Bone Cancer: Causes, Symptoms and Treatment
Understating what is bone cancer and Learning about its causes and risk factors, types, diagnosis, stages, prognosis and treatment.
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Last updated on 3rd Jul, 2025
Introduction
Bone cancer encompasses several types of cancers that develop within the bones. As cancer cells grow, they can damage healthy bone tissue. While bone cancer can form in any bone, it most often affects the thigh bone, shin bone, or upper arm.
When cancer originates in the bone, it is referred to as primary bone cancer or a bone sarcoma. In contrast, cancers that begin in other parts of the body, such as the breast, prostate, or lungs, can spread to the bones. These secondary tumours are known as bony metastases.
Types of Bone Cancer
Bone cancer is categorised based on the type of cell and tissue where it originates. The three main types of primary bone cancer are:
Osteosarcoma – The most common form, developing in bone-forming cells. It primarily affects teenagers but can also occur in children and young adults.
Ewing sarcoma – This type can arise in bones or nearby soft tissues. It is most frequently found in children and teenagers but can also affect young adults.
Chondrosarcoma – Originating in cartilage, the flexible tissue between bones and joints, this cancer is more prevalent in adults.
Less common types of bone cancer:
Chordoma – A tumour that develops in the spine or at the base of the skull.
Fibrosarcoma – Arises in fibrous connective tissue at the ends of bones.
Giant cell tumour – Usually benign (non-cancerous), but in rare cases, it may become malignant.
Undifferentiated pleomorphic sarcoma – A rare and aggressive cancer that can form in bone or soft tissue.
Causes and Risk Factors of Bone Cancer
Bone cancer develops when genetic mutations cause cells to grow and divide uncontrollably. While the body usually regulates cell growth and eliminates abnormal cells, these mutations can interfere with that process, leading to cancer.
The exact cause of these mutations is not always known, but several factors may contribute, including:
Environmental exposure – Radiation exposure may increase the risk of bone cancer.
Genetic conditions – Inherited disorders like hereditary retinoblastoma, Li-Fraumeni syndrome, and tuberous sclerosis complex can increase the risk of certain bone cancers.
Underlying medical conditions – Bone disorders like Paget’s disease of bone can cause abnormal cell growth, raising the risk of certain types of bone cancer like osteosarcoma.
Risk Factors for Bone Cancer
Certain factors may make bone cancer more likely, such as:
Age – The risk of primary bone cancers, such as chondrosarcoma and chordoma, increases with age.
Previous cancer treatments – High-dose radiotherapy or chemotherapy, particularly with alkylating agents, may increase the risk of osteosarcoma. A small percentage of children who have had a haematopoietic stem cell transplant may also develop osteosarcoma.
Height and bone growth – Taller-than-average children may have a slightly increased risk of osteosarcoma due to higher cell activity in the growth plates of long bones.
Symptoms of Bone Cancer
Some individuals with bone cancer may not show any symptoms apart from a painless lump. For others, a variety of symptoms can develop, which can sometimes be confused with other conditions like “growing pains,” sports injuries, arthritis, or Lyme disease, leading to a delayed diagnosis.
Common symptoms of bone cancer include:
Bone pain – Pain that becomes progressively more persistent, often more intense at night, and may feel throbbing, aching, or sharp.
Lump – A lump in the affected area, which can vary from hard to soft to the touch.
Swelling – Unexplained swelling around the affected bone.
Movement difficulties – If swelling is near a joint, it can result in difficulty moving.
Fatigue – Unexplained tiredness or weakness.
Fever – A fever that persists without a clear cause.
Bone cancer can be curable if identified early, before it has the chance to spread to other organs. Early diagnosis is crucial for improving treatment outcomes, so it’s important to consult your doctor if you have any worrying symptoms.
Diagnosis of Bone Cancer
Diagnosing bone cancer typically involves imaging tests to examine the affected bone. To determine whether a growth in the bone is cancerous, a tissue sample may be taken and analysed for cancer cells.
1. Imaging Tests
Imaging tests create detailed pictures of the body, helping to identify the location and size of bone cancer. These tests can include:
X-ray
Magnetic Resonance Imaging (MRI)
Computerised Tomography (CT) Scan
Positron Emission Tomography (PET) Scan
Bone Scan
2. Biopsy
A biopsy is a procedure in which a sample of tissue is removed for examination in a laboratory. For bone cancer, this sample may be taken in the following ways:
Needle biopsy – A thin needle is inserted through the skin and guided into the cancerous area to collect tissue samples.
Surgical biopsy – A surgeon makes an incision in the skin to access the tumour and removes a tissue sample for testing.
The type of biopsy and the method used will be carefully planned by your medical team to ensure it doesn’t complicate future surgery for cancer removal. It is essential to seek a referral to a healthcare team experienced in bone cancer treatment before undergoing a biopsy.
Stages of bone cancer
Staging bone cancer is crucial for developing an effective treatment plan. Here’s a summary of the different stages:
Stage 1:
The tumour is small and localised.
It grows slowly and has not spread beyond the original bone.
Stage 2:
The tumour is larger than in stage 1.
It remains localised but may be growing at a faster rate.
Stage 3:
The cancer may have spread to nearby bones.
This stage reflects a more aggressive growth pattern.
Stage 4:
The cancer has metastasised to lymph nodes or other parts of the body.
This stage indicates advanced disease, requiring a more intensive treatment approach.
Staging involves imaging studies and potentially biopsies, which help the medical team formulate a personalised treatment strategy.
Treatment Options for Bone Cancer
Treating bone cancer typically involves a combination of methods, with surgery being the primary approach:
1. Surgery
Limb-Sparing Surgery: Removes the tumour and some healthy tissue while preserving the limb. Bone grafts may be used for reconstruction.
Amputation: If the tumour is large or has spread, the limb may need to be removed. Patients are fitted with a prosthetic limb after recovery.
2. Radiation Therapy
Used to shrink tumours before surgery or to destroy remaining cancer cells afterwards. It may also be an alternative when surgery isn't viable.
3. Chemotherapy
Often employed for types like osteosarcoma and Ewing sarcoma. It helps shrink tumours before surgery and clears residual cells post-surgery. Common agents include:
Cisplatin
Cyclophosphamide
Doxorubicin
Etoposide
4. Targeted Therapy
Involves medications that target specific genetic or protein changes in cancer cells, useful for cancers resistant to chemotherapy.
5. Considerations for Treatment
Treatment decisions are influenced by:
The type and location of the cancer
The stage of the disease
The patient’s overall health and preferences
A combination of these treatments is often necessary for the best outcomes. If surgery is not possible, alternatives like chemotherapy, radiation, or targeted therapies may be used effectively.
Prognosis and Survival Rates of bone cancer
Survival rates vary based on age, overall health, type of bone cancer, and the stage at diagnosis. The five-year relative survival rate for primary bone cancer is around 67%, with better outcomes generally seen in patients diagnosed before the cancer spreads. Advances in treatment may also enhance these rates.
While successful treatment can lead to long-term remission, individuals with more aggressive forms of bone cancer may need ongoing radiation or chemotherapy. Each case is distinct, and your healthcare provider can give specific insights based on your circumstances.
Can bone cancers be prevented?
Currently, there is no known way to prevent bone cancers, as the exact causes remain unclear. Although radiation therapy is a recognised risk factor for bone cancer, it is often essential for treating other types of cancer, making complete avoidance impossible.
Conclusion
Bone cancer that begins in the bones is known as primary bone cancer and is relatively rare compared to secondary or metastatic bone cancer, which arises from other areas and spreads to the bones. The primary bone cancers are of mainly four types. Chondrosarcoma and chordoma typically affect adults aged 40 and above, while Ewing's sarcoma and osteosarcoma are more frequently seen in children and adolescents. The most common symptom for all types is persistent or unusual pain or swelling in the affected area. Treatment generally involves surgery to remove the tumour, along with possible chemotherapy and targeted therapies.
If you observe any unusual changes in your bones, such as a lump or increasing pain, it's important to see a healthcare professional.
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