Bone cancer

Bone cancer is cancer that begins in or spreads to your bones. Bone cancer can grow in any of the more than 200 bones in your body, although some bones are affected more commonly than others. Bone cancer can affect both adults and children.

Bone cancer can be either primary or secondary. Each one is treated differently.

Primary bone cancer starts in the bone and is a rare form of cancer. The cancer cells can grow on the surface, in its outer layer or in the centre of the bone. They gradually destroy the healthy bone and can spread to other parts of the body. Osteosarcoma (bone sarcoma) is the most common type of primary bone cancer.

Secondary bone cancer is cancer that starts somewhere else in the body and spreads to the bones. It is more common than primary bone cancer. Any type of cancer can spread to the bone, but the most common types are breast, lung, kidney, thyroid and prostate cancers as well as myeloma and melanoma.

Secondary bone cancers are usually found in the hip, thighbone, shoulder or spine.

There are many different types of primary bone cancer. The most common is osteosarcoma, which usually affects children, young adults or older adults in their 70s and 80s.

The second most common type is chondrosarcoma, which starts in the cartilage located at the ends of your bones. It usually affects adults over 40 years of age and commonly affects the pelvis, shoulder, upper parts of the arms or legs or the ribs.

Ewing sarcoma is a type of cancer that grows in the bone or soft tissues around the bone. Ewing sarcoma usually affects children or young adults and can grow quickly. It is often found in the pelvis, ribs, legs, upper arms or spine.

Some other types of cancer grow in the marrow inside the bones, including leukaemia, multiple myeloma and lymphoma. Treatment for these types of cancers is usually different to treatment for cancers that affect other parts of the bone.

The most common symptom of bone cancer is pain in the bone or joint that isn't relieved by taking pain medicine. It may be there most of the time and get worse at night or after physical activity.

Other symptoms may include:

• swelling over the bone
• stiff bones
• bones that break easily
• problems moving around, such as an unexplained limp
• losing feeling in a limb

Doctors don't fully understand why some people develop primary bone cancer, but some things can increase your risk, including:

• having another bone disease, such as Paget's disease of the bone
• having had radiotherapy in the past
• some chemotherapy medicines
• some genetic conditions or gene changes
• a family history of certain cancers

See your doctor if you have ongoing pain in a bone or joint that doesn't go away or gets worse over time, especially if it is worse at night or during activity. It's important to get any unusual or persistent symptoms checked even if they seem minor.

You should also see your doctor if you notice:

• a lump or swelling over a bone
• a bone that breaks easily or without a clear cause
• stiffness in a joint or limb that doesn't improve
• numbness, tingling or weakness in a limb
• unexplained weight loss or tiredness
• an unexplained limp or change in how you walk

Most of the time, these symptoms are caused by conditions other than bone cancer, but it's important to have them checked early. The sooner a diagnosis is made, the sooner you can begin the right treatment.

If you have previously had cancer and develop new bone pain or other symptoms, speak with your doctor promptly, as some cancers can spread to the bone.

Your doctor will examine you and refer you for some tests. These might include an x-ray, bone scintigraphy (bone scan), computed tomography (CT), magnetic resonance imaging (MRI) or positron emission tomography (PET) scan.

Your doctor may remove a small sample of tissue to have examined in a laboratory (a biopsy) to make a definite diagnosis. This can either be done with a small needle inserted into the tissue or during surgery.

The type of treatment depends on the type of bone cancer and how far it has spread (known as its stage).

Treatment for primary bone cancer may involve one or more of these options:

• surgery to remove the tumour
• chemotherapy
• radiotherapy

Secondary bone cancer often can't be cured, but it may be controlled for many years in some people. The aim of secondary bone cancer treatment is to shrink the cancer and reduce your symptoms. As well as chemotherapy or radiotherapy, you may be offered hormone therapy, immunotherapy or targeted therapy.

If you have surgery, your surgeon will try to remove the cancer while ensuring you can still use the affected part of your body. Usually, the operation will remove the part of the bone affected by the cancer and a small amount of normal bone around it. Your doctor will try to leave the rest of the bone in place. The gap may be filled with artificial bone, made from metal or a healthy piece of bone taken from another part of your body. This is called a bone graft.

In about 1 in 10 cases, the whole limb must be removed. This is called an amputation. Afterwards, an artificial limb, called a prosthesis, may be fitted.

If surgery is not possible — for example, in some parts of the spine or face — your doctor may recommend radiotherapy or chemotherapy.

Many people who have primary bone cancer treatment go into remission. That means your symptoms get better or disappear. If you are in remission, you will still need to go for regular checks with your specialist and have monitoring for any recurrence.

If you had part of the bone removed, the remaining limb might look and feel different.

A physiotherapist will work with you to strengthen your limb and help it move better.

If you had an amputation, you will need to wait for the wound to heal and the swelling to go down before you can have an artificial limb fitted. Then you will need rehabilitation to learn how to use your new limb. An occupational therapist can help you adapt your daily activities so you can manage them after an amputation or with a prosthesis. Some people may choose to use a wheelchair.

After having treatment for cancer, many people feel afraid that the cancer will return. If you are struggling, seek support from your doctor, a therapist or other people who have had cancer.

Bone cancer and its treatment can lead to a range of complications, depending on the type of cancer, where it is in the body, and how far it has spread. One of the most common complications is weakened bones, which can make them more likely to fracture, even with minor injuries or normal activity.

Other possible complications include:

• loss of mobility, especially if the cancer affects weight-bearing bones or the spine
• nerve damage if the tumour presses on nearby nerves, which can lead to numbness, pain or muscle weakness
• infection or delayed healing after surgery
• side effects from treatment, such as fatigue, nausea or increased risk of infections from chemotherapy
• emotional and psychological challenges, including anxiety or fear about recurrence

In advanced stages, bone cancer can spread to other parts of the body (metastasis). This may affect your overall health and make treatment more complex. Your medical team will work with you to help manage these complications and maintain the best possible quality of life during and after treatment.

There is no known way to prevent primary bone cancer, as its causes are not fully understood. Some risk factors like previous radiotherapy, genetic conditions, or bone diseases such as Paget's disease may increase your risk.

Because many of these risks can't be changed, there are no standard prevention strategies. Being aware of symptoms and discussing any concerns with your doctor can support early diagnosis and treatment.

If you have had cancer before, regular check-ups are important as some cancers can spread to the bones (secondary bone cancer).

For more information and support, try these resources:

• Cancer Council Australia provides services and support to all people affected by cancer — call 13 11 20.
• Limbs4Life provides information and support for amputees — call 1300 782 231.
• CanTeen provides support for young people (aged 12 to 24) living with cancer and their families — call 1800 835 932.
• Beyond Blue provides support for people with depression and anxiety — call 1300 22 4636.

Languages other than English

• General information about cancer is available in many community languages at the Cancer Institute NSW.
• Cancer Council South Australia has information on cancer risks, tests and treatment in many different community languages.

Information for Aboriginal and/or Torres Strait Islander peoples

• Read all about cancer for Aboriginal and/or Torres Strait Islander peoples at Cancer Council NSW.
• Watch the video Our Mob and Cancer.