Overview

Primary bone cancer is a rare type of cancer that begins in the bones. Around 550 new cases are diagnosed each year in the UK.

This is a separate condition from secondary bone cancer, which is cancer that spreads to the bones after developing in another part of the body.

These pages only refer to primary bone cancer.

Find out more about secondary bone cancer on the Macmillan website

Signs and symptoms of bone cancer

Bone cancer can affect any bone, but most cases develop in the long bones of the legs or upper arms.

The main symptoms include:

• persistent bone pain that gets worse over time and continues into the night
• swelling and redness (inflammation) over a bone, which can make movement difficult if the affected bone is near a joint
• a noticeable lump over a bone
• a weak bone that breaks (fractures) more easily than normal
• problems moving around - for example, walking with a limp

If you or your child are experiencing persistent, severe or worsening bone pain, visit your GP.

While it's highly unlikely to be the result of bone cancer, it does require further investigation.

Types of bone cancer

Some of the main types of bone cancer are:

• osteosarcoma – the most common type, which mostly affects children and young adults under 20
• Ewing sarcoma – which most commonly affects people aged between 10 and 20
• chondrosarcoma – which tends to affect adults aged over 40

Young people can be affected because the rapid growth spurts that occur during puberty may make bone tumours develop.

The above types of bone cancer affect different types of cell. The treatment and outlook will depend on the type of bone cancer you have.

What causes bone cancer?

In most cases, it's not known why a person develops bone cancer.

You're more at risk of developing it if you:

• have had previous exposure to radiation during radiotherapy
• have a condition known as Paget’s disease of the bone – however, only a very small number of people with Paget’s disease will actually develop bone cancer
• have a rare genetic condition called Li-Fraumeni syndrome – people with this condition have a faulty version of a gene that normally helps stop the growth of cancerous cells

How bone cancer is treated

Treatment for bone cancer depends on the type of bone cancer you have and how far it has spread.

Most people have a combination of:

• surgery to remove the section of cancerous bone – it's often possible to reconstruct or replace the bone that's been removed, but amputation is sometimes necessary
• chemotherapy – treatment with powerful cancer-killing medication
• radiotherapy – where radiation is used to destroy cancerous cells

In some cases of osteosarcoma, a medication called mifamurtide may also be recommended.

Outlook

The outlook for bone cancer depends on factors such as your age, the type of bone cancer you have, how far the cancer has spread (the stage), and how likely it is to spread further (the grade).

Generally, bone cancer is much easier to cure in otherwise healthy people whose cancer hasn't spread.

Overall, around 6 in every 10 people with bone cancer will live for at least 5 years from the time of their diagnosis, and many of these may be cured completely.

Cancer Research UK: statistics and outlook for bone cancer

Symptoms

Bone pain is the most common symptom of bone cancer. Some people experience other symptoms as well.

Bone pain

Pain caused by bone cancer usually begins with a feeling of tenderness in the affected bone. This gradually progresses to a persistent ache or an ache that comes and goes, which continues at night and when resting.

Any bone can be affected, although bone cancer most often develops in the long bones of the legs or upper arms.

The pain can sometimes be wrongly mistaken for arthritis in adults and growing pains in children and teenagers.

Other symptoms

Some people also experience swelling and redness (inflammation) or notice a lump on or around the affected bone.

If the bone is near a joint, the swelling may make it difficult to use the joint. This may make it difficult to walk, and you may walk with a limp.

In some cases, the cancer can weaken a bone, causing it to break (fracture) easily after a minor injury or fall.

Less common symptoms can include:

• a high temperature
• unexplained weight loss
• sweating, particularly at night

When to seek medical advice

See your GP if you or your child experiences persistent, severe or worsening bone pain, or if you're worried about any of the other symptoms of bone cancer.

While it's highly unlikely that your symptoms are caused by cancer, it's best to be sure by getting a proper diagnosis.

Who can get it

Cancer occurs when the cells in a certain area of your body divide and multiply too rapidly. This produces a lump of tissue known as a tumour.

The exact reason why this happens is often not known, but certain things can increase your chance of developing the condition, including:

• previous radiotherapy treatment
• other bone conditions, such as Paget’s disease of the bone
• rare genetic conditions, such as Li-Fraumeni syndrome
• a history of certain other conditions, including retinoblastoma and umbilical hernia

These risk factors are described in more detail below.

Radiotherapy treatment

Previous exposure to high doses of radiation during radiotherapy may cause cancerous changes in your bone cells at a later stage, although this risk is thought to be small.

Bone conditions

Some non-cancerous (benign) conditions affecting the bones may increase your chances of developing bone cancer, although the risk is still small.

In particular, a condition called Paget’s disease of the bone can increase the risk of bone cancer in people over 50-60 years of age.

Rarer conditions that cause tumours to grow in your bones, such as Ollier's disease, can also increase your risk of bone cancer.

Genetic conditions

A rare genetic condition called Li-Fraumeni syndrome can increase your risk of developing bone cancer, as well as several other types of cancer.

People with this condition have a faulty version of a gene that usually helps stop the growth of tumours in the body.

Other conditions

People who had a rare type of eye cancer called retinoblastoma as a child may be more likely to develop bone cancer, because the same inherited faulty gene can be responsible for both conditions.

Research has also found that babies born with an umbilical hernia are three times more likely to develop a type of bone cancer called Ewing sarcoma, although the risk is still very small.

Diagnosis

If you're experiencing bone pain, your GP will ask about your symptoms and examine the affected area, before deciding whether you need to have any further tests.

They will look for any swelling or lumps, and ask if you have problems moving the affected area.

They may ask about the type of pain you experience – whether it's constant or comes and goes, and whether anything makes it worse.

After being examined, you may be referred for an X-ray of the affected area to look for any problems in the bones.

If the X-ray shows abnormal areas, you'll be referred to an orthopaedic surgeon (a specialist in bone conditions) or bone cancer specialist for a further assessment.

X-rays

An X-ray is a procedure where radiation is used to produce images of the inside of the body. It's a particularly effective way of looking at bones.

X-rays can often detect damage to the bones caused by cancer, or new bone that's growing because of cancer. 

They can also determine whether your symptoms are caused by something else, such as a broken bone (fracture).

If an X-ray suggests you may have bone cancer, you should be referred to a specialist centre with expertise in diagnosing and treating the condition.

As bone cancer is rare, there are a small number of specialist centres, so you may have to travel outside your local area for advice and treatment.

Biopsy

The most definitive way of diagnosing bone cancer is to take a sample of affected bone and send it to a laboratory for testing. This is known as a biopsy.

A biopsy can determine exactly what type of bone cancer you have and what grade it is.

A biopsy can be carried out in 2 ways:

• A core needle biopsy is performed under anaesthetic (depending on where the bone is located, this could be a local anaesthetic or general anaesthetic). A thin needle is inserted into the bone and used to remove a sample of tissue.
• An open biopsy is performed under a general anaesthetic. The surgeon makes an incision in the affected bone to remove a sample of tissue.

You may need to have an open biopsy if the results of a core needle biopsy are inconclusive.

Further tests

If the results of the biopsy confirm or suggest bone cancer, it's likely you'll have further tests to assess how far the cancer has spread.

MRI scan

An MRI scan uses a strong magnetic field and radio waves to produce detailed pictures of the bones and soft tissues.

An MRI scan is an effective way of assessing the size and spread of any cancerous tumour in or around the bones.

CT scan

A CT scan involves taking a series of X-rays and using a computer to reassemble them into a detailed three-dimensional (3-D) image of your body.

CT scans are often used to check if the cancer has spread to your lungs. Chest X-rays may also be taken for this purpose.

Bone scans

A bone scan can give more detailed information about the inside of your bones than an X-ray. During a bone scan, a small amount of radioactive material is injected into your veins.

Abnormal areas of bone will absorb the material at a faster rate than normal bone and will show up as "hot spots" on the scan.

Bone marrow biopsy

If you have a type of bone cancer called Ewing sarcoma, you may have a test called a bone marrow biopsy to check if the cancer has spread to the bone marrow (the tissue inside your bones).

During the test, a needle is inserted into your bone to remove a sample of your bone marrow. This may be done under either local or general anaesthetic.

Staging and grading

Once these tests have been completed, it should be possible to tell you what stage and grade the bone cancer is. Staging is a description of how far a cancer has spread and grading is a description of how quickly the cancer is likely to spread in the future.

A widely used staging system for bone cancer in the UK uses 3 main stages:

• Stage 1 – the cancer is low-grade and has not spread beyond the bone
• Stage 2 – the cancer has still not spread beyond the bone, but is a high-grade
• Stage 3  – the cancer has spread into other parts of the body, such as the lungs

Most cases of stage 1 bone cancer and some stage 2 bone cancers have a good chance of being cured.

Unfortunately, stage 3 bone cancer is more difficult to cure, although treatment can relieve symptoms and slow the spread of the cancer.

Coping with a diagnosis

Being told you have bone cancer can be a distressing and frightening experience.

Receiving that type of news can be upsetting at any age, but can be particularly difficult if you are still in your teenage years, or if you're a parent of a child who has just been told they have bone cancer.

These types of feelings can cause considerable stress and anxiety, which in some cases can trigger depression.

If you think you may be depressed, your GP may be a good person to talk to about support and possibly treatment.

You may also find it useful to contact the Bone Cancer Research Trust, which is the UK’s leading charity for people affected by bone cancer, if you need more information.

If you're a teenager you may want to contact the Teenage Cancer Trust, which is a charity for teenagers and young adults affected by cancer.

Treatment