Page last updated: November 2025

The information on this webpage was adapted from Understanding Primary Bone Cancer - Information for people affected by cancer (2025 edition). This webpage was last updated in November 2025.

Expert content reviewers:

This information has been clinically reviewed by Prof Peter Choong AO, Orthopaedic Surgeon, and Sir Hugh Devine Professor, St Vincent’s Hospital, and Head of Department of Surgery, The University of Melbourne, VIC.

This edition is based on the previous edition, which was reviewed by the following panel:

  • Prof Peter Choong AO
  • Catherine Chapman, Adolescent and Young Adult and Sarcoma Cancer Specialist Nurse, Division of Cancer and Ambulatory Support, Canberra Hospital, ACT
  • A/Prof Paul Craft AM, Medical Oncologist, Canberra Hospital and Australian National University, ACT
  • Belinda Fowlie, Bone Tumour Nurse Practitioner Candidate, SA Bone and Soft Tissue Tumour Unit, Flinders Medical Centre, SA
  • Prof Angela Hong, Radiation Oncologist, Chris O’Brien Lifehouse, and Clinical Professor, The University of Sydney, NSW
  • Vicki Moss, Nurse Practitioner, SA Bone and Soft Tissue Tumour Unit, Flinders Medical Centre, SA
  • A/Prof and Dr Marianne Phillips, Paediatric and Adolescent Oncologist and Palliative Care Physician, Perth Children’s Hospital, WA
  • Chris Sibthorpe, 13 11 20 Consultant, Cancer Council Queensland
  • Stephanie Webster, Consumer

What is bone cancer?

Bone cancer can start as either a primary or secondary cancer. The two types are different and this page is only about primary bone cancer. 

  • Primary bone cancer means that the cancer starts in a bone. It may develop on the surface, 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. Primary bone cancer is also known as bone sarcoma. 
  • 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 bone.

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 bone) and an inner core (known as trabecular bone), where bone marrow is found.

Cartilage is the tough material at the end of each bone that allows one bone to move against another at a joint.

Bones commonly affected by primary bone cancer include the spine, ribs, pelvis and upper bones of the arms (humerus) and legs (femur).

Your guide to best cancer care

Cancer that affects the soft tissues around the bones is known as soft tissue sarcoma, and may be treated differently.

For an overview of what to expect at every stage of your care for bone and soft tissue sarcomas, see the guide to best cancer care for sarcoma.

This is a short guide to what is recommended, from diagnosis to treatment and beyond.

Read the guide

Types of primary bone cancer

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

Osteosarcoma

About 35% of bone cancers are osteosarcoma:

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

Chondrosarcoma

About 30% of bone cancers are chondrosarcoma:

  • starts in cells that grow cartilage
  • often affects the bones in the upper arms and legs, pelvis, ribs or shoulder blades
  • most often occurs in adults aged over 40
  • slow growing; rare types can spread to other parts of the body
  • most are low-grade tumours

Ewing sarcoma

About 15% of bone cancers are Ewing sarcoma:

  • affects cells in the bone or soft tissue that multiply rapidly
  • often affects the pelvis, legs, ribs, spine or upper arms 
  • most common in children and young adults
  • are high-grade tumours

How common is bone cancer?

Primary bone cancer is rare. About 270 Australians are diagnosed with primary bone cancer each year. It affects people of all ages, but most often occurs in people aged 10–25 and over 50.

Risk factors

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

Previous radiation exposure

Radiation therapy to treat cancer increases the risk of developing bone cancer.

The risk is higher when high doses of radiation therapy have been given in childhood. Most people who have radiation therapy will not develop bone cancer.

Chemotherapy for another cancer

Some drugs may increase the risk of osteosarcoma.

Genetic factors

Some inherited conditions, such as Li-Fraumeni syndrome, increase the risk of bone cancer.

People with a strong family history of certain types of cancer are also at risk. Ask for a referral to a family cancer clinic for more information.

Some people develop bone cancer because of gene changes that happen during their lifetime, rather than inheriting a faulty gene.

Other bone conditions

Some people who have benign bone conditions, such as Paget’s disease of the bone, are at higher risk.

Symptoms

The most common symptom is pain in the affected bone or joint that doesn’t improve with mild pain medicines such as paracetamol.

You might have this pain most of the time, and 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 moving around (e.g. walking with a limp)
  • loss of feeling in the affected arm or leg (limb)
  • bone that breaks for no reason.

These symptoms do not necessarily mean you have primary bone cancer. If your symptoms last longer than two weeks, you should see your doctor.

Diagnosis

If you have symptoms, your doctor will ask about your medical history and do a physical examination. It is likely that you will have some of the following tests:

  • x-rays – can show bone damage or whether new bone is growing
  • blood tests – help check your overall health
  • CT and/or MRI scans – create pictures to highlight any bone abnormality
  • specialised scans – highlight any cancerous areas in the body with a small amount of radioactive solution that is injected before a scan to, e.g. PET, thallium or technetium scans
  • bone biopsy – collects some cells and tissues from the outer part of the affected bone. The biopsy may be done in one of two ways. In a core biopsy, a local anaesthetic is used to numb the area, then a sample is taken using a needle. A CT or ultrasound scan is used to guide the needle into place. For an open biopsy, you have a general anaesthetic, then the surgeon makes a cut in the skin to remove a piece of bone. The sample is tested for cancer cells and checked for gene changes
  • bone marrow biopsy – a thin needle is used to remove a sample of marrow from the hip bone.

Selecting the bone site to biopsy

A bone biopsy is a specialised test. It is best to have the biopsy at the specialist treatment centre (see below) where you would be treated if it is cancer.

The specialists will usually work together to decide the best site to place the needle. The site to biopsy must be carefully chosen so it doesn’t cause problems if further surgery is needed.

This also helps ensure the sample is useful and reduces the risk of the cancer spreading.

Staging and grading

The test results will help show where the cancer is and if it has spread. This is called staging. Knowing the stage helps your doctors plan your treatment.

Many cancers are staged using a system that divides them into four stages, but bone cancer is different. It is usually divided into localised or advanced. Ask your doctor to explain the stage of cancer to you.

  • Localised – the cancer contains low-grade cells and is found in the bone in which it started. It can be removed by surgery (resectable) or not removed completely (non-resectable). 
  • Advanced (metastatic) – the cancer is any grade and has spread to other parts of the body (e.g. the lungs). 

Grading describes how quickly a cancer might grow. In general, the lower the grade, the better the outlook.

  • Low grade  – the cancer cells look like normal cells. They usually grow slowly and are less likely to spread.
  • High grade – the cancer cells look very abnormal. They grow quickly and are more likely to spread.

Understanding Primary Bone Cancer

Download our Understanding Primary Bone Cancer fact sheet to learn more.

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Primary bone cancer overview