Cancer that begins in the bone is called primary bone cancer. Primary bone cancer is relatively uncommon in comparison with secondary or metastatic cancer (cancer that occurs initially in another organ and then spreads to bone tissue).

Causes of Bone Cancer

It's not clear what causes most bone cancers. Doctors know bone cancer begins as an error in a cell's DNA. The error tells the cell to grow and divide in an uncontrolled way. These cells go on living, rather than dying at a set time. The accumulating mutated cells form a mass (tumor) that can invade nearby structures or spread to other areas of the body.

Types of bone cancer

Bone cancers are broken down into separate types based on the type of cell where the cancer began. Bone cancer types include:

• Osteosarcoma. Osteosarcoma begins in the bone cells. Osteosarcoma occurs most often in children and young adults.
• Chondrosarcoma. Chondrosarcoma begins in cartilage cells that are commonly found on the ends of bones. Chondrosarcoma most commonly affects older adults.
• Ewing's sarcoma. It's not clear where in bone Ewing's sarcoma begins. Scientists believe Ewing's sarcoma may begin in nerve tissue within the bone. Ewing's sarcoma occurs most often in children and young adults.

Signs & Symptoms of Bone Cancer

Signs and symptoms of bone cancer include:

• Bone pain
• Swelling and tenderness near the affected area
• Weakened bones, sometimes leading to fractures
• Fatigue
• Unintended weight loss

Diagnosis of Bone Cancer

• The presenting symptom is usually pain. Pathologic fracture may be present and is more common in the lower than the upper extremity.
• The presenting radiologic finding on X-ray is often destruction of bone. In a patient with a known primary malignant tumor presenting with a painful, destructive lesion of bone, a diagnosis of metastatic cancer can be made with some assurance. However, there are individuals in whom the primary cancer is not yet recognized at the time when the early metastatic lesion in bone becomes painful.
• A CAT scan, MRI, radionuclide bone scan or a skeletal survey may be done to pinpoint which bones have been affected.

Treatments of Bone Cancer

The treatment options for your bone cancer are based on the type of cancer you have, the stage of the cancer, your overall health and your preferences. Bone cancer treatment typically involves surgery, chemotherapy, radiation or a combination of treatments.

Surgery

The goal of surgery is to remove the entire bone cancer. To accomplish this, doctors remove the tumor and a small portion of healthy tissue that surrounds it. Types of surgery used to treat bone cancer include:

• Surgery to remove a limb. Bone cancers that are large or located in a complicated point on the bone may require surgery to remove all or part of a limb (amputation). As other treatments have been developed, this procedure is becoming less common. You'll likely be fitted with an artificial limb after surgery and will go through training to learn to do everyday tasks using your new limb.
• Surgery to remove the cancer, but spare the limb. If a bone cancer can be separated from nerves and other tissue, the surgeon may be able to remove the bone cancer and spare the limb. Since some of the bone is removed with the cancer, the surgeon replaces the lost bone with some bone from another area of your body or with a special metal prosthesis. Intense rehabilitative therapy may be necessary after limb-sparing surgery in order for the affected arm or leg to become fully functional.
• Surgery for cancer that doesn't affect the limbs. If bone cancer occurs in bones other than those of the arms and legs, surgeons may remove the bone and some surrounding tissue, such as in cancer that affects a rib, or may remove the cancer while preserving as much of the bone as possible, such as in cancer that affects the spine. Bone removed during surgery can be replaced with a piece of bone from another area of the body or with a special metal prosthesis.

Radiation therapy

Radiation therapy uses high-powered beams of energy, such as X-rays, to kill cancer cells. During radiation therapy, you lie on a table while a special machine moves around you and aims the energy beams at precise points on your body. Radiation therapy may be used to shrink a bone cancer to increase the likelihood that a surgeon can remove the entire cancer with surgery. In this situation, radiation therapy may be combined with chemotherapy. Radiation therapy may also be used in people with bone cancer that can't be removed with surgery. Radiation therapy may also be used after surgery to kill any cancer cells that may be left behind. For people with advanced bone cancer, radiation therapy may help control signs and symptoms, such as pain.

Chemotherapy

Chemotherapy is a drug treatment that uses chemicals to kill cancer cells. Chemotherapy is most often given through a vein (intravenously). The chemotherapy medications travel throughout your body. Chemotherapy is often used before surgery, usually in combination with radiation therapy, to shrink a bone cancer to a more manageable size that allows the surgeon to use a limb-sparing surgery. Chemotherapy may also be used in people with bone cancer that has spread beyond the bone to other areas of the body.

When to seek Medical Advice

Make an appointment with your doctor if you or your child develops signs and symptoms that worry you.