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Bone Cancer

Bone cancer, also known as bone sarcoma, develops when cells of the bone and cartilage grow in an uncontrolled or abnormal way.

Last modified: February 28, 2022

Quick facts about bone cancerQuick facts

  • Bone cancer can begin in any bone in the body and may develop from the centre of the bone, on the surface of the bone or on the outer layer of the bone
  • Primary bone cancer is different to secondary (or metastatic) bone cancer, which refers to a cancer that started somewhere else in the body and has spread to the bones

Types of bone cancerTypes of bone cancer

There are more than 30 types of primary bone cancer.

The most common types of bone cancer include:

Osteosarcoma Chondrosarcoma Ewing’s sarcoma

Osteosarcoma

This type of bone cancer affects the cells which grow bone tissue. Osteosarcoma is fast-growing and often develops in the long bones (arms or legs) but can start in any bone. It accounts for approximately 35% of bone cancers and is most common in children and young adults with growing bones or adults over 70 years of age.

Chondrosarcoma

This type of bone cancer grows in the cartilage. Chondrosarcoma is slow-growing and often develops in the pelvis, ribs, shoulder blade, upper arms or legs. It accounts for approximately 30% of bone cancers and is most common in adults over 50 years of age.

Ewing’s sarcoma

Ewing’s sarcoma grows in the bones or in the soft tissue around the bones. This type of bone sarcoma is fast-growing and often develops in the spine, legs, upper arms, pelvis and ribs. Ewing’s sarcoma accounts for approximately 15% of bone cancers and is most common in children and young adults.

Signs and symptoms of bone cancerSigns and symptoms

As signs and symptoms for bone cancer can be similar to other common conditions such as arthritis and osteoporosis, it’s important to see your GP or healthcare professional if you experience any of the symptoms below. Discussing anything concerning with your doctor as soon as possible can help give you peace of mind and offer the best chance of successful treatment if you receive a bone cancer diagnosis.

Symptoms may include:

  • Pain the bones and joints that may worsen at night or during activity

  • Swelling over the affected part of the bone

  • Stiffness or tenderness in the bone

  • Problems with movement such as an unexplained limp

  • A fractured bone, even with no or minimal trauma

  • Unexplained weight loss

Stages of bone cancerStages

The TNM system is used to stage bone cancer, and it helps doctors understand what your cancer looks like. TNM stands for:

  • Tumour – describes the size of the tumour. The tumour can be graded from T1 (describing a tumour 8cm or less), T2 (describing a tumour larger than 8cm) or T3 (there is more than one separate tumour in the bone). This stage applies to osteosarcoma which often develops in the long bones of the arms or legs
  • Node – is a measure of whether the tumour has spread to nearby lymph nodes. Nodes can be graded from N0, where there has been no spread, through to N1, where the cancer has spread to the lymph nodes. It is rare for primary bone cancer to spread to the lymph nodes
  • Metastasis – the degree to which the cancer has spread to other organs of the body. Metastasis can be graded from M0, where there has been no spread, through to M1, where the cancer has spread to other organs of the body and formed additional tumours

Bone cancer is also given a grade to determine how quickly it will grow. Bone cancers with a higher grade are more aggressive and have a higher likelihood of growing and spreading faster compared to those with a lower grade.

  • Low grade – the cancer cells in the bone are slow growing and tend not to spread
  • High grade– the cancer cells look very different compared to healthy bone cells and tissue, and tend to grow and spread more quickly

The TNM system, along with the grading, helps determine the stage of your bone cancer using the guidelines below:

Stage I bone cancer Stage II bone cancer Stage III bone cancer Stage IV bone cancer

Stage I

A single low grade tumour that has not spread beyond the bone to the lymph nodes or other organs of the body.

Stage II

A single high grade tumour that has not spread beyond the bone to the lymph nodes or other organs of the body.

Stage III

Several high grade tumours in the same bone that has not spread beyond the bone to the lymph nodes or other organs of the body.

Stage IV

The tumour may be any size or grade and has spread to the lymph nodes and other organs of the body.

Treatment for bone cancer

There are many different types of treatment for bone cancer. Your treatment will depend on you and your cancer.

Learn more

Frequently asked questions about bone cancerFAQs

Is bone cancer hereditary?

While there may be genetic changes linked to bone cancer that can be inherited, the majority of bone cancers are not caused by inherited genes.

There are two common inherited disorders that have been linked to bone cancer, including:

  • Hereditary retinoblastoma – Children diagnosed with this form of eye cancer face an increased risk of developing bone and soft tissue sarcomas
  • Li-Fraumeni syndrome (LFS) – A genetic disorder that can increase a person’s chance of developing bone cancer
What causes bone cancer?

The cause of bone cancer is not fully known, however there are some factors which contribute to the risk of bone cancer developing, including:

  • Genetics – People with a history of sarcomas in their family have a higher risk of developing bone sarcoma
  • Radiation therapy – People who have had radiation treatment for other conditions have a higher risk of developing bone cancer in the part of the body that was treated with radiation therapy. The risk is higher for people who have had high doses of radiation therapy at a young age
  • Bone conditions – Some people who have had Paget’s disease and other conditions of the bone are at higher risk of developing bone sarcoma
How is bone cancer diagnosed?

There are many different tests that are used to diagnose bone cancer, alongside a physical examination. These tests may include an x-ray, CT or MRI scan as well as a bone biopsy (generally a fine needle aspiration (FNA), core needle biopsy or surgical open biopsy) to reveal and detect any bone abnormalities. You may receive additional scans such as a PET-CT scan to understand if the cancer has spread elsewhere in your body.

What is the difference between primary and secondary bone cancer?

Bone cancer can develop as a primary or secondary cancer. Primary bone cancer is a form of cancer that begins in any bone in the body and may develop from the centre of the bone, on the surface of the bone or the outer layer of the bone. Secondary (or metastatic) bone cancer refers to a cancer that has started somewhere else in the body (e.g. the lung or the breast) and has spread to the bones.

What can I do to decrease my risk of bone cancer?

While there are no proven measures to prevent bone cancer,  there are lifestyle-related factors you may like to consider to reduce your risk of developing cancer in general. These include:

  • Getting regular exercise – At least 30 minutes of moderate-intensity exercise each day
  • Reducing your alcohol intake – If you choose to drink, try to limit your alcohol intake to no more than two standard drinks a day
  • Eating a healthy, balanced diet – Eat a fibre-rich diet from grain and legume sources, as well as enjoying a variety of fruit (two serves) and vegetables (five serves) per day, limiting your intake of salt and saturated fats, and avoiding all processed meat

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ReferencesReferences

For a full list of references, click here.
  1. American Cancer Society. (2021). Bone Cancer. Retrieved on 13 December 2021 from https://www.cancer.org/cancer/bone-cancer/about/what-is-bone-cancer.html
  2. American Cancer Society (2021). Bone Cancer Stages. Retrieved on 13 December 2021 from https://www.cancer.org/cancer/bone-cancer/detection-diagnosis-staging/staging.html
  3. Net. (2020). Bone Cancer: Symptoms and Signs.Retrieved on 13 December 2021 from https://www.cancer.net/cancer-types/bone-cancer/symptoms-and-signs
  4. Net. (2020). Bone Cancer (Sarcoma of the Bone): Stages and Grades.Retrieved on 13 December 2021 from https://www.cancer.net/cancer-types/bone-cancer-sarcoma-bone/stages-and-grades
  5. National Cancer Institute. (2020). Adult Soft Tissue Sarcoma Treatment (PDQ®)–Patient Version. Retrieved on 13 December 2021 from https://www.cancer.gov/types/soft-tissue-sarcoma/patient/adult-soft-tissue-treatment-pdq#_26
  6. (2022). Bone Cancer: Types, Causes, Symptoms, and more. Retrieved on 21 February 2022 from Bone Cancer: Types, Causes & Symptoms (healthline.com)
  7. Health Promotion Board. (2021). Singapore Cancer Registry Annual Report 2018. Retrieved on 28 February 2022 from https://www.nrdo.gov.sg/docs/librariesprovider3/default-document-library/scr-annual-report-2018.pdf?sfvrsn=bcf56c25_0
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