Bone cancer

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

The bones

Your body is made up of more than 200 bones. These bones work together to help you move, protect your organs and store some of your body’s essential minerals (such as calcium).

Who does it affect?
What are the symptoms?
How is it diagnosed?
How are they treated?
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 your 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 your thigh or shin bones or pelvis. Ewing’s sarcoma can also develop in the soft tissue.

Who does it affect?

You can develop bone cancers at any age. However, some types are thought to be associated with the ‘growth spurts’ that occur from ten years of age, when your 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 depend on the size of the cancer and where it is in your body. You may experience pain around the area of the tumour or notice some swelling. If the cancer is near a joint, you may have some difficulty moving that part of your 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. You may need X-rays, a bone scan, a CT scan and an MRI scan to help the specialists find the location of the cancer and how much it has spread.

They will also need to take a sample of your bone (a biopsy) to examine under a microscope. This may need to be done by a surgeon who specialises in bone tumours, so that might mean that you'll need to go to another hospital. Find out more about biopsies.

How are they treated?

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

Surgery

Surgery involves having an operation to remove the tumour from the bone. This is usually done in by an orthopaedic surgeon who specialises in tumours. Your specialist will discuss everything with you beforehand. They will 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. Read more about having surgery.

Chemotherapy

Chemotherapy targets 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 tumour and make it easier to remove. It may also be given afterwards to destroy any remaining cancer cells. Read more about having chemotherapy. 

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. Read more about having radiotherapy.

Proton Beam Therapy

For certain types of bone tumours, your specialist may recommend you have a specialised form of radiotherapy called proton beam therapy. Read more about Proton Beam Therapy.

What are the treatment side effects?

If you are undergoing chemotherapy, you may experience tiredness, sickness, diarrhoea and temporary hair loss. You may also be at greater risk of infections.

Radiotherapy can also make you feel tired and sick. You 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 treatment is complete you will still need to be seen regularly at an outpatient clinic. At this clinic, your specialist will be looking for any signs that your cancer has returned (this is known as a relapse).

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

Long-term follow up

Once your risk of relapse has reduced, ongoing follow up focuses on looking out for any potential long-term side effects of treatment. This will depend on the type of cancer you had and the treatment you received. A personalised surveillance plan is usually created. This will outline the specific long-term follow up and ongoing investigations that you require.

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

Long-term side effects

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

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

Losing a limb or part of one can be very difficult to deal with. It may help to talk things through with someone close to you or someone in your medical team. If you're struggling, make sure you contact an organisation for support with your emotional wellbeing

Updated March 2018, next review due 2021.

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