Bone cancer

Primary bone cancer starts in one of the bones that make up the skeleton. If your child has cancer that started elsewhere but has spread to their bones, this is known as ‘secondary bone cancer’ or ‘bone metastasis’. The information below refers to primary bone cancer.

The body is made up of more than 200 bones. These bones work together to help you move, protect vital organs and store essential minerals.

Types of bone cancer
Who does it affect?
What are the symptoms?
How is it diagnosed?
How are they treated?
What are the treatment side effects?
After treatment

Types of bone cancer

There are a number of different types of bone cancers. However, the ones that are most common in young people are:

  • Osteosarcoma which can start in any bone but it is most likely to occur in the knee, thigh bone, shin bone or upper arm
  • Ewing’s sarcoma which can also affect any bone but it is most likely to occur in the thigh or shin bones or pelvis. Ewing’s sarcoma can also develop in the soft tissue.

Who does it affect?

Bone cancers can develop at any age. However, some types are thought to be associated with the ‘growth spurts’ that occur from ten years of age, when bones are growing rapidly.

Osteosarcomas are more commonly diagnosed in teenagers and young adults rather than younger children. Ewing’s sarcomas are more common in teenagers and young adults than any other age group.

What are the symptoms?

The symptoms of bone cancer will vary depending on the size of the cancer and where it is in the body. Your child may experience pain around the area of the tumour or notice some swelling. If the cancer is near a joint, they may have some difficulty moving that part of their body. Occasionally, a bone that is weakened by bone cancer may break – but this is very rare.

These symptoms may also be linked to a number of different conditions, so it’s important to visit your GP and get checked out.

How is it diagnosed?

Bone cancer is usually diagnosed by specialists at a hospital or bone treatment centre. Your child may need X-rays, a bone scan, a CT scan and an MRI scan to help the specialists determine the location of the cancer and how much it has spread.

They will also need to take a sample of the bone (a biopsy) to examine under a microscope. This, and any further surgery, may need to be done by a surgeon who specialises in bone tumours, so your child may need to be referred to another hospital. Your child will be given a local or general anaesthetic while they do the biopsy.

How are they treated?

The most common types of treatment for bone cancers are surgery, chemotherapy and radiotherapy. Talk to your specialist about your child's individual treatment plan.

Surgery

Surgery involves having an operation to remove the tumour from the bone. This is usually done in a specialist centre by an orthopaedic surgeon who specialises in tumours. Your specialist will discuss your child's options with you beforehand. In the past, it was often necessary to remove the limb affected by cancer. However, specialists will now try to use ‘limb-sparing surgery’, if possible. This means that they will replace the part of the bone that has been removed with a specially made metal bone (or joint) called a prosthesis or with bone from another part of the body.

Chemotherapy

Chemotherapy involves targeting the cancer cells with anti-cancer drugs. It is an important part of the treatment for both osteosarcomas and Ewing’s sarcomas. It may be given before surgery or radiotherapy to shrink the size of your child's tumour and make it easier to remove. It may also be given afterwards to destroy any remaining cancer cells.

Radiotherapy

Radiotherapy is often used for Ewing’s sarcomas and other bone cancers that are not able to be removed by surgery. This treatment will usually be given in the radiotherapy department of a hospital over the course of a few weeks.

Proton Beam Therapy

For certain types of bone tumours, your specialist may recommend your child have a specialised form of radiotherapy called proton beam therapy which can involve travelling abroad.

What are the treatment side effects?

If your child is undergoing chemotherapy, they may experience side effects such as tiredness, sickness, diarrhoea and temporary hair loss. They may also be at greater risk of infections.

Radiotherapy can also make them feel tired and sick. They might experience skin irritation similar to sunburn and hair loss in the area that is being treated.

Talk to your specialist or nurses about how you can manage these side effects, or see the side effects section of our website for more information.

After treatment

Follow-up

After your child's treatment is complete they will still need to be seen regularly at an outpatient clinic. At this clinic, your specialist will be looking for any signs that the cancer has returned (this is known as a relapse). This may include regular chest X-rays.

They will also check that your child's major organs, such as their heart and lungs, are still functioning correctly and haven’t been affected by their cancer treatment.

Long-term follow-up

Once your child's risk of relapse has reduced, the focus of ongoing follow-up changes to looking out for potential long-term side effects of treatment.The risk of long-term side effects depends on the type of cancer your child had and the treatment they received.

A personalised surveillance plan is usually created that outlines the specific long-term follow up and on-going investigations that your child requires. Many people are at low risk of future health problems but some will have significant ongoing health needs. Talk to your specialist about the potential long-term side effects of your treatment.

If your child has a prosthesis (a metal bone or joint), it is also important to keep an eye out for any signs of infection. If they experience pain or fever, talk to a specialist as soon as possible.

Long-term side effects

Whether your child has had limb-sparing surgery or an amputation, it will take them time to adjust to the changes. After the operation, they will need physiotherapy to help them regain their strength. Depending on the limb affected, they may have some difficulty with getting around and doing everything that they did before cancer.

If your child has limb-saving surgery while they are still growing, they may need a further operation to ensure that their limb with the metal fitting or bone graft continues to lengthen at the same rate as the rest of their body.

Losing a limb - or part of one - can be very difficult to deal with. It may help for your child to talk things through with someone close to them or someone in their medical team. Your team may also be able to direct you to specialists or organisations who can support you and your child with emotions and the impact on day-to-day life.

Where next?

Updated November 2017, next review due 2019.

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