Bone cancer

Bone cancer is a growth of cells that starts in a bone. It's also called primary bone cancer. Bone cancer can start in any bone. But it most often affects the thighbone, called the femur.

Bone cancer is different from cancer that starts elsewhere in the body and spreads to the bones, called bone metastasis. Bone cancer also is different from cancers that start in the bone marrow, such as multiple myeloma.

BAlthough these conditions all involve bones, they develop from different cells or tissues and may need different treatments.

Cancer that starts in the bones is rare. There are several types of bone cancer. Some types of bone cancer mainly happen in children. Other types happen mostly in adults.

Bone cancer treatments may include surgery, chemotherapy and radiation therapy. The treatment plan depends on the type of bone cancer, its location and stage, and other individual factors.

Signs and symptoms of bone cancer may include:

• Bone pain.
• Swelling and tenderness near the affected area.
• Weakened bone, which can lead to a broken bone.
• Feeling very tired.
• Losing weight without trying.

Symptoms can vary depending on which bone is affected. When bone cancer develops in the long bones of the legs or arms, pain around the knee, thigh, shoulder or upper arm is common.

Bone cancer in the pelvis may cause hip or groin pain. Tumors in the spine can cause back pain and, if they press on nerves, numbness or weakness. Bone cancers involving the skull or jaw may cause swelling, pain or difficulty swallowing. These symptoms are more often caused by conditions other than bone cancer, but ongoing pain or swelling should be evaluated by a healthcare professional.

When to seek care

Make an appointment with a doctor or other healthcare professional if you have any symptoms that worry you, such as bone pain or swelling.

The cause of most bone cancers isn't known. Bone cancer starts when cells in bone or bone-forming tissue develop changes in their DNA. A cell's DNA holds the instructions that tell the cell what to do. In healthy cells, the DNA gives instructions that help control when cells grow, multiply and die. In cancer cells, the DNA changes give different instructions. These changes tell the cancer cells to grow and divide when they shouldn't or to keep living when healthy cells would die. This causes too many irregular cells to accumulate.

The cancer cells might form a mass called a tumor. The tumor can grow to invade and destroy healthy tissue. In time, cancer cells can break away and spread to other parts of the body. When cancer spreads, it's called metastatic cancer. Metastatic cancer is named for the original tumor site. For example, a tumor that initially started in the breast and then spread to the bone is called metastatic breast cancer in the bone.

Most bone cancers are not inherited. But a small number are linked to rare inherited genetic conditions, such as Li-Fraumeni syndrome and hereditary retinoblastoma. Having one of these conditions raises the risk of developing some types of bone cancer. But most people diagnosed with bone cancer do not have an inherited syndrome.

Things that raise the risk of bone cancer include:

• Inherited genetic syndromes. Some rare genetic syndromes passed through families raise the risk of bone cancer. Examples include Li-Fraumeni syndrome and hereditary retinoblastoma.
• Other bone conditions. Some other bone conditions may increase the risk of bone cancer. These include Paget's disease of bone and fibrous dysplasia.
• Cancer treatment. Radiation therapy for cancer and some kinds of chemotherapy medicines used to treat cancer may raise the risk of bone cancer.

Healthcare professionals haven't found any ways to prevent bone cancer.

Your care team may start with a physical exam and medical history. You may have blood tests to learn more about your overall health or rule out other conditions. Blood tests alone can't diagnose bone cancer. Imaging tests and a biopsy are usually needed to confirm the diagnosis.

Imaging tests

Imaging tests make pictures of the body. They can show the location and size of a bone cancer. Tests might include:

• X-ray.
• Magnetic resonance imaging (MRI).
• Computerized tomography (CT) scan.
• Positron emission tomography (PET) scan.
• Bone scan.

Biopsy

A biopsy is a procedure to remove a sample of tissue for testing in a lab. For bone cancer, the sample of tissue might be collected by:

• Inserting a needle through the skin. During a needle biopsy, a healthcare professional inserts a thin needle through the skin and guides it into the cancer. The health professional uses the needle to collect small samples of tissue.
• Removing the sample during surgery. During a surgical biopsy, a surgeon makes an incision in the skin to access the cancer. The surgeon removes a piece of the cancer for testing.

Determining the type of biopsy you need and how to do the biopsy requires careful planning by your medical team. Healthcare professionals need to perform the biopsy in a way that won't interfere with future surgery to remove bone cancer. Whenever possible, the biopsy should be performed by the team that will treat the bone cancer.

Bone cancer treatments may include surgery, chemotherapy and radiation therapy. Which treatments are best for your bone cancer depends on several factors. These factors include the type, location and stage of the bone cancer. Your healthcare team also considers your overall health and your preferences.

Surgery

The goal of surgery for bone cancer is to remove all of the cancer. The surgeon may remove the bone cancer and some healthy tissue around it. Then the surgeon repairs the bone. This might involve using a piece of bone from another part of your body. Or the bone may be repaired with metal or plastic material.

Sometimes surgeons need to remove an arm or leg to get all of the cancer. This isn't common, but it might be needed if the cancer grows very large, if the cancer is in a place that makes surgery difficult, or if important nerves, blood vessels or other structures are involved. After an arm or leg is removed, you may choose to use an artificial limb. With training and time with the new limb, you can learn to do many everyday tasks.

Chemotherapy

Chemotherapy treats cancer with strong medicines. Many chemotherapy medicines exist. Most chemotherapy medicines are given through a vein. Some come in pill form.

Chemotherapy is often used after surgery for some types of bone cancer. It can kill any cancer cells that remain and lower the risk that the cancer will come back. Sometimes chemotherapy is given before surgery to shrink a bone cancer and make it easier to remove.

Not all types of bone cancer respond to chemotherapy treatments. Chemotherapy is often used to treat osteosarcoma and Ewing sarcoma. It's not often used for chondrosarcoma but may be used for certain uncommon subtypes.

Radiation therapy

Radiation therapy treats cancer with powerful energy beams. The energy can come from X-rays, protons or other sources. During radiation therapy, you lie on a table while a machine moves around you. The machine directs radiation to precise points on your body.

Radiation therapy might be used after surgery to kill any bone cancer cells that might remain. It also might help control bone cancer when surgery isn't an option.

Some types of bone cancer are more likely to be helped by radiation therapy than others. Radiation therapy may be an option for treating Ewing sarcoma. It's not often used to treat chondrosarcoma or osteosarcoma but may be used when surgery cannot remove the tumor completely.

A cancer diagnosis can feel overwhelming. With time, you'll find ways to cope with the distress and uncertainty of cancer. Until then, you may find it helps to:

• Learn enough about bone cancer to make decisions about your care. Ask your healthcare team about your bone cancer, including your treatment options and, if you like, your prognosis. As you learn more about bone cancer, you may feel more confident in making treatment decisions.
• Keep friends and family close. Keeping your close relationships strong can help you deal with your bone cancer. Friends and family can provide the practical support you'll need, such as helping take care of your home if you're in the hospital. And they can serve as emotional support when you feel overwhelmed by cancer.
• Find someone to talk with. Find a good listener who is willing to listen to you talk about your hopes and fears. This may be a friend or family member. The concern and understanding of a counselor, medical social worker, clergy member or cancer support group also may be helpful. Ask your healthcare team about support groups in your area.

If you have any symptoms that worry you, start by making an appointment with a doctor or other healthcare professional. If your health professional suspects you may have bone cancer, you may be referred to a specialist. Bone cancer is often treated by a team of specialists that may include:

• Surgeons who operate on bones and joints, called orthopedic surgeons.
• Orthopedic surgeons who specialize in operating on cancers that affect the bones, called orthopedic oncologists.
• Doctors who specialize in treating cancer with medicine, called medical oncologists.
• Doctors who specialize in treating blood and bone marrow conditions including cancer, called hematologists.
• Doctors who use radiation to treat cancer, called radiation oncologists.
• Doctors who analyze tissue to diagnose the specific type of cancer, called pathologists.
• Rehabilitation specialists who can help you recover after surgery.

How to prepare

Because appointments can be brief, it's a good idea to be prepared. Try to:

• Be aware of any restrictions before your appointment. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
• Write down any symptoms you have, including any that may seem unrelated to the reason you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medicines, vitamins or supplements that you're taking.
• Consider taking a family member or friend along. Sometimes it can be difficult to remember all the information provided during an appointment. Someone who goes with you may remember something that you missed or forgot.
• Bring your previous scans or X-rays, the related reports and any other medical records important to this situation to the appointment.

Questions to ask

Preparing a list of questions can help you make the most of your time with your care team. List your questions from most important to least important in case time runs out. For bone cancer, some basic questions to ask include:

• What type of bone cancer do I have?
• What is the stage of my bone cancer?
• How quickly is my bone cancer growing?
• Will I need any additional tests?
• Should my biopsy or treatment be done at a center that specializes in bone cancer?
• What are the treatment options for my bone cancer?
• What are the chances that treatment will cure my bone cancer?
• What are the side effects and risks of each treatment option?
• Will treatment make it impossible for me to have children?
• I have other health conditions. How will cancer treatments affect my other conditions?
• Is there one treatment that you think is best for me?
• What would you recommend to a friend or family member in my situation?
• Should I see a specialist? What will that cost, and will my insurance cover it?
• If I would like a second opinion, can you recommend a specialist?
• Are there any brochures or other printed material that I can take with me? What websites do you recommend?

In addition to the questions that you've prepared, don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Be prepared to answer some questions about your symptoms and your health history. Questions may include:

• When did you first begin experiencing symptoms?
• Have your symptoms been ongoing, or do they come and go?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?