Primary bone cancer is a cancer that starts in one of the bones that make up your skeleton. If you have cancer that started elsewhere, but has spread to your bones, this is known as ‘secondary bone cancer’ or ‘bone metastasis’. The information below refers to primary bone cancer.
Your body is made up of more than 200 bones. These bones work together to help you move, protect your organs (such as your lungs) and store some of your body’s essential minerals (such as calcium).
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.
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.
The symptoms of bone cancer will vary depending 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.
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 determine 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, and any further surgery, may need to be done by a surgeon who specialises in bone tumours, so you may need to be referred to another hospital. You will be given a local or general anaesthetic while they do the biopsy.
The most common types of treatment for bone cancers are surgery, chemotherapy and radiotherapy. Talk to your specialist about your individual treatment plan.
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 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 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 tumour and make it easier to remove. It may also be given afterwards to destroy any remaining cancer cells.
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 you travel abroad to have a specialised form of radiotherapy called proton beam therapy. See our Proton Beam Therapy section for more information.
If you are undergoing chemotherapy, you may experience side-effects such as 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 sun burn 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 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, the focus of on-going 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 you had and the treatment you received. A personalised surveillance plan is usually created that outlines the specific long term follow up and on-going investigations that you require. Many people are at low risk of future health problems but some will have significant on-going 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.
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.
Updated December 2014, next review planned 2017.