Primary bone cancer

Saturday 1 August, 2015

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On this page: The bones | What is bone cancer? | How common is bone cancer? | What types are there? | What are the risk factors? | What are the symptoms? | Diagnosis | Grading and staging


This information has been prepared to help you understand more about primary bone cancer, also known as bone sarcoma. In this section we’ve used the term bone cancer. It includes basic information about how primary bone cancer is diagnosed and treated.

The bones

A typical healthy adult has over 200 bones, which:

  • support and protect internal organs
  • are attached to muscles to allow movement
  • contain bone marrow, which produces and stores new blood cells
  • store proteins, minerals and nutrients, such as calcium.

The bones are made up of different parts, including a hard outer layer (cortical bone) and a spongy inner core (trabecular bone). Cartilage is the tough material at the end of each bone that allows one bone to move against another. These are called joints.

What is bone cancer?

Bone cancer can be either primary bone cancer or secondary bone cancer. The two types of bone cancer are quite different. This fact sheet is only about primary bone cancer (bone sarcoma).

Primary bone cancer is cancer that starts in the bones. It may develop on the surface of the bone, in the outer layer or from the centre of the bone. As a tumour grows, cancer cells multiply and destroy the bone. If left untreated, primary bone cancer can spread to other parts of the body.

Secondary (metastatic) bone cancer means a cancer that started in another part of the body, such as the breasts, lungs or prostate, and has spread to the bones.

How common is bone cancer?

Bone cancer is rare. About 195 Australians are diagnosed with primary bone cancer each year.

Bone cancer affects people of all ages, and it is slightly more common in males than females. If it develops later in life, it may be linked to another bone disease, such as Paget’s disease, which causes enlarged and deformed bones.

Secondary bone cancer is more common than primary bone cancer, and is treated differently.

What types are there?

There are more than 30 types of primary bone cancer. The most common types include:

Osteosarcoma
  • affects cells that grow bone tissue
  • often occurs in younger people with growing bones
Chondrosarcoma
  • begins in the cartilage
  • often affects the pelvis, thigh bone, ribs and shoulder blade
  • most often occurs in middle-aged people
Ewing’s sarcoma
  • affects cells in the bone or soft tissue that multiply rapidly and often have a large lump associated with them
  • is usually found in children and young adults

Some types of cancer affect the soft tissues around the bones. These are known as soft tissue sarcomas and may be treated differently. For more details, talk to your doctor or call Cancer Council 13 11 20.

What are the risk factors?

The causes of most bone cancers are unknown, but some factors that increase the risk include:

Previous radiotherapy

Radiotherapy to treat cancer increases the risk of developing bone cancer in the future. The risk is higher for people who have had high doses of radiotherapy at a young age. Most people who have had radiotherapy will not develop bone cancer.

Other bone conditions

Some people who have had Paget’s disease of the bone, fibrous dysplasia or multiple enchondromas are at higher risk of bone cancer. Some studies also suggest that people who have had soft tissue sarcoma are at an increased risk of developing bone cancer.

Genetic factors

Some inherited conditions such as Li-Fraumeni syndrome increase the risk of bone cancer. People with a strong family history of certain other types of cancer are also at risk. Talk to a family cancer centre (also known as Clinical Genetics or Familial Cancer Service) for more information.

Some people develop bone cancer due to genetic changes that happen during their lifetime, rather than inheriting a faulty gene.

What are the symptoms?

The most common symptom of bone cancer is strong pain in the bones and joints. The pain gradually becomes constant and does not improve with mild pain medication such as paracetamol. It may be worse at night or during activity.

Other symptoms can include:

  • swelling over the affected part of the bone
  • stiffness or tenderness in the bone
  • problems with movement, such as an unexplained limp
  • unexplained weight loss
  • loss of feeling in the affected limb
  • tiredness.

Most people who have these symptoms do not have bone cancer. However, if you have symptoms for more than two weeks, you should see your general practitioner (GP).

Diagnosis

If you are experiencing symptoms that could be caused by bone cancer, your doctor will arrange some tests, including:

  • x-rays – painless scans of the bones
  • CT or MRI scans – a special computer is used to scan and create pictures of your body, sometimes in 3D, that will help to highlight any bone abnormality. It may take about an hour to perform
  • biopsy – a small tissue sample is taken. A local anaesthetic is used to numb the area, then a thin needle is inserted into the bone. The sample is examined under a microscope. A bone biopsy may also be done using general anaesthesia.

Grading and staging

Grading
Grading describes how quickly a cancer might grow.
low grade the cancer cells look similar to normal bone cells, are usually slow-growing and are less likely to spread
high grade the cancer cells look very abnormal and grow quickly, and are more likely to spread

Staging
Staging describes how far the cancer has spread. Knowing the stage helps doctors plan the most suitable treatment for you. The stages of bone cancer are also based on the grade of the cancer.
Stage 1 the cancer contains low-grade cells, and there is no spread beyond the bone
Stage 2 the cancer contains high-grade cells, and there is no spread beyond the bone
Stage 3 the cancer is any grade, and has spread to other parts of the body

Reviewed by: Prof Peter Choong, Director of Orthopaedics, St Vincent’s Hospital, and Chair of the Bone and Soft Tissue Sarcoma Service, Peter MacCallum Cancer Centre, VIC; Dr Jayesh Desai, Medical Oncologist, Royal Melbourne Hospital, Walter and Eliza Hall Institute and Peter MacCallum Cancer Centre, VIC; Sandeep Gupta, Musculoskeletal-Amputee Physiotherapist, Royal Prince Alfred Hospital, NSW; Fiona Hammond, Nurse Coordinator, Bone and Soft Tissue Service, Peter MacCallum Cancer Centre, VIC; Meghann Lang, Nurse Care Coordinator, Adolescents and Young Adults & Sarcoma, The Canberra Hospital, ACT.
Updated: 01 Aug, 2015