Overview Bone cancer is a malignant (cancerous) tumor of the bone that destroys normal bone tissue. Not all bone tumors are malignant. In fact, benign (noncancerous) bone tumors are more common than malignant ones. Both malignant and benign bone tumors may grow and compress healthy bone tissue, but benign tumors do not spread, do not destroy bone tissue, and are rarely a threat to life.
Malignant tumors that begin in bone tissue are called primary bone cancer. Cancer that metastasizes (spreads) to the bones from other parts of the body, such as the breast, lung, or prostate, is called metastatic cancer, and is named for the organ or tissue in which it began. Primary bone cancer is far less common than cancer that spreads to the bones.
Tumor Types Cancer can begin in any type of bone tissue. Bones are made up of osteoid (hard or compact), cartilaginous (tough, flexible), and fibrous (threadlike) tissue, as well as elements of bone marrow (soft, spongy tissue in the center of most bones).
Common types of primary bone cancer include:
• Osteosarcoma, which arises from osteoid tissue in the bone. This tumor occurs most often in the knee and upper arm.
• Chondrosarcoma, which begins in cartilaginous tissue. Cartilage pads the ends of bones and lines the joints. Chondrosarcoma occurs most often in the pelvis (located between the hip bones), upper leg, and shoulder. Sometimes a chondrosarcoma contains cancerous bone cells. In that case, doctors classify the tumor as an osteosarcoma.
• The Ewings Sarcoma Family of Tumors (ESFTs), which usually occur in bone but may also arise in soft tissue (muscle, fat, fibrous tissue, blood vessels, or other supporting tissue). Scientists think that ESFTs arise from elements of primitive nerve tissue in the bone or soft tissue. ESFTs occur most commonly along the backbone and pelvis and in the legs and arms.
Other types of cancer that arise in soft tissue are called soft tissue sarcomas. They are not bone cancer.
Symptoms Pain is the most common symptom of bone cancer, but not all bone cancers cause pain. Persistent or unusual pain or swelling in or near a bone can be caused by cancer or by other conditions. It is important to see a doctor to determine the cause.
Treatment Treatment options depend on the type, size, location, and stage of the cancer, as well as the person’s age and general health. Treatment options for bone cancer include surgery, chemotherapy, radiation therapy, and cryosurgery.
• Surgery is the usual treatment for bone cancer. The surgeon removes the entire tumor with negative margins (no cancer cells are found at the edge or border of the tissue removed during surgery). The surgeon may also use special surgical techniques to minimize the amount of healthy tissue removed with the tumor.
Dramatic improvements in surgical techniques and preoperative tumor treatment have made it possible for most patients with bone cancer in an arm or leg to avoid radical surgical procedures (removal of the entire limb). However, most patients who undergo limb-sparing surgery need reconstructive surgery to maximize limb function.
• Chemotherapy is the use of anticancer drugs to kill cancer cells. Patients who have bone cancer usually receive a combination of anticancer drugs. However, chemotherapy is not currently used to treat chondrosarcoma.
• Radiation therapy, also called radiotherapy, involves the use of high-energy x-rays to kill cancer cells. This treatment may be used in combination with surgery. It is often used to treat chondrosarcoma, which cannot be treated with chemotherapy, as well as ESFTs. It may also be used for patients who refuse surgery.
• Cryosurgery is the use of liquid nitrogen to freeze and kill cancer cells. This technique can sometimes be used instead of conventional surgery to destroy the tumor