Bone Cancer Risk Factors
Understating what is bone cancer and Learning about its types, risk factors and its clinical implications, symptoms and prevention strategy.
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Last updated on 13th Jun, 2025
Introduction
Bone cancer begins within the bone itself, with the thigh bone being the most frequently affected area. It’s essential to clarify that "bone cancer" refers specifically to cancers that start in the bones, not those that have metastasised from other locations in the body. For instance, if lung cancer spreads to the bones, it is still referred to as lung cancer.
Bone cancer is relatively uncommon and can be classified into various types, which differ in how often they occur among different age groups. Some types are primarily found in children, while others are more prevalent in adults.
Types of Bone Cancer
Primary bone cancers, known as bone sarcomas, originate within the bone itself. Here are the main types:
1. Osteosarcoma
Osteosarcoma is the most prevalent primary bone cancer, typically affecting those aged 10 to 30. It generally arises in the arms, legs, or pelvis, with about 10% occurring in individuals over 60. This type is more common in males.
2. Ewing Tumour (Ewing Sarcoma)
Ewing tumours are the second most common bone cancer in children and young adults and are rare in adults over 30. They typically develop in the pelvic bones, chest wall, spine, and long bones.
3. Chondrosarcoma
Chondrosarcoma originates from cartilage cells and is the second most common primary bone cancer. It is uncommon in individuals under 20, with risk increasing with age. These tumours often occur in the pelvic bones and legs. They are graded from I to III based on growth rate, with lower grades being slower-growing.
4. Uncommon Subtypes of Chondrosarcoma
Dedifferentiated: Starts as a typical chondrosarcoma but can change into high-grade sarcoma cells, growing more rapidly.
Mesenchymal: Often seen in younger adults, this type grows quickly and is more likely to recur.
Clear Cell: Rare and usually slow-growing, with a low chance of spreading unless recurrent.
5. High-Grade Undifferentiated Pleomorphic Sarcoma (UPS) of Bone
This rare cancer typically begins in soft tissues but can also affect bones, particularly the legs or arms, and is more common in older adults.
6. Fibrosarcoma of Bone
Fibrosarcoma is more frequently found in soft tissues and usually affects middle-aged adults, primarily in the legs, arms, and jaw.
7. Giant Cell Tumour of Bone
Giant cell tumours can be either benign or malignant, mainly affecting those in their 20s and 30s, often near the knees. They can recur after surgery but rarely spread to other parts of the body.
8. Chordoma
Chordomas are uncommon tumours that develop in the spine, especially at the base of the skull or the sacrum. They tend to grow slowly and may recur locally if not completely removed.
9. Other Cancers in the Bone
Some cancers affecting the bone do not originate from bone cells, including:
Multiple Myeloma: Arises from plasma cells in the bone marrow.
Leukaemias: Start in blood-forming cells in the bone marrow.
Non-Hodgkin Lymphomas: Occasionally present as primary non-Hodgkin lymphoma in the bones.
Risk Factors for Bone Cancer
Several factors have been linked to an increased risk of developing bone cancer:
1. Previous Cancer Treatment
Those who have received radiation therapy or certain chemotherapy drugs for other cancers may be at a greater risk of later developing bone cancer.
2. Genetic Factors
Some rare inherited genetic disorders can heighten the likelihood of bone cancer, such as:
Li-Fraumeni syndrome: Associated with mutations in the p53 tumour suppressor gene.
Hereditary retinoblastoma: This condition raises the risk of osteosarcoma.
Other genetic syndromes linked to specific bone cancers include Rothmund-Thomson syndrome, multiple exostoses syndrome, and tuberous sclerosis.
3. Benign Bone Conditions
In rare cases, benign bone conditions can progress to cancer. For instance, Paget's disease and multiple enchondromas may increase the risk.
4. Environmental and Lifestyle Factors
Exposure to high doses of radiation can lead to changes in bone cells that may result in cancer. This risk is particularly noted in individuals who have undergone high-dose radiation therapy or chemotherapy with alkylating agents during childhood. Common alkylating agents include:
Carboplatin
Cisplatin
Cyclophosphamide
About 5% of children who have received myeloablative hematopoietic stem cell transplants for cancer may later develop osteosarcoma.
5. Biological and Demographic Factors
Older Age: The risk of certain primary bone cancers, such as chondrosarcoma and chordoma, increases with age.
Height: Taller individuals, especially children, may face a higher risk of osteosarcoma due to increased cell activity in the growth plates of long bones.
6. Medical and Health History
Children who have had retinoblastoma may be at greater risk of developing bone cancer because of the same genetic factors.
Research suggests that babies born with an umbilical hernia may have an increased risk of Ewing sarcoma, although the overall risk remains low.
Certain benign conditions, particularly Paget's disease, can elevate the risk of bone cancer in older adults, especially those over 50. Paget's disease involves abnormal bone cell development, resulting in heavier but weaker bones.
Symptoms of Bone Cancer
The signs and symptoms of bone cancer can include:
Bone Pain: Ongoing pain in the affected bone or surrounding areas.
Swelling and Tenderness: Noticeable swelling or sensitivity around the affected site.
Weakened Bone: A greater risk of fractures due to compromised bone strength.
Fatigue: feeling of tiredness or lack of energy.
Unintentional Weight Loss: Significant weight loss without trying.
Prevention and Risk Reduction for Bone Cancer
At present, experts do not completely understand what causes bone cancers, and no specific preventive measures are known. Since radiation therapy, a known risk factor for bone cancer, is sometimes required for other cancers, it cannot be entirely avoided.
After treatment, it’s essential to keep all follow-up appointments. During the first two years, you may need to visit your healthcare provider every three to six months, with intervals becoming less frequent afterwards. This consistent monitoring helps detect any potential recurrence of cancer early, when treatment is most effective.
Conclusion
Overall, approximately 60% of individuals diagnosed with bone cancer will survive for at least five years after their diagnosis, with many experiencing a full recovery. The prognosis for bone cancer is influenced by several factors, such as age, the specific type of bone cancer, the extent of its spread (known as the stage), and its potential for further spread (referred to as the grade). Typically, bone cancer is more manageable in otherwise healthy individuals when it has not spread beyond its original site.
Nonetheless, if you observe any unusual changes in your bones, such as a lump or increasing pain, it’s advisable to consult a healthcare provider. While these symptoms typically do not indicate cancer, only a professional can determine the underlying issue.
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