Bone cancer

Tuesday 30 November, 2010

Reviewed: Annie Angle, cancer nurse (Dip. Oncology Nursing, Royal Marsden, London)

On this page: What's bone cancer? ι Types of bone cancer ι How common is bone cancer? ι Causes ι Symptoms ι Diagnosis 

What is bone cancer?

Bone cancer is a rare type of cancer that forms as a painful lump (tumour) in bone. It's also known as bone sarcoma. When a bone cancer begins to grow, the cancer cells multiply and start to destroy the bone.

The affected bone becomes weak and starts to cause problems. The most common places where bone cancer develops are around the knee, the wrist, the shoulder and the pelvis.

Types of bone cancer

There are over 30 types of bone cancers.

  • Osteosarcoma is the most common type; it's made up of millions of abnormal bone-producing cells.
  • Chondrosarcoma is a bone cancer that is made up of millions of abnormal cartilage cells.
  • Ewing sarcoma is another type of bone cancer.

Some types of bone cancer affect the soft tissues of the body. These are called soft tissue sarcomas.

How common is bone cancer?

Bone cancer is rare. About 70 Victorians are diagnosed with some type of primary bone cancer each year (a rate of about 1 case per 100,000 people). Rates for males and females are very similar.

Causes

We don't know exactly what causes most bone cancer. There are several risk factors.

Age

Bone cancer commonly affects teenagers and young adults, and people over the age of 55. Bone cancer that develops later in life is usually linked to a prior disease of the bone, such as Paget disease.

Radiotherapy

There is a very small risk of bone cancer for people who have had radiotherapy. Radiotherapy sometimes affects bone in the treatment area. The risk is higher for people who had high doses of radiotherapy at a very young age. Most people who have had radiotherapy in the past will not develop a bone cancer.

Other medical conditions

Some people who have had Paget disease of the bone, fibrous dysplasia or multiple enchondromas are at higher risk of bone cancer.

Genetic factors

Most bone cancers are not caused by inheriting a faulty gene. However, some inherited conditions, such as Li-Fraumeni syndrome, put people at higher risk. This condition runs in families and puts people at higher risk of several types of cancer, including bone cancer. People who have a strong family history of certain types of cancer are also at risk.

Children who have had a rare type of eye cancer called retinoblastoma are at a higher risk of osteosarcoma.

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

Symptoms

The most common symptom of bone cancer is a painful swelling. Pain may not be constant. It may be much worse at night or during activity. Taking pain-relieving tablets may not help.

As the cancer grows over weeks or months the pain may get worse and become constant. The pain may cause problems with movement. For example, you may have a limp if the cancer is in the leg. Sometimes you may be able to feel a lump.

Most people who have pain and swelling don't have bone cancer. It's much more likely to be a less serious condition. However, if you have symptoms that stay for more than two weeks you should see your doctor.

Diagnosis

If your doctor thinks you may have bone cancer they will carry out blood tests, xrays and scans. These tests are needed to rule out other conditions. If the results suggest that you may have bone cancer, your doctor will refer you to a specialist centre.

You may need to have a biopsy. This is the only sure way to diagnose a bone cancer. A biopsy means taking a sample of cells from the lump and examining them under a microscope. Your doctor will use a fine needle to do this. You'll have local anaesthetic to numb the area before the needle is put into the lump.

A bone biopsy should only be carried out by a specialist who does them regularly. It is important that the biopsy is done properly in order to minimise the chance of the cancer spreading. It could also affect the type of treatment that you may be able to have.

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