Bone Cancer
Bone
Cancer: Questions and Answers
1. What are bones made of and how do they function?
Mature bones are made up of three types of tissue: compact
tissue (the hard outer portion of most bones); cancellous
tissue (spongy tissue inside the bones that contains bone
marrow, which makes blood cells); and subchondral tissue
(smooth bone tissue of the joints). A layer of cartilage
covers subchondral tissue to cushion the movement of joints.
Bones support and protect internal organs, act as levers
and braces for muscles to produce movement, and produce
and store blood cells in the bone marrow.
2. Are all bone tumors cancerous?
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.
Cancer that arises in the bone (primary bone cancer) is
not the same disease as cancer that spreads to the bone
from another part of the body (secondary bone cancer). Primary
bone cancer is rare, with approximately 2,500 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 another organ, such as the breasts,
lungs, and prostate.
This fact sheet deals with primary bone cancer.
3. What types of cancer arise in the bones?
The most common type of bone cancer is osteosarcoma, which
develops in new tissue in growing bones. Another type of
cancer, chondrosarcoma, arises in cartilage. Evidence suggests
that Ewing’s sarcoma, 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 occurs more often
in adults (see chart).
Cancers of the Bone Types of Cancer Tissue of Origin Common
Locations Common Ages
Osteosarcoma Osteoid Knees, upper legs, upper arms 10–25
Chondrosarcoma Cartilage Pelvis, upper legs, shoulders 50–60
Ewing’s Sarcoma Immature nerve tissue,
usually in bone marrow Pelvis, upper legs, ribs, arms 10–20
4. What are possible risk factors for bone cancer?
Although scientists are not certain what causes bone cancer,
a number of factors may put a person at increased risk.
These cancers occur more frequently in children and young
adults, particularly those who have had radiation or chemotherapy
treatments for other conditions. Adults with Paget’s disease,
a noncancerous condition characterized by abnormal development
of new bone cells, may be at increased risk for osteosarcoma.
A 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.
5. What are the symptoms of bone cancer?
Pain is the most common symptom of bone cancer. However,
symptoms may vary depending on the location and size of
the cancer. 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. It is important
to check with a doctor.
6. How is bone cancer diagnosed?
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 to determine
the level of an enzyme called alkaline phosphatase. A large
amount of alkaline phosphatase can be found in the blood
when the cells that form bone tissue are very active—when
children are growing, when a broken bone is mending, or
when disease or a tumor causes production of abnormal bone
tissue. Because high levels of this enzyme can normally
be found in growing children and adolescents, this test
is not a completely reliable indicator of bone cancer.
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.
7. What are the treatment options for bone cancer?
Treatment options depend on the type, size, location, and
stage of the cancer, as well as the person’s age and general
health. 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 many
cases. When appropriate, surgeons avoid amputation by removing
only the cancerous section of the bone and replacing it
with an artificial device called a prosthesis.
Chemotherapy and radiation may also be used alone or in
combination. Because of the tendency for Ewing’s sarcoma
to metastasize rapidly, multidrug chemotherapy is often
used, in addition to radiation therapy or surgery on the
primary tumor.
8. Are new treatments being studied?
To develop new, more effective treatments, the National
Cancer Institute is sponsoring clinical trials (treatment
studies with cancer patients) in many hospitals and cancer
centers around the country. Clinical trials are a critical
step in the development of new methods of treatment. Before
any new treatment can be recommended for general use, doctors
conduct clinical trials to find out whether the treatment
is safe for patients and effective against the disease.
Various forms of cancer treatments using surgery, radiation
therapy, and chemotherapy for bone cancer are being tested
in clinical trials.
Patients who are interested in learning more about participating
in clinical trials can call the Cancer Information Service
or access the clinical trials page of the National Cancer
Institute’s Web site at http://www.cancer.gov/clinical_trials
on the Internet.
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The information on this page has been extracted from http://www.cancer.gov/cancertopics/factsheet/
Sites-Types/bone.
