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National Cancer Institute Fact Sheet
    Reviewed: 03/13/2008
Bone Cancer: Questions and Answers

Key Points

  1. What is bone cancer?

    Bone cancer is a malignant (cancerous) tumor of the bone that destroys normal bone tissue (1). Not all bone tumors are malignant. In fact, benign (noncancerous) bone tumors are more common than malignant ones. Both malignant and benign bone tumors may grow and compress healthy bone tissue, but benign tumors do not spread, do not destroy bone tissue, and are rarely a threat to life.

    Malignant tumors that begin in bone tissue are called primary bone cancer. Cancer that metastasizes (spreads) to the bones from other parts of the body, such as the breast, lung, or prostate, is called metastatic cancer, and is named for the organ or tissue in which it began. Primary bone cancer is far less common than cancer that spreads to the bones.

  2. Are there different types of primary bone cancer?

    Yes. Cancer can begin in any type of bone tissue. Bones are made up of osteoid (hard or compact), cartilaginous (tough, flexible), and fibrous (threadlike) tissue, as well as elements of bone marrow (soft, spongy tissue in the center of most bones).

    Common types of primary bone cancer include:

    • Osteosarcoma, which arises from osteoid tissue in the bone. This tumor occurs most often in the knee and upper arm (1).

    • Chondrosarcoma, which begins in cartilaginous tissue. Cartilage pads the ends of bones and lines the joints. Chondrosarcoma occurs most often in the pelvis (located between the hip bones), upper leg, and shoulder. Sometimes a chondrosarcoma contains cancerous bone cells. In that case, doctors classify the tumor as an osteosarcoma.

    • The Ewing Sarcoma Family of Tumors (ESFTs), which usually occur in bone but may also arise in soft tissue (muscle, fat, fibrous tissue, blood vessels, or other supporting tissue). Scientists think that ESFTs arise from elements of primitive nerve tissue in the bone or soft tissue (2). ESFTs occur most commonly along the backbone and pelvis and in the legs and arms (3).

    Other types of cancer that arise in soft tissue are called soft tissue sarcomas. They are not bone cancer and are not described in this resource. (More information about these types of cancer is available in the NCI fact sheet Soft Tissue Sarcomas: Questions and Answers at http://www.cancer.gov/cancertopics/factsheet/Sites-Types/soft-tissue-sarcoma on the Internet.)

  3. What are the possible causes of bone cancer?

    Although bone cancer does not have a clearly defined cause, researchers have identified several factors that increase the likelihood of developing these tumors. Osteosarcoma occurs more frequently in people who have had high-dose external radiation therapy or treatment with certain anticancer drugs; children seem to be particularly susceptible. A small number of bone cancers are due to heredity. For example, children who have had hereditary retinoblastoma (an uncommon cancer of the eye) are at a higher risk of developing osteosarcoma, particularly if they are treated with radiation. Additionally, people who have hereditary defects of bones and people with metal implants, which doctors sometimes use to repair fractures, are more likely to develop osteosarcoma (4). Ewing sarcoma is not strongly associated with any heredity cancer syndromes, congenital childhood diseases, or previous radiation exposure (2).

  4. How often does bone cancer occur?

    Primary bone cancer is rare. It accounts for much less than 1 percent of all cancers. About 2,300 new cases of primary bone cancer are diagnosed in the United States each year (5). Different types of bone cancer are more likely to occur in certain populations:

    • Osteosarcoma occurs most commonly between ages 10 and 19. However, people over age 40 who have other conditions, such as Paget disease (a benign condition characterized by abnormal development of new bone cells), are at increased risk of developing this cancer.

    • Chondrosarcoma occurs mainly in older adults (over age 40). The risk increases with advancing age. This disease rarely occurs in children and adolescents.

    • ESFTs occur most often in children and adolescents under 19 years of age. Boys are affected more often than girls. These tumors are extremely rare in African American children.

  5. What are the symptoms of bone cancer?

    Pain is the most common symptom of bone cancer, but not all bone cancers cause pain (1). Persistent or unusual pain or swelling in or near a bone can be caused by cancer or by other conditions. It is important to see a doctor to determine the cause.

  6. How is bone cancer diagnosed?

    To help diagnose bone cancer, the doctor asks about the patient’s personal and family medical history. The doctor also performs a physical examination and may order laboratory and other diagnostic tests. These tests may include (1):

    • X-rays, which can show the location, size, and shape of a bone tumor. If x-rays suggest that an abnormal area may be cancer, the doctor is likely to recommend special imaging tests. Even if x-rays suggest that an abnormal area is benign, the doctor may want to do further tests, especially if the patient is experiencing unusual or persistent pain.

    o A bone scan, which is a test in which a small amount of radioactive material is injected into a blood vessel and travels through the bloodstream; it then collects in the bones and is detected by a scanner.

    o A computed tomography (CT or CAT) scan, which is a series of detailed pictures of areas inside the body, taken from different angles, that are created by a computer linked to an x-ray machine.

    o A magnetic resonance imaging (MRI) procedure, which uses a powerful magnet linked to a computer to create detailed pictures of areas inside the body without using x-rays.

    o A positron emission tomography (PET) scan, in which a small amount of radioactive glucose (sugar) is injected into a vein, and a scanner is used to make detailed, computerized pictures of areas inside the body where the glucose is used. Because cancer cells often use more glucose than normal cells, the pictures can be used to find cancer cells in the body.

    o An angiogram, which is an x-ray of blood vessels.

    • Biopsy (removal of a tissue sample from the bone tumor) to determine whether cancer is present. The surgeon may perform a needle biopsy or an incisional biopsy. During a needle biopsy, the surgeon makes a small hole in the bone and removes a sample of tissue from the tumor with a needle-like instrument. In an incisional biopsy, the surgeon cuts into the tumor and removes a sample of tissue. Biopsies are best done by an orthopedic oncologist (a doctor experienced in the treatment of bone cancer) (1). A pathologist (a doctor who identifies disease by studying cells and tissues under a microscope) examines the tissue to determine whether it is cancerous.

    • Blood tests to determine the level of an enzyme called alkaline phosphatase. A large amount of this enzyme is present in the blood when the cells that form bone tissue are very active—when children are growing, when a broken bone is mending, or when a disease or tumor causes production of abnormal bone tissue. Because high levels of alkaline phosphatase are normal in growing children and adolescents, this test is not a completely reliable indicator of bone cancer (1, 6) .

  7. What are the treatment options for bone cancer?

    Treatment options depend on the type, size, location, and stage of the cancer, as well as the person’s age and general health. Treatment options for bone cancer include surgery, chemotherapy, radiation therapy, and cryosurgery.

    • Surgery is the usual treatment for bone cancer. The surgeon removes the entire tumor with negative margins (no cancer cells are found at the edge or border of the tissue removed during surgery). The surgeon may also use special surgical techniques to minimize the amount of healthy tissue removed with the tumor.

    Dramatic improvements in surgical techniques and preoperative tumor treatment have made it possible for most patients with bone cancer in an arm or leg to avoid radical surgical procedures (removal of the entire limb). However, most patients who undergo limb-sparing surgery need reconstructive surgery to maximize limb function (1).

    • Chemotherapy is the use of anticancer drugs to kill cancer cells. Patients who have bone cancer usually receive a combination of anticancer drugs. However, chemotherapy is not currently used to treat chondrosarcoma (1).

    • Radiation therapy, also called radiotherapy, involves the use of high-energy x-rays to kill cancer cells. This treatment may be used in combination with surgery. It is often used to treat chondrosarcoma, which cannot be treated with chemotherapy, as well as ESFTs (1). It may also be used for patients who refuse surgery.

    • Cryosurgery is the use of liquid nitrogen to freeze and kill cancer cells. This technique can sometimes be used instead of conventional surgery to destroy the tumor (1).

  8. Is follow-up treatment necessary? What does it involve?

    Yes. Bone cancer sometimes metastasizes, particularly to the lungs, or can recur (come back), either at the same location or in other bones in the body (1). People who have had bone cancer should see their doctor regularly and should report any unusual symptoms right away. Follow-up varies for different types and stages of bone cancer. Generally, patients are checked frequently by their doctor and have regular blood tests and x-rays. People who have had bone cancer, particularly children and adolescents, have an increased likelihood of developing another type of cancer, such as leukemia, later in life. Regular follow-up care ensures that changes in health are discussed and that problems are treated as soon as possible.

  9. Are clinical trials (research studies) available for people with bone cancer?

    Yes. Participation in clinical trials is an important treatment option for many people with bone cancer. To develop new treatments and better ways to use current treatments, the National Cancer Institute (NCI), a part of the National Institutes of Health, is sponsoring clinical trials in many hospitals and cancer centers around the country. Clinical trials are a critical step in the development of new methods of treatment. Before any new treatment can be recommended for general use, doctors conduct clinical trials to find out whether the treatment is safe for patients and effective against the disease.

    People interested in taking part in a clinical trial should talk with their doctor. Information about clinical trials is available from the NCI’s Cancer Information Service (CIS) (see below) at 1–800–4–CANCER and in the NCI booklet Taking Part in Cancer Treatment Research Studies, which can be found at http://www.cancer.gov/clinicaltrials/Taking-Part-in-Cancer-Treatment-Research-Studies on the Internet. This booklet describes how research studies are carried out and explains their possible benefits and risks. Further information about clinical trials is available at http://www.cancer.gov/clinicaltrials on the NCI’s Web site. The Web site offers detailed information about specific ongoing studies by linking to PDQ®, the NCI’s comprehensive cancer information database. The CIS also provides information from PDQ.

Selected References

  1. Malawer MM, Helman LJ, O'Sullivan B. Sarcomas of bone. In: DeVita VT, Hellman S, Rosenberg SA, editors. Cancer: Principles and Practice of Oncology. Vol. 2. 7th ed. Philadelphia: Lippincott Williams and Wilkins, 2004.

  2. Pizzo P, Poplack DG, editors. Principles and Practice of Pediatric Oncology. 4th ed. Philadelphia: Lippincott Williams and Wilkins, 2002.

  3. Ries LAG, Smith MA, Gurney JG, et al., editors. Cancer Incidence and Survival among Children and Adolescents: United States SEER Program 1975-1999. Bethesda, MD: National Cancer Institute, 1999.

  4. Miller RW, Boice JD, Curtis RE. Bone cancer. In: Schottenfeld D, Fraumeni JF, editors. Cancer Epidemiology and Prevention. 2nd ed. New York: Oxford University Press, 1996.

  5. American Cancer Society (2008). Cancer Facts and Figures 2008. Atlanta, GA: American Cancer Society. Retrieved March 13, 2008, from http://www.cancer.org/downloads/STT/2008CAFFfinalsecured.pdf.

  6. Fischbach FT, Dunning MB. A Manual of Laboratory and Diagnostic Tests. 7th ed. Philadelphia: Lippincott Williams and Wilkins, 2004.

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Related NCI materials and Web pages:

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NCI's Cancer Information Service
Telephone (toll-free): 1–800–4–CANCER (1–800–422–6237)
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LiveHelp® online chat: https://cissecure.nci.nih.gov/livehelp/welcome.asp


Glossary Terms

abnormal
Not normal. An abnormal lesion or growth may be cancerous, premalignant (likely to become cancer), or benign.
amputation (am-pyoo-TAY-shun)
Surgery to remove part or all of a limb or appendage.
backbone
The bones, muscles, tendons, and other tissues that reach from the base of the skull to the tailbone. The backbone encloses the spinal cord and the fluid surrounding the spinal cord. Also called spine, spinal column, and vertebral column.
benign (beh-NINE)
Not cancerous. Benign tumors may grow larger but do not spread to other parts of the body.
benign tumor (beh-NINE TOO-mer)
A noncancerous growth that does not invade nearby tissue or spread to other parts of the body.
biopsy (BY-op-see)
The removal of cells or tissues for examination by a pathologist. The pathologist may study the tissue under a microscope or perform other tests on the cells or tissue. There are many different types of biopsy procedures. The most common types include: (1) incisional biopsy, in which only a sample of tissue is removed; (2) excisional biopsy, in which an entire lump or suspicious area is removed; and (3) needle biopsy, in which a sample of tissue or fluid is removed with a needle. When a wide needle is used, the procedure is called a core biopsy. When a thin needle is used, the procedure is called a fine-needle aspiration biopsy.
blood vessel
A tube through which the blood circulates in the body. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins.
bone cancer (... KAN-ser)
Primary bone cancer is cancer that forms in cells of the bone. Some types of primary bone cancer are osteosarcoma, Ewing sarcoma, malignant fibrous histiocytoma, and chondrosarcoma. Secondary bone cancer is cancer that spreads to the bone from another part of the body (such as the prostate, breast, or lung).
bone marrow (bone MAYR-oh)
The soft, sponge-like tissue in the center of most bones. It produces white blood cells, red blood cells, and platelets.
bone scan
A technique to create images of bones on a computer screen or on film. A small amount of radioactive material is injected into a blood vessel and travels through the bloodstream; it collects in the bones and is detected by a scanner.
breast (brest)
Glandular organ located on the chest. The breast is made up of connective tissue, fat, and breast tissue that contains the glands that can make milk. Also called mammary gland.
cancer (KAN-ser)
A term for diseases in which abnormal cells divide without control. Cancer cells can invade nearby tissues and can spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord.
Cancer Information Service
CIS. The Cancer Information Service is the National Cancer Institute's link to the public, interpreting and explaining research findings in a clear and understandable manner, and providing personalized responses to specific questions about cancer. Access the CIS by calling 1-800-4-CANCER (1-800-422-6237), or by using the LiveHelp instant-messaging service at https://cissecure.nci.nih.gov/livehelp/welcome.asp. Also called CIS.
cartilage (KAR-tih-lij)
A tough, flexible tissue that lines joints and gives structure to the nose, ears, larynx, and other parts of the body.
cell (sel)
The individual unit that makes up the tissues of the body. All living things are made up of one or more cells.
chemotherapy (KEE-moh-THAYR-uh-pee)
Treatment with drugs that kill cancer cells.
chondrosarcoma (KON-droh-sar-KOH-muh)
A type of cancer that forms in bone cartilage. It usually starts in the pelvis (between the hip bones), the shoulder, the ribs, or at the ends of the long bones of the arms and legs. A rare type of chondrosarcoma called extraskeletal chondrosarcoma does not form in bone cartilage. Instead, it forms in the soft tissues of the upper part of the arms and legs. Chondrosarcoma can occur at any age but is more common in people older than 40 years. It is a type of bone cancer.
clinical trial
A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis, or treatment of a disease. Also called a clinical study.
cryosurgery (KRY-oh-SER-juh-ree)
A procedure in which tissue is frozen to destroy abnormal cells. This is usually done with a special instrument that contains liquid nitrogen or liquid carbon dioxide. Also called cryoablation.
CT scan
Computed tomography scan. A series of detailed pictures of areas inside the body taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computed tomography scan, computerized tomography, computerized axial tomography scan, and CAT scan.
diagnosis (DY-ug-NOH-sis)
The process of identifying a disease, such as cancer, from its signs and symptoms.
diagnostic procedure
A method used to identify a disease.
dose
The amount of medicine taken, or radiation given, at one time.
drug
Any substance, other than food, that is used to prevent, diagnose, treat or relieve symptoms of a disease or abnormal condition. Also refers to a substance that alters mood or body function, or that can be habit-forming or addictive, especially a narcotic.
enzyme
A protein that speeds up chemical reactions in the body.
fibrous
Containing or resembling fibers.
follow-up
Monitoring a person's health over time after treatment. This includes keeping track of the health of people who participate in a clinical study or clinical trial for a period of time, both during the study and after the study ends.
hereditary (huh-REH-dih-tayr-ee)
Transmitted from parent to child by information contained in the genes.
imaging (IH-muh-jing)
In medicine, a process that makes pictures of areas inside the body. Imaging uses methods such as x-rays (high-energy radiation), ultrasound (high-energy sound waves), and radio waves.
implant
A substance or object that is put in the body as a prosthesis, or for treatment or diagnosis.
incisional biopsy (in-SIH-zhun-al BY-op-see)
A surgical procedure in which a portion of a lump or suspicious area is removed for diagnosis. The tissue is then examined under a microscope.
injection
Use of a syringe and needle to push fluids or drugs into the body; often called a "shot."
leukemia (loo-KEE-mee-uh)
Cancer that starts in blood-forming tissue such as the bone marrow and causes large numbers of blood cells to be produced and enter the bloodstream.
lung
One of a pair of organs in the chest that supplies the body with oxygen, and removes carbon dioxide from the body.
magnetic resonance imaging (mag-NEH-tik REH-zuh-nunts IH-muh-jing)
A procedure in which radio waves and a powerful magnet linked to a computer are used to create detailed pictures of areas inside the body. These pictures can show the difference between normal and diseased tissue. Magnetic resonance imaging makes better images of organs and soft tissue than other scanning techniques, such as computed tomography (CT) or x-ray. Magnetic resonance imaging is especially useful for imaging the brain, the spine, the soft tissue of joints, and the inside of bones. Also called MRI, nuclear magnetic resonance imaging, and NMRI.
malignant (muh-LIG-nunt)
Cancerous. Malignant tumors can invade and destroy nearby tissue and spread to other parts of the body.
metastatic cancer (meh-tuh-STA-tik KAN-ser)
Cancer that has spread from the place in which it started to other parts of the body.
National Cancer Institute
The National Cancer Institute, part of the National Institutes of Health of the United States Department of Health and Human Services, is the Federal Government's principal agency for cancer research. The National Cancer Institute conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the National Cancer Institute Web site at http://www.cancer.gov. Also called NCI.
National Institutes of Health
NIH. A federal agency in the U.S. that conducts biomedical research in its own laboratories; supports the research of non-Federal scientists in universities, medical schools, hospitals, and research institutions throughout the country and abroad; helps in the training of research investigators; and fosters communication of medical information. Access the National Institutes of Health Web site at http://www.nih.gov. Also called NIH.
needle biopsy (NEE-dul BY-op-see)
The removal of tissue or fluid with a needle for examination under a microscope. When a wide needle is used, the procedure is called a core biopsy. When a thin needle is used, the procedure is called a fine-needle aspiration biopsy.
nerve
A bundle of fibers that receives and sends messages between the body and the brain. The messages are sent by chemical and electrical changes in the cells that make up the nerves.
oncologist (on-KAH-loh-jist)
A doctor who specializes in treating cancer. Some oncologists specialize in a particular type of cancer treatment. For example, a radiation oncologist specializes in treating cancer with radiation.
organ
A part of the body that performs a specific function. For example, the heart is an organ.
osteosarcoma (OS-tee-oh-sar-KOH-muh)
A cancer of the bone that usually affects the large bones of the arm or leg. It occurs most commonly in young people and affects more males than females. Also called osteogenic sarcoma.
pathologist (puh-THAH-loh-jist)
A doctor who identifies diseases by studying cells and tissues under a microscope.
PDQ
PDQ is an online database developed and maintained by the National Cancer Institute. Designed to make the most current, credible, and accurate cancer information available to health professionals and the public, PDQ contains peer-reviewed summaries on cancer treatment, screening, prevention, genetics, complementary and alternative medicine, and supportive care; a registry of cancer clinical trials from around the world; and directories of physicians, professionals who provide genetics services, and organizations that provide cancer care. Most of this information, and more specific information about PDQ, can be found on the NCI's Web site at http://www.cancer.gov/cancertopics/pdq. Also called Physician Data Query.
pelvis
The lower part of the abdomen, located between the hip bones.
positron emission tomography scan (PAH-zih-tron ee-MIH-shun toh-MAH-gruh-fee skan)
PET scan. A procedure in which a small amount of radioactive glucose (sugar) is injected into a vein, and a scanner is used to make detailed, computerized pictures of areas inside the body where the glucose is used. Because cancer cells often use more glucose than normal cells, the pictures can be used to find cancer cells in the body. Also called PET scan.
prostate (PROS-tayt)
A gland in the male reproductive system. The prostate surrounds the part of the urethra (the tube that empties the bladder) just below the bladder, and produces a fluid that forms part of the semen.
radiation (RAY-dee-AY-shun)
Energy released in the form of particle or electromagnetic waves. Common sources of radiation include radon gas, cosmic rays from outer space, medical x-rays, and energy given off by a radioisotope (unstable form of a chemical element that releases radiation as it breaks down and becomes more stable).
radiation therapy (RAY-dee-AY-shun THAYR-uh-pee)
The use of high-energy radiation from x-rays, gamma rays, neutrons, protons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Also called radiotherapy and irradiation.
radioactive (RAY-dee-oh-AK-tiv)
Giving off radiation.
radiotherapy (RAY-dee-oh-THAYR-uh-pee)
The use of high-energy radiation from x-rays, gamma rays, neutrons, protons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy). Systemic radiotherapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Also called radiation therapy and irradiation.
reconstructive surgery
Surgery that is done to reshape or rebuild (reconstruct) a part of the body changed by previous surgery.
retinoblastoma (REH-tih-noh-blas-TOH-muh)
Cancer that forms in the tissues of the retina (the light-sensitive layers of nerve tissue at the back of the eye). Retinoblastoma usually occurs in children younger than 5 years. It may be hereditary or nonhereditary (sporadic).
sarcoma
A cancer of the bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue.
scanner
In medicine, an instrument that takes pictures of the inside of the body.
soft tissue
Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body.
soft tissue sarcoma (…TIH-shoo sar-KOH-muh)
A cancer that begins in the muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body.
stage
The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer, and whether the cancer has spread from the original site to other parts of the body.
surgeon
A doctor who removes or repairs a part of the body by operating on the patient.
surgery (SER-juh-ree)
A procedure to remove or repair a part of the body or to find out whether disease is present. An operation.
symptom
An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.
syndrome (SIN-drome)
A set of symptoms or conditions that occur together and suggest the presence of a certain disease or an increased chance of developing the disease.
tissue (TISH-oo)
A group or layer of cells that work together to perform a specific function.
tumor (TOO-mer)
An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancerous), or malignant (cancerous). Also called neoplasm.
x-ray
A type of high-energy radiation. In low doses, x-rays are used to diagnose diseases by making pictures of the inside of the body. In high doses, x-rays are used to treat cancer.


Table of Links

1http://cancer.gov/cancertopics/factsheet/Sites-Types/soft-tissue-sarcoma
2http://cancer.gov/cancertopics/factsheet/Sites-Types/metastatic
3http://cancer.gov/cancertopics/factsheet/Therapy/cryosurgery
4http://cancer.gov/cancertopics/factsheet/Therapy/followup
5http://cancer.gov/cancertopics/types/bone
6http://cancer.gov/cancertopics/chemotherapy-and-you
7http://www.cancer.gov/clinicaltrials
8http://cancer.gov/cancertopics/radiation-therapy-and-you
9http://www.cancer.gov/clinicaltrials/Taking-Part-in-Cancer-Treatment-Research-S
tudies