Frequently Asked Questions About Bone Cancer
Q. What is the difference between primary bone cancer and secondary bone cancer?
Primary bone cancer refers to cancers that start in the bone. Secondary bone cancer is cancer that spreads to the bone from another part of the body. Primary bone cancer is rare, with approximately 2,400 new cases diagnosed each year in the United States. More commonly, bones are the site of tumors that result from the spread (metastasis) of cancer from other parts of the body such as the breasts, lungs or prostate. Bone metastases can cause pain and can lead to other symptoms such as hypercalcemia (abnormally high levels of calcium in the blood).
Q. Are there different types of primary bone cancer?
A. There are several types of cancer that start in the bones. The most common is osteosarcoma, which often develops in new tissue in growing bones. Evidence suggests that Ewing’s sarcoma (see Ewing’s family of tumors), another form of bone cancer, begins in immature nerve tissue in bone marrow. Osteosarcoma and Ewing’s sarcoma tend to occur more frequently in children and adolescents, while chondrosarcoma, which starts in cartilage, occurs more often in adults.
Q. What are the risk factors for bone cancer?
A. There are a number of factors that may put a person at increased risk for bone cancer. Children and adolescents, particularly those who have had radiation or chemotherapy treatments for other conditions, develop bone cancer more frequently than adults. Adults with Paget’s disease, a noncancerous condition characterized by abnormal development of new bone cells, may be at increased risk for osteosarcoma. A very small number of bone cancers are due to heredity. For example, children with hereditary retinoblastoma (an uncommon cancer of the eye) are at a higher risk of developing osteosarcoma.
Q. What are the symptoms of bone cancer?
A. The symptoms of bone cancer vary from person to person, depending on the location and size of the cancer. Pain is the most common symptom. Tumors that occur in or near joints may cause swelling or tenderness in the affected area. Bone cancer can also interfere with normal movements and can weaken the bones, occasionally leading to a fracture. Other symptoms may include fatigue, fever, weight loss, and anemia. None of these symptoms is a sure sign of cancer. They may also be caused by other, less serious conditions. If you have these symptoms, you should consult a doctor.
Q. How is bone cancer diagnosed?
A. To diagnose bone cancer, the doctor asks about the patient’s personal and family medical history and does a complete medical exam. The doctor may suggest a blood test, since some bone tumors can be associated with increased levels of certain proteins in the blood.
X-rays can show the location, size, and shape of a bone tumor. If x-rays suggest that a tumor may be cancer, the doctor may recommend special imaging tests such as a bone scan, a CT (or CAT) scan, an MRI, or an angiogram. However, a biopsy—the removal of a sample of tissue from the bone tumor—is needed to determine whether cancer is present.
The surgeon may perform a needle biopsy or an incisional biopsy. During a needle biopsy, the surgeon makes a small hole in the bone and removes a sample of tissue from the tumor with a needle-like instrument. In an incisional biopsy, the surgeon cuts into the tumor and removes a sample of tissue. Biopsies are best done by orthopedic oncologists – doctors experienced in the diagnosis of bone cancer. A pathologist – a doctor who identifies disease by studying cells and tissues under a microscope – examines the tissue to determine whether it is cancerous.
Q. Are there bone tumors that are not cancerous?
A. Bone tumors may be benign (noncancerous) or malignant (cancerous). Benign bone tumors are more common than malignant ones. Both types may grow and compress healthy bone tissue and absorb or replace it with abnormal tissue. However, benign tumors do not spread and are rarely life-threatening.
Q. What are the treatment options for bone cancer?
A. Treatment options depend on the type, size, location and stage of the cancer, as well as the person’s age and general health. The three main types of treatment for bone cancer are surgery, chemotherapy and radiation therapy.
Surgery is often the primary treatment. Although amputation of a limb is sometimes necessary, pre- or post-operative chemotherapy has made limb-sparing surgery possible in most cases. When appropriate, surgeons avoid amputation by removing only the cancerous section of the bone and replacing it with an artificial device called an endoprosthesis.
Chemotherapy and radiation may also be used alone or in combination. Because Ewing’s sarcoma tends to metastasize rapidly, multidrug chemotherapy is often used in addition to radiation therapy or surgery on the primary tumor.