surgery) radiation therapy
- Adjuvant (after surgery) radiation therapy
- Radiation to treat pain or prevent fractures
Chemotherapy
Chemotherapy for bone cancer is used in several ways, depending on the type of bone cancer, its stage, and the patient's overall health. It's rarely used alone as the primary treatment for most bone cancers, but rather as an adjunct to other treatments like surgery or radiation. Types of chemotherapy for bone cancer include:
- Neoadjuvant chemotherapy: This means chemotherapy is given before surgery or radiation. Its purpose is to shrink the tumor, making surgery easier and potentially less invasive. It can also help kill any microscopic cancer cells that might have spread beyond the main tumor.
- Adjuvant chemotherapy: This is chemotherapy given after surgery or radiation. The goal is to eliminate any remaining cancer cells that might not have been removed or destroyed by the initial treatment, thereby reducing the risk of recurrence.
- Palliative chemotherapy: If the cancer has spread widely (metastasized) and is incurable, chemotherapy might be used to relieve symptoms, slow the progression of the disease, and improve the patient's quality of life. This focuses on managing pain and other effects of the cancer, rather than a cure.
- Systemic chemotherapy: Most chemotherapy drugs used for bone cancer are systemic, meaning they travel throughout the bloodstream to reach cancer cells all over the body. This is important because bone cancer can sometimes spread to other parts of the body.
Bone cancer FAQs
Given the rarity of bone cancer, it’s quite common to have questions. Your AHN Care Team is here to discuss any questions or concerns you may have, but in the meantime, here are some answers to frequently asked questions to help you better understand bone cancer.
What are the early warning signs of bone cancer?
While not every person who develops bone cancer will experience these early warning signs, some common symptoms include persistent bone pain, swelling, and limited range of motion in the affected area. Fatigue and unexplained weight loss may also occur. It is also important to remember that a person could experience some of these sensations and not develop bone cancer. Regular preventive exams and open conversations with your doctor are important to help spot any health issue or concern early.
Where does bone cancer usually start?
Bone cancer primarily starts in the long bones found in the arms and legs. Bone cancer can occur in any bone as they contain many different types of cells.
What is the life expectancy of a person with bone cancer?
Life expectancy varies greatly depending on the type and stage of bone cancer, as well as the person’s overall health and how the cancer responds to treatment. The five-year survival rate is around 70%.
How long can you have bone cancer without knowing?
This is varies from person to person and the type of bone cancer that is occurring in the body. Some bone cancers grow slowly, so you could have it for months or even years before symptoms become noticeable.
What does cancerous bone pain feel like?
Cancerous bone pain is often described as a deep, aching pain that may be constant or intermittent and can worsen at night or with activity. If you notice this sensation, talk with your doctor so they can determine what testing might be necessary.
Contact us
To make an appointment you can:
- Call (412) DOCTORS (412) 362-8677
- Schedule online
- Use MyChart and schedule with Dr. Lisa Ercolano to make an appointment
Please bring all relevant imaging on CD or through PowerShare with correlating reports for review by our team to your first appointment.