If cancer is found in the bones, it is usually because it has spread there from elsewhere in the body; such cancer is treated based on where it came from. When tumors do start in the bones, they’re usually benign.
While primary bone sarcomas are rare, they destroy healthy bone tissue and need prompt treatment. Fortunately, they are usually found in the earlier stages before they have spread. Bone sarcomas are categorized based on the type of cell or tissue they develop in, with some more common in children and teens (Ewing sarcoma and osteosarcoma) and some more common in adults (chondrosarcoma).
Cancers like leukemia and multiple myeloma can also develop in the bone marrow, with the latter potentially causing bone tumors to form.
Bone Cancer Types and Risk Factors
The main types of bone sarcomas are:
- Osteosarcoma is the most common bone sarcoma and usually starts in osteoblasts, the cells that grow into new bone tissue. While osteosarcoma can develop at any age (10 percent of patients are over 60), it usually affects younger patients, especially teens. It’s usually found in the ends of longer bones like the arms and legs, particularly near the knee. Other than age, risk factors include:
- Height: Children who are tall for their age seem to develop the disease more frequently.
- Gender: Osteosarcoma is more common in males.
- Radiation Exposure: Radiation therapy can put you at higher risk for osteosarcoma, with higher doses and a younger treatment age particular factors.
- Certain Bone Diseases: Non-cancerous diseases like Paget’s and osteochondroma tumors can increase your risk for osteosarcoma.
- Inherited Cancer Syndromes: While osteosarcoma typically does not run in families, risk is heightened by rare inherited syndromes that can cause cancer, including retinoblastoma (an eye cancer), Li-Fraumeni syndrome, Rothmund-Thomson syndrome, Bloom syndrome, Werner syndrome and Diamond-Blackfan anemia.
- Chondrosarcoma forms in cartilage tissue and is the most common adult bone sarcoma, tending to affect those over 40. It can appear in the hip joints, pelvis and shoulders—sometimes from a preexisting, benign (noncancerous) tumor in bone or cartilage.
- Ewing Sarcoma mainly forms in certain bone cells but can also develop in soft tissue cells. It is most frequently found in the pelvis, legs, and chest wall, including the ribs and shoulder blades. Risk factors include:
- Age: Most Ewing tumors affect teens, but they can also develop in younger children and adults (usually in their 20s or 30s).
- Race: Whites (Hispanic and non-Hispanic) are more likely to get Ewing tumors than other races/ethnicities.
Bone Cancer Symptoms
Bone cancer may not cause any symptoms when it begins to develop, but over time patients may experience:
- Pain in a bone or joint (the most common symptom)
- Swelling or a lump
- Unexplained bone break
Ewing tumors can also cause:
- Unexplained weight loss
Bone Cancer Diagnosis and Treatment
Successful bone cancer treatment depends on a complete and accurate diagnosis. Each of our patients receives a thorough evaluation so we can create an individualized plan. We diagnose bone sarcomas with:
- History and Physical Examination
- Imaging Tests
- CT (CAT) Scan
- PET Scan
- Bone Scan
- Blood work
When possible, surgery is used to remove the tumor—often with a limb-saving approach. Chemotherapy is often used—before surgery to shrink the tumor and reduce the amount of bone tissue taken and/or after surgery to make sure the cancer does not return. Freezing any remaining cancerous cells can also keep the cancer from returning.
In some cases, we may also use external radiation, though bone cancer is not particularly sensitive to the therapy.
Regardless of the approach, we make a thorough evaluation before making a recommendation. Treatment options typically depend on:
- The tumor’s location, size, and stage
- Whether the tumor is completely removable with surgery
- The effect the treatment might have on the patient’s appearance and function—including whether the bones are still growing in younger patients and whether the patient wants to play sports or do other specific activities
- Whether the cancer is newly diagnosed or has returned
- The patient’s age and general health