Bone Cancer: Overview

What is bone cancer?

Cancer starts when cells change (mutate) and grow out of control. The changed (abnormal) cells often grow to form a lump or mass called a tumor. Cancer cells can also grow into (invade) nearby areas. They can spread to other parts of the body, too. This is called metastasis.

Primary bone cancer is cancer that starts in the cells that make up your bones. It's sometimes just called bone cancer. Primary bone cancer is very different from secondary, or metastatic, bone cancer. Metastatic bone cancer is cancer that started in another part of the body and spread to the bones. Primary bone cancers are quite rare in adults. Most of the time when an adult has cancer in the bones, it spread there from cancer that started in a different place.

The main types of primary bone cancer are:

• Osteosarcoma

• Chondrosarcoma

• Ewing sarcoma

• Chordoma

Who is at risk for bone cancer?

A risk factor is anything that may increase your chance of having a disease. The exact cause of someone’s cancer may not be known. But risk factors can make it more likely for a person to have cancer. Some risk factors can't be controlled. But others may be things you can change.

Anyone can get primary bone cancer. But some factors that might increase your risk for it include:

• A family history of certain genetic syndromes or rare cancers, such as Li-Fraumeni syndrome or retinoblastoma

• Past radiation therapy or certain chemotherapy medicines to treat another cancer during childhood

• Having Paget disease of the bone

• Having certain types of bone or cartilage tumors that are not cancer

• Bone marrow transplant was done when you were a child (rare)

Talk with your healthcare provider about your risk factors for bone cancer and what you can do about them.

What are the symptoms of bone cancer?

Symptoms of primary bone cancer tend to develop slowly over time. They depend on the type of bone cancer, where it is, and size of the tumor. Here are some common symptoms:

• Pain in the bone

• Swelling or a lump or mass

• A bone breaks (fractures) for no reason

• Fever, weight loss, fatigue, numbness, or weakness

Many of these may be caused by other health problems. But it's important to see your healthcare provider if you have these symptoms. Only a healthcare provider can tell if you have cancer.

How is bone cancer diagnosed?

If your healthcare provider thinks you may have primary bone cancer, you will need certain exams and tests to be sure. Your healthcare provider will ask you about your health history, your symptoms, risk factors, and family history of disease. A physical exam will be done. You may also need blood tests and an X-ray or other imaging tests.

A biopsy is the only way to tell for sure if you have bone cancer. A biopsy can also show if the tumor is a primary or secondary bone cancer. (A secondary bone cancer is one that has spread to the bone from cancer that started in another part of the body.) For a biopsy, small pieces of tissue are taken out from the tumor and tested for cancer cells. The results will come back in about 1 week.

After a diagnosis of bone cancer, you’ll need more tests. These help your providers learn more about your overall health and the exact type of bone cancer. They're used to find out the stage and grade of the cancer. The stage is how much cancer there is and how far it has spread (metastasized) in your body. It's one of the most important things to know when deciding how to treat the cancer. The grade is used as part of staging. It gives an idea of how fast the cancer will grow and spread.

Once your cancer is staged, your provider will talk with you about what this means for your treatment. Ask your provider to explain the details of your cancer to you in a way you can understand.

How is bone cancer treated?

Your treatment choices depend on the type of primary bone cancer you have, test results, and the stage of the cancer. The goal of treatment may be to cure you, control the cancer, or help ease problems caused by the cancer. Talk with your healthcare team about your treatment choices, the goals of treatment, and what the risks and side effects may be. Other things to think about are if the cancer can be removed with surgery, how your body will look and work after treatment, and your overall health.

Types of treatment for cancer are either local or systemic. Local treatments remove, destroy, or control cancer cells in one area. Surgery and radiation are local treatments. Systemic treatment is used to destroy or control cancer cells that may have traveled around your body. When taken by pill or injection, chemotherapy and targeted therapy are systemic treatments.

You may have just one treatment or a combination of treatments. Tests will be done during treatment to see how well it's working.

Bone cancer may be treated with:

• Surgery

• Radiation therapy

• Chemotherapy

• Targeted therapy

• Supportive care

Talk with your healthcare providers about your treatment options. Make a list of questions. Think about the benefits and possible side effects of each option. Talk about your concerns with your healthcare provider before making a decision.

What are treatment side effects? 

Cancer treatment such as chemotherapy and radiation can damage normal cells. This can cause side effects such as hair loss, mouth sores, and vomiting. Talk with your healthcare provider about side effects linked to your treatment. There are often ways to manage them. There may be things you can do and medicines you can take to help prevent or control many treatment side effects.

Coping with bone cancer

Many people feel worried, depressed, and stressed when dealing with cancer. Getting treatment for cancer can be hard on your mind and body. Keep talking with your healthcare team about any problems or concerns you have. Work together to ease the effect of cancer and its symptoms that impact your daily life.

Here are some tips:

• Talk with your family or friends.

• Ask your healthcare team or social worker for help.

• Speak with a counselor.

• Talk with a spiritual advisor, such as a minister or rabbi.

• Ask your healthcare team about medicines for depression or anxiety.

• Keep socially active.

• Join a cancer support group in person or online.

Cancer treatment is also hard on the body. To help yourself stay healthier, try to:

• Eat a healthy diet, with a focus on high-protein foods.

• Drink plenty of water, fruit juices, and other liquids.

• Keep physically active.

• Rest as much as needed.

• Talk with your healthcare team about ways to manage treatment side effects.

• Take your medicines as directed by your team.

When should I call my healthcare provider?

Your healthcare provider will talk with you about when to call. For instance, you may be told to call if you have:

• New symptoms or symptoms that get worse

• Signs of an infection, such as a fever or chills

• Side effects of treatment that affect your daily function or don’t get better with treatment

Ask your healthcare provider what signs to watch for and when to call. Know how to get help after office hours and on weekends and holidays. 

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your provider if you have questions.