What is Bone Cancer?
Bone cancer starts in the bone. Cancer starts when cells in the body begin to grow out of control. Cells in nearly any part of the body can become cancer, and can spread to other areas of the body.
Types of bone tumors
Most of the time when someone with cancer is told they have bone cancer, the doctor is talking about a cancer that has spread to the bones from somewhere else. This is called metastatic cancer. It can be seen in many different types of advanced cancer like breast cancer, prostate cancer, and lung cancer. When these cancers in the bone are looked at under a microscope, they look like the tissue they came from. For example, if someone has lung cancer that has spread to bone, the cells of the bone cancer still look and act like lung cancer cells. They do not look or act like bone cancer cells, even though they are in the bones. Since these cancer cells still act like lung cancer cells, they still need to be treated with drugs that are used for lung cancer.
Malignant bone cancer
Osteosarcoma (also called osteogenic sarcoma) is the most common primary bone cancer. This cancer starts in the bone cells. It most often occurs in young people between the ages of 10 and 30, but about 10% of osteosarcoma cases develop in people in their 60s and 70s, according to a study from the American Cancer Society. It is rare in middle-aged people, and is more common in males than females. These tumors develop most often in bones of the arms, legs, or pelvis.
Chondrosarcoma is a cancer of cartilage cells. It is the second most common primary bone cancer. This cancer is rare in people younger than 20. After age 20, the risk of getting a chondrosarcoma goes up until about age 75. Women get this cancer as often as men.
Chondrosarcomas can develop anywhere there is cartilage. Most develop in bones such as the pelvis, leg bone or arm bone. Occasionally, chondrosarcoma will develop in the trachea, larynx, and chest wall. Other sites are the scapula (shoulder blade), ribs, or skull.
Benign (non-cancerous) tumors of cartilage are more common than malignant ones. These are called enchondromas. Another type of benign tumor that has cartilage is a bony projection capped by cartilage called an osteochondroma. These benign tumors rarely turn into cancer. There is a slightly higher chance of cancer developing in people who have many of these tumors, but this is still not common.
Chondrosarcomas are classified by grade, which measures how fast they grow. The grade is assigned by the pathologist (a doctor specially trained to examine and diagnose tissue samples under a microscope). The lower the grade, the slower the cancer grows. When a cancer is slow growing, the chance that it will spread is lower and so the outlook is better. Most chondrosarcomas are either low grade (grade I) or intermediate grade (grade II). High-grade (grade III) chondrosarcomas, which are the most likely to spread, are less common.
Some chondrosarcomas have distinctive features under a microscope. These variants of chondrosarcoma can have a different prognosis (outlook) than usual chondrosarcomas.
- Dedifferentiated chondrosarcomas start out as typical chondrosarcomas but then some parts of the tumor change into cells like those of a high-grade sarcoma (such as high grade forms of malignant fibrous histiocytoma, osteosarcoma, or fibrosarcoma). This variant of chondrosarcoma tends to occur in older patients and is more aggressive than usual chondrosarcomas.
- Clear cell chondrosarcomas are rare and grow slowly. They rarely spread to other parts of the body unless they have already come back several times in the original location.
- Mesenchymal chondrosarcomas can grow rapidly, but like Ewing tumor, are sensitive to treatment with radiation and chemotherapy.
Ewing tumor is the third most common primary bone cancer, and the second most common in children, adolescents, and young adults. This cancer (also called Ewing sarcoma) is named after the doctor who first described it in 1921, Dr. James Ewing. Most Ewing tumors develop in bones, but they can start in other tissues and organs. The most common sites for this cancer are the pelvis, the chest wall (such as the ribs or shoulder blades), and the long bones of the legs or arms. This cancer is most common in children and teenagers and is rare in adults older than 30. Ewing tumors occur most often in white people and are very rare among African Americans and Asian Americans.
Malignant fibrous histiocytoma
Malignant fibrous histiocytoma Malignant fibrous histiocytoma more often starts in soft tissue (connective tissues such as ligaments, tendons, fat, and muscle) than in bones. This cancer is also known as pleomorphic undifferentiated sarcoma, especially when it starts in soft tissues. When MFH occurs in bones, it usually affects the legs (often around the knees) or arms. This cancer most often occurs in elderly and middle-aged adults and is rare among children. MFH mostly tends to grow locally, but it can spread to distant sites, like the lungs.
Fibrosarcoma is another type of cancer that develops more often in soft tissues than it does in bones. Fibrosarcoma usually occurs in elderly and middle-aged adults. Bones in the legs, arms, and jaw are most often affected.
Giant cell tumor of bone
This type of primary bone tumor has benign and malignant forms. The benign (non-cancerous) form is most common. Giant cell bone tumors typically affect the leg (usually near the knees) or arm bones of young and middle-aged adults. They don’t often spread to distant sites, but tend to come back where they started after surgery (this is called local recurrence). This can happen several times. With each recurrence, the tumor becomes more likely to spread to other parts of the body. Rarely, a malignant giant cell bone tumor spreads to other parts of the body without first recurring locally.
This primary tumor of bone usually occurs in the base of the skull and bones of the spine. It develops most often in adults older than 30, and is about twice as common in men as in women. Chordomas tend to grow slowly and often do not spread to other parts of the body, but they often come back in the same area if they are not removed completely. The lymph nodes, the lungs, and the liver are the most common areas for secondary tumor spread.
Bone cancer symptoms
- Pain: is the most common complaint of patients with bone cancer. At first, the pain is not constant. It may be worse at night or when the bone is used (for example, leg pain when walking). As the cancer grows, the pain will be there all the time. The pain increases with activity and the person might limp if a leg is involved.
- Swelling: in the area of the pain may not occur until weeks later. It might be possible to feel a lump or mass depending on the location of the tumor.
- Cancers in the bones of the neck can cause a lump in the back of the throat that can lead to trouble swallowing or make it hard to breathe.
- Fractures: Bone cancer can weaken the bone it develops in, but most of the time the bones do not fracture (break). People with a fracture next to or through a bone cancer usually describe sudden severe pain in a limb that had been sore for a few months.
- Other symptoms: Cancer in the bones of the spine can press on nerves, leading to numbness and tingling or even weakness. Cancer can cause weight loss and fatigue. If the cancer spreads to internal organs it may cause other symptoms, too. For example, if the cancer spreads to the lung, you may have trouble breathing.
Any of these symptoms are more often due to conditions other than cancer, such as injuries or arthritis. Still, if these problems go on for a long time without a known reason, you should see your doctor.
Bone cancer diagnosis
A patient’s symptoms, physical exam, and results of imaging tests and blood tests may suggest that bone cancer is present. But in most cases, doctors must confirm this suspicion by examining a tissue or cell sample under a microscope (a procedure known as a biopsy).
Other diseases, such as bone infections, can cause symptoms and imaging results that could be confused with bone cancer. Accurate diagnosis of bone cancer often depends on combining information about its location (what bone is affected and even which part of the bone is involved), appearance on x-rays, and appearance under a microscope.
Since a single bone metastasis can have the same signs and symptoms as a primary bone tumor, many doctors require a biopsy to diagnose a patient’s first bone metastasis. After that, additional bone metastases can usually be diagnosed based on x-rays and other imaging tests.
Depending on the type and stage of your cancer, you may need more than one type of treatment. Doctors on your cancer treatment team may include:
An orthopedic surgeon: a doctor who uses surgery to treat bone and joint problems. An orthopedic oncologist: an orthopedic surgeon that specializes in treating cancer of the bones and joints
A radiation oncologist: a doctor who uses radiation to treat cancer
A medical oncologist: a doctor who uses chemotherapy and other medicines to treat cancer
Many other specialists may be involved in your care as well, including nurse practitioners, nurses, psychologists, social workers, rehabilitation specialists, and other health professionals.
The main types of treatment for bone cancer are:
- Targeted therapy.
Often, more than one type of treatment is used. For information about some of the most common approaches used based on the extent of the disease, see the section “ Treating specific bone cancers.”
It is important to discuss all of your treatment options, including their goals and possible side effects, with your doctors to help make the decision that best fits your needs. It’s also very important to ask questions if there is anything you’re not sure about.
Doctors treating you in Austria through AT-MED
Prof. Univ. Dr. Christian Singer, obstetrician-gynecologist
Prof. Univ. Dr. Johannes Drach, internist, specialist in haemato-oncology
Prof. Univ. Dr. Schillinger Martin, cardiologist, angiologist
Prof. Univ. Dr. Ulrich Steinhart, obstetrician-gynecologist
Dr. Rainer Kotz, Orthopedics and endoprotection
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