Bone cancer is a malignant tumor that can start in the bone itself, called a primary bone tumor, or develop when cancer from another part of the body spreads to the bones, leading to bone metastases, also known as secondary bone cancer.

This condition can affect any bone in the body, but it is more common in long bones such as the femur (in the leg) or the humerus (in the arm). It typically causes symptoms like bone pain, joint swelling, and frequent or easily occurring fractures.

Treatment for bone cancer is managed by an oncologist and usually involves chemotherapy, radiation therapy, or surgery, depending on the tumor’s type, size, and location.

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Bone cancer symptoms

The most common symptoms of bone cancer include:

Bone pain that comes and goes;
Pain that worsens at night or when moving the affected limb;
Swelling or tenderness near the affected bone or joint;
A lump or mass that can be felt over the bone;
Fragile bones that fracture easily after minor injuries, especially in the arms, legs, or spine.

Other possible signs include unexplained weight loss, persistent fatigue, and ongoing fever.

When bone cancer affects the spine, it can compress nearby nerves, leading to numbness, tingling, or weakness in different parts of the body, depending on where the tumor is located.

Symptoms of bone metastasis

Symptoms of bone metastasis, or secondary bone cancer, are generally the same as those seen in primary bone cancer.

Confirming a diagnosis

A diagnosis of bone cancer is made by an oncologist after assessing the person’s symptoms, medical history, and results from physical exams, blood tests, and imaging studies.

The imaging tests that may be ordered include:

X-rays;
CT scan;
MRI;
Bone scan (nuclear medicine scintigraphy);
PET/CT scan.

Blood tests, tumor markers, or a bone biopsy may also be requested to confirm the diagnosis.

Possible causes

The main causes and risk factors for bone cancer include:

Family history of bone cancer;
Age, as it is more common in children and young adults;
Paget’s disease of bone;
Previous radiation therapy;
Inherited syndromes such as Li-Fraumeni, Werner, or Rothmund-Thomson syndromes.

Certain cancers, like breast, lung, or prostate cancer, are also more likely to spread to the bones and cause bone metastases.

Different types

There are several types of bone cancer, which are classified based on the specific cells where the cancer starts. These include:

1. Osteosarcoma

Osteosarcoma is the most common type of primary malignant bone tumor. It starts in the cells responsible for forming bone and typically affects the long bones of the arms, legs, and pelvis.

This type of bone cancer mainly occurs in children, teenagers, and young adults under 25 years old.

2. Chondrosarcoma

Chondrosarcoma is another type of primary bone tumor that begins in cartilage cells. It is the second most common form of bone cancer.

It tends to occur more often in men over 50 years of age.

3. Ewing sarcoma

Ewing sarcoma is a rare form of cancer that develops in the bones or surrounding soft tissues. It primarily affects children and adolescents and is uncommon in adults over 30.

This cancer often develops in the pelvic bones or in the long bones of the legs and arms.

4. Fibrosarcoma

Fibrosarcoma is a type of primary bone cancer that develops from soft tissues, such as ligaments and tendons, located near bones.

It usually affects the legs, arms, or jaw and occurs more frequently in adults.

5. Giant cell tumor of bone

A giant cell tumor of bone can be either benign or malignant and typically develops near the knees, arms, or legs.

This tumor is more common in young adults.

6. Chordoma

Chordoma is a rare primary bone tumor that develops at the base of the skull or along the spine. It is more often diagnosed in adults over 30 years old.

7. Undifferentiated pleomorphic sarcoma (formerly malignant fibrous histiocytoma)

Undifferentiated pleomorphic sarcoma (UPS) is a type of primary bone cancer that begins in ligaments and tendons near bones. It is more common in older adults.

8. Bone metastasis

Bone metastasis is a type of secondary bone cancer, meaning it does not originate from bone cells.

It often develops when advanced cancer from another organ, such as the breast, prostate, or lungs, spreads to the bones.

Treatment for bone cancer

Treatment for bone cancer should be guided by an oncologist and depends on the tumor’s type, size, location, and whether it has spread to other parts of the body.

The main treatment options for bone cancer include:

1. Radiation therapy

Radiation therapy uses high doses of radiation to destroy cancer cells, slow tumor growth, and shrink tumor size. It can be recommended before surgery to make tumor removal easier.

However, bone cancer cells are often less sensitive to radiation, so radiation therapy is usually combined with other treatments rather than used alone.

2. Chemotherapy

Chemotherapy uses drugs that target cancer cells during specific phases of cell division to stop them from multiplying.

These medications are typically administered intravenously but may sometimes be given orally, depending on the drug and the stage of the cancer.

Chemotherapy is most effective for certain types of bone cancer, such as osteosarcoma and Ewing sarcoma, but may also be used for secondary bone metastases.

3. Surgery

Surgery is performed to remove the tumor along with a small margin of healthy tissue. In some cases, bone grafts or artificial implants are used to reconstruct or repair the affected bone.

In severe cases, amputation of the affected limb may be necessary to prevent the spread of cancer, although doctors try to preserve as much function as possible. When needed, an endoprosthesis can be created to replace the removed bone.

4. Palliative care

When bone cancer is at an advanced stage, especially in metastatic cases, palliative care may be recommended.

This type of care focuses on improving the person’s quality of life by reducing pain and managing symptoms through pain relievers and supportive measures.

Treatment for bone metastasis

Treatment for secondary bone cancer is carried out by a multidisciplinary team, which may include an oncologist, orthopedic surgeon, primary care doctor, psychologist, radiation therapist, and nursing staff.

The main goals are to treat the primary cancer, prevent pathological fractures, and improve the person’s quality of life. Preventive surgeries may be performed to avoid complications.

Pain management for bone metastasis may involve:

Pain relievers (analgesics);
Nonsteroidal anti-inflammatory drugs (NSAIDs);
Bone-modifying agents such as bisphosphonates (e.g., zoledronic acid) or denosumab to relieve bone pain and prevent bone damage.

For people with persistent or recurrent bone pain after radiation therapy, additional options such as radiofrequency ablation, cryoablation, or focused ultrasound therapy may be recommended.

Bone Cancer: Symptoms, Diagnosis & Treatment