Bone Cancer: Questions and Answers
- 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.
- 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.)
- 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).
- 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
• 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.
- 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.
- 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,
- 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,
• 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
• 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).
- 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.
- 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
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.
- 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.
- Pizzo P, Poplack DG, editors. Principles and Practice
of Pediatric Oncology. 4th ed. Philadelphia: Lippincott Williams and
- 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.
- 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.
- 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.
- Fischbach FT, Dunning MB. A Manual of Laboratory
and Diagnostic Tests. 7th ed. Philadelphia: Lippincott Williams and Wilkins,
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