Primary bone cancer

Thursday 1 June, 2017

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


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 (known as cortical or compact bone) and a spongy inner core (known as trabecular or cancellous bone). Cartilage is the tough material at the end of each bone that allows one bone to move against another. This meeting point is called a joint.

What is bone cancer?

Bone cancer can be either primary or secondary bone cancer. The two types are quite different and this information is only about primary bone cancer.

  • Primary bone cancer – means that the cancer 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 that the cancer started in another part of the body, such as the breast or lung, and has spread to the bones.

How common is bone cancer?

Bone cancer is rare. About 200 Australians are diagnosed with primary bone cancer each year.1 It affects people of all ages and is slightly more common in males than females. If it develops later in life, it may be linked to another bone condition (see risk factors).

Primary Bone Cancer

Types of bone cancer

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

Osteosarcoma (about 35% of bone cancers)

  • starts in cells that grow bone tissue
  • often affects the arms, legs and pelvis, but may occur in any bone
  • occurs in children and young adults with growing bones and older people in their 70s and 80s
  • most are high-grade tumours

Chondrosarcoma (about 30% of bone cancers)

  • starts in cells that grow cartilage
  • often affects the bones in the upper arms and legs, pelvis, ribs and shoulder blade
  • most often occurs in middleaged and older people
  • slow-growing form of cancer that rarely spreads to other parts of the body
  • most are low-grade tumours

Ewing's sarcoma (about 15% of bone cancers)

  • affects cells in the bone or soft tissue that multiply rapidly and often have a large lump associated with them
  • often affects the pelvis (hips), legs, ribs, spine, upper arms
  • common in children and young adults
  • are all high-grade tumours

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. The risk is higher for people who have high doses of radiotherapy at a young age. Most people who have 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 a 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 clinic for more information. Some people develop bone cancer due to genetic changes that happen during their lifetime, rather than inheriting a faulty gene. Most bone cancers are not hereditary.

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-relieving medicines 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, e.g. an unexplained limp
  • loss of feeling in the affected limb
  • a fractured bone unexplained weight loss
  • tiredness.

Most people who have these symptoms do not have bone cancer. 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 take your medical history and perform a physical examination. Bone cancer can be difficult to diagnose and it is likely that you will have some of the following tests:

  • x-rays – painless scans of the bones, which can reveal bone damage or the creation of new bone
  • blood tests – including a full blood count
  • CT or MRI scans – a special computer is used to scan and create pictures to highlight any bone abnormality; it takes about an hour to perform
  • PET scan – you will be injected with a small amount of radioactive glucose solution to highlight any cancerous areas on the scan; it may take around 90 minutes to perform
  • bone biopsy – removal of some cells and tissues from the affected bone for examination under a microscope. The biopsy may be done in one of two ways. In a core needle biopsy, a local anaesthetic is used to numb the area, then a thin needle is inserted into the bone under CT guidance. An open or surgical biopsy is done under general anaesthesia. The surgeon will cut through the skin to expose the bone and take a tissue sample.

Staging

The test results will help your doctors assign a stage to describe the bone cancer. You may also undergo some other diagnostic tests (such as a bone scan, bone marrow biopsy, PET scan or chest CT) to assess whether the bone cancer has spread from the original site to other parts of the body. Staging describes how far the cancer has spread and helps your health care team plan the most suitable treatment for you.

Grading

Grading describes how quickly a cancer might grow.

Low grade

The cancer cells look similar to normal cells. They are usually slow growing and less likely to spread.

High grade

The cancer cells look very abnormal. They grow quickly and are more likely to spread.

Stages of bone cancer

There are different staging systems used for bone cancer. Ask your doctor to explain your stage to you.

Stage 1 (localised)

The cancer contains low-grade cells; there is no spread beyond the bone.

Stage 2 (localised)

The cancer contains high-grade cells; there is no spread beyond the bone.

Stage 3 (localised)

There are several high-grade tumours in the same bone; there is no spread beyond the bone.

Stage 4 (advanced)

The cancer is any grade and has spread to other parts of the body (e.g. the lungs).

Selection of bone biopsy site

The site to biopsy must be carefully chosen so it doesn't cause problems if further surgery is needed. It is important that a bone biopsy is performed by a doctor who specialises in treating bone cancer. This also helps ensure the sample is useful and reduces the risk of the cancer spreading.


Reviewed by: Dr Richard Boyle, Orthopaedic Oncological and Reconstructive Surgeon, Royal Prince Alfred Hospital, North Shore Private Hospital and Chris O'Brien Lifehouse, NSW; Dr Jayesh Desai, Medical Oncologist, Peter MacCallum Cancer Centre, VIC; Sandeep Gupta, Head of Physiotherapy, Balmain Hospital, NSW; Prof Angela Hong, Radiation Oncologist, Chris O'Brien Lifehouse and University of Sydney, NSW; James Hyett, Consumer; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA.
1. Australian Institute of Health and Welfare (AIHW), Australian Cancer Incidence and Mortality (ACIM) books: Bone cancer, AIHW, Canberra, 2017.