Bone Cancer

Bone cancer is cancer that affects the bones. There are two broad groups. Primary bone cancer begins in the bone itself and is uncommon; its types include osteosarcoma, Ewing sarcoma, and chondrosarcoma, and some types are more common in children and young adults. Secondary (or metastatic) bone cancer is cancer that has spread to the bone from a primary tumor elsewhere, such as the breast, prostate, or lung — this is more common than primary bone cancer.

This article focuses mainly on primary bone cancer. Because bone pain has many causes, most of which are not cancer, the key message is simply that ongoing, unexplained bone pain should be checked by a doctor.

The most common symptom is persistent bone pain that may get worse over time, can be worse at night, and may not fully ease with rest or ordinary painkillers. There may be swelling or a lump over the affected bone, and the area can feel tender.

Sometimes a bone weakened by cancer breaks more easily than expected, even after a minor injury. General symptoms such as tiredness, unintended weight loss, or a raised temperature are less common but can occur.

In most cases the cause of primary bone cancer is not known. Some factors can increase the risk, including previous radiotherapy, certain rare genetic conditions, and a bone condition called Paget's disease of bone that mostly affects older adults.

Some types of primary bone cancer are more common in children and teenagers, while others tend to affect older adults. Having risk factors does not mean cancer will develop, and most people with bone pain do not have cancer.

Assessment usually begins with an X-ray of the painful area, which can show changes in the bone. If bone cancer is suspected, further scans such as MRI, CT, or a bone scan help show the size of the tumor and whether it has spread.

The diagnosis is confirmed with a biopsy, where a small sample of the bone is taken and examined under a microscope. Because bone tumors are uncommon and specialized, tests and treatment are best carried out by a team with experience in bone cancer.

Treatment is planned by a multidisciplinary team and depends on the type of bone cancer, its size and location, and whether it has spread. The main treatments are surgery to remove the cancer, chemotherapy, and radiotherapy, often used in combination.

Where possible, surgery aims to remove the tumor while preserving the limb (limb-sparing surgery), sometimes using a bone graft or a metal implant to reconstruct the area; amputation is needed less often than in the past. Chemotherapy and radiotherapy may be used before or after surgery. Rehabilitation and supportive care are important parts of the plan.

The outlook depends on the type of bone cancer, where it is, its size, and whether it has spread when it is found. Treatment has improved over the years, and many people with primary bone cancer are treated successfully, particularly when it is found early and cared for by a specialist team.

There is no known way to prevent primary bone cancer. The most useful step is not to ignore persistent, unexplained bone pain, so that any problem can be found and treated as early as possible.