Bone cancer

Find out about bone cancer, including what the symptoms are, what causes it, and how it's diagnosed and treated.

What is bone cancer?

• Cancer that starts in the bones is called primary bone cancer. It's also known as sarcoma and is very rare.
• You can get primary bone cancer in any bone, but it most commonly affects the hips (pelvis), ribs and bones in the arms and legs.
• The most common types of primary bone cancer are osteosarcoma, chondrosarcoma and Ewing sarcoma.
• Things that can increase your chance of getting primary bone cancer include your age, having another bone condition like Paget's disease of bone, and having radiotherapy or chemotherapy for cancer in the past.
• Surgery and chemotherapy are often used to treat primary bone cancer. Radiotherapy and targeted medicines may also be used.

Secondary bone cancer

Primary bone cancer is not the same as secondary bone cancer, which starts in another part of the body and spreads to the bones.

Symptoms of bone cancer

Main symptoms of bone cancer

The symptoms of primary bone cancer depend on the type and size of the cancer and where it is.

The main symptoms of bone cancer are:

• bone pain or tenderness – the pain may be constant or come and go, and it may be worse at night
• a lump or swelling (but it may not always be easy to see or feel)
• problems moving around – if the cancer is close to a joint, it may be difficult to move the joint and you may walk with a limp

Less common symptoms of bone cancer include:

• feeling very tired even after a good night's sleep
• high temperature (fever) – you may sweat a lot
• losing weight without trying to
• breaking a bone, but this is a very rare symptom of bone cancer

See a GP if:

• you have pain or tenderness in a bone, particularly if it's worse at night
• you notice a change that's not normal for you – for example, you have a lump or swelling or unexpected weight loss
• pain in your bones or joints is making it difficult for you to move around

You might not have bone cancer, but it's important to see a GP so they can check your symptoms. Finding bone cancer early can mean it's easier to treat.

What happens at your GP appointment

The GP will look at the part of your body that's painful.

They may feel your lymph nodes to check for any swelling. Lymph nodes are small glands found throughout the body, including in the neck, armpit and groin.

Tell the GP if you or a member of your family have had cancer in the past.

Referral to a specialist

The GP may refer you to a specialist in hospital for more tests if they think you have a condition that needs to be investigated.

This may be an urgent referral if you have certain symptoms. This does not definitely mean you have cancer.

Causes of bone cancer

Main causes of bone cancer

It's not known what causes most primary bone cancers.

Some types of bone cancers are more common in certain age groups.

For example:

• Ewing sarcoma is more common in children and teenagers, but it can also affect adults
• osteosarcoma often affects children and teenagers (10 to 19 years)
• chondrosarcoma tends to affect adults aged 30 to 60 years

You're also more likely to get bone cancer if:

• you've had radiotherapy or chemotherapy treatment for cancer in the past, particularly during childhood
• you have an inherited condition like hereditary retinoblastoma, Li-Fraumeni syndrome or Werner syndrome
• you have another bone condition, such as Paget's disease of bone or a non-cancerous (benign) bone tumour

Tests and next steps for bone cancer

Main tests for bone cancer

If a GP thinks you could have bone cancer, they'll refer you to a bone specialist (an orthopaedic doctor) for some tests.

Tests you may have include:

• an X-ray
• a scan, such as a CT scan or MRI scan
• a bone biopsy – where a surgeon removes a small sample of bone so it can be sent to a lab and checked for cancer
• blood tests
• a bone marrow biopsy

Bone marrow is a spongy substance inside bones.

During a bone marrow biopsy, a thin needle is used to remove some bone marrow cells, usually from your hip. The sample is checked for cancer.

Getting your results

Your specialist should let you know when you can expect to get the results of the bone biopsy. They will be sent to the GP or the hospital where you had the procedure.

It should take about 2 weeks for the results to come back, but sometimes it might be longer.

Try not to worry if your results are taking longer than you expect. It does not mean anything is wrong.

You can call the hospital or GP if you're worried. They should be able to update you.

A specialist will explain what the results mean and what will happen next. You may want to bring someone with you for support.

If you're told you have bone cancer

Being told you have bone cancer can feel overwhelming. You may be feeling anxious about what will happen next.

It can help to bring someone with you to any appointments you have.

A group of specialists will look after you throughout your diagnosis, during and after treatment.

Your team will include a clinical nurse specialist who will be your main point of contact during and after treatment.

You can ask them any questions you have.

Treatment for bone cancer

Main treatments for bone cancer

Primary bone cancer can often be treated.

The treatment you have will depend on:

• the type of bone cancer you have
• where the cancer is
• your general health
• your treatment preferences

Surgery and chemotherapy are the main treatments for primary bone cancer. Radiotherapy or targeted medicines are also used to treat some types of bone cancer.

The specialist care team looking after you will:

• explain the treatments, benefits and side effects
• work with you to create a treatment plan that's best for you
• discuss the chances of the bone cancer coming back and how it will be treated if it does

You'll have regular check-ups during and after any treatments. Depending on the stage of your bone cancer, you may have tests and scans.

If you have any symptoms or side effects you're worried about, talk to your specialists. You do not need to wait for your next check-up.

Secondary bone cancer is treated differently to primary bone cancer.

Surgery

Surgery is one of the main treatments for primary bone cancer.

The type of surgery you need depends on things such as:

• the size of the cancer
• where the tumour is and if it has spread to other areas of your body
• how well chemotherapy has worked to shrink the tumour (if you’ve had it)

Types of bone cancer surgery include:

• cutting out the affected bone and replacing it with a metal implant or bone from another part of your body
• removing the affected limb (amputation) – this may be needed if the tumour has spread to the surrounding area
• removing cancer that has spread to another part of your body (metastasectomy)

As part of your recovery you will need physiotherapy to help you regain your mobility.

You'll also need regular follow up appointments to check your progress and deal with any problems.

Chemotherapy

Chemotherapy uses medicines to kill cancer cells.

It's very effective in treating some types of bone cancer, particularly Ewing sarcoma.

Reasons you may need to have chemotherapy include:

• to shrink a tumour before surgery and make it easier to remove
• to reduce the chances of the cancer coming back after surgery
• if you have Ewing sarcoma that cannot be completely removed with surgery, you may need chemotherapy with radiotherapy
• to slow the growth of a tumour and help control your symptoms if the cancer cannot be cured

Radiotherapy

Radiotherapy uses high-energy rays of radiation to kill cancer cells.

It's not always used to treat bone cancer, but it may be needed:

• if you have Ewing sarcoma
• if you have osteosarcoma or chondrosarcoma and surgery is not possible
• to reduce the chance of bone cancer coming back after having surgery

The type of radiotherapy you need will depend on the type of bone cancer you have and what stage it's at.

Targeted medicines

Targeted medicines aim to stop the cancer growing.

They may be recommended depending on:

• the type of bone cancer you have
• how big the cancer is and how far it has spread (the stage)
• any other treatments you've had for the cancer
• your general level of health

You may have a targeted medicine on its own or in combination with chemotherapy.

What happens if you've been told your cancer cannot be cured

If you've been diagnosed with advanced bone cancer, it might be very hard to treat. It may not be possible to cure the cancer.

In this situation, the aim of your treatment will be to limit the cancer and its symptoms, and help you live longer.

Finding out the cancer cannot be cured can be very hard news to take in.

You'll be referred to a special team of doctors and nurses called the palliative care team or symptom control team.

They'll work with you to help manage your symptoms and make you feel more comfortable.

The clinical nurse specialist or palliative care team can also help you and your loved ones get any support you need.