Bone Cancer: Types, Symptoms, Diagnosis, Treatment

Bone cancer is a rare type of cancer that occurs when bone cells begin to grow uncontrollably.

Bone is a framework of connective tissue, a type of soft, supportive tissue. It also contains calcium and other minerals that strengthen the bones. Bone cells such as osteoblast, osteoclasts, and osteocytes are found throughout this structure.

Supporting bones include the long bones in the arms and legs. The organs of the chest are protected by the rib cage and the bones of the skull protect the brain.

Cartilage covers the ends of each long bone. Tendons hold the joints of long bones together. Tendons and cartilage form joints that allow the bones to move against one another without friction.

What are the types of bone cancer?

Bone cancer can be categorised as primary or secondary.

Primary bone cancer

Primary bone cancer originates in bone cells. Doctors may use the term bone sarcoma when discussing primary bone cancer. Sarcomas are malignancies that begin in any connective tissue in the body, including tendons, muscles, fatty tissues, and blood vessels.

Osteosarcoma is the most prevalent form of primary bone cancer. It begins in the cells where new bone tissues are produced and typically affects the ends of big bones, like the arms, legs, or pelvis (hip bone). Most cases affect people between the ages of 10 and 30.
Ewing's sarcoma is a highly malignant tumour that typically affects people under the age of 30 years. The spine, shoulder blades, ribs, pelvis, and the long bones of the legs are among the common locations.
Chondrosarcoma, which is the second most prevalent form of primary bone cancer starts in the cartilage. It is more common among older adults and rarely affects individuals under 20 years old. The scapula, ribs, and pelvic bones are among the common locations.
Chordomas refer to a rare tumour, which typically develops at the base of the skull or the bottom of the spine. It is more common among adults aged above 30 years. It is also twice as likely to develop in men compared to women.

Secondary bone cancer

Secondary bone cancer or bone metastasis describes cancer that started elsewhere in the body before spreading to the bones.

It typically occurs with advanced cancers such as breast, prostate, or lung cancers. The pelvis, femur (upper leg bone), humerus (upper arm bone), ribs and skull are some of the commonly affected areas along with the spine, which is the most frequently affected area.

What are the risk factors for developing bone cancer?

The exact cause of bone cancer is unclear, but the following risk factors put you at a higher risk of developing it:

Previous exposure to radiotherapy
Certain non-cancerous bone conditions: Paget’s disease, hereditary multiple osteochondromas, fibrous dysplasia
Inherited cancer syndromes: Hereditary retinoblastoma, Li-Fraumeni syndrome

What are the signs and symptoms of bone cancer?

The symptoms of bone cancer depend on the type, location, and size of the tumour. Most symptoms are not noticeable in the early stages of cancer. Symptoms of bone cancer include:

Pain and swelling of the affected bones
Bone pain that worsens at night and on rest
Decreased range of motion
Fatigue
Fracture due to weak bones
Fever
Unexplained weight loss

How do doctors diagnose bone cancer?

For a bone cancer diagnosis, your doctor will evaluate your medical history and symptoms. Your doctor will also perform a physical examination and blood tests may also be requested.

Below are other frequently used diagnostic tests:

X-ray
- X-ray is typically the first test conducted if bone cancer is suspected. A chest X-ray may occasionally be performed to determine if cancer has spread to the lungs in adult patients.
- In X-ray, important cues such as a broken bone (fracture), swelling of the bone or soft tissues around the bone and growth of new bone can indicate the presence of bone cancer.
Magnetic resonance imaging (MRI)
- An MRI scan is conducted to assess the precise extent of the tumour and provide additional information for any bone abnormalities seen on an X-ray to plan for surgery to be planned.
Computed tomography (CT) scan
- A CT scan displays comprehensive cross-sectional images of parts of the body. It aids in the detection of cancer that may have spread to other body parts.
Bone scan
- A bone scan involves injecting radioactive material and observing areas of active bone changes to determine if cancer has spread to other body parts through specific areas of the skeleton.
- It may be necessary to perform additional tests, such as X-rays, MRI scans or a bone biopsy, in order to make an accurate diagnosis.
Biopsy
- A biopsy involves the collection of a sample of abnormal cells to be inspected under a microscope. A biopsy may be performed to confirm a bone cancer diagnosis if the results of imaging tests indicate the possibility of the disease.
- There are two types of bone biopsy: Core needle biopsy, open biopsy.
Bone marrow biopsy
- If you are diagnosed with Ewing’s sarcoma, a bone marrow biopsy may be done to evaluate the spread of cancer to your bone marrow (tissue in the centre of your bones).

Learn more about the different types of screening and diagnostic procedures performed to diagnose bone cancer.

How is bone cancer treated?

The treatment of choice for bone cancer depends on the type of cancer, the tumour's position and size, and the stage of cancer. The key treatments used are surgery, chemotherapy, and radiotherapy.

Surgery
- Surgery is performed to remove cancer cells along with some surrounding healthy cells.
- Limb-sparing surgery is performed when cancer is limited to the bone. The most prevalent type of limb-sparing surgery entails removing a portion of the affected bone and some surrounding tissue in case cancerous cells have spread into the surrounding tissue. The excised section of bone may be replaced with a prosthesis (a metal implant) or a piece of bone from any other part of your body (bone graft).
- If limb-sparing surgery is impossible or has not been successful, amputation may be necessary. This include situations such as the cancer has extended to the major blood vessels and nerves or it has developed in a location where surgery is not possible.
Chemotherapy
- Chemotherapy involves the use of potent cancer-killing drugs and is an important treatment for osteosarcoma and Ewing’s sarcoma. However, it is not used as frequently for chondrosarcomas and chordomas as these cancers are less responsive to chemotherapy.
Radiotherapy
- Radiotherapy employs high-energy radiation to reduce the size of tumours, kill cancer cells and alleviate the symptoms of advanced cancer. Not all types of bone cancer are treated with radiotherapy due to the higher dose required to destroy cancer cells, which may harm surrounding healthy cells. However, it may be a significant component of cancer treatment for Ewing’s sarcoma.

Learn more about the different types of treatment technologies to treat bone cancer.

What can I do to reduce the risk of developing bone cancer?

As the causes of bone cancer are still unknown to experts, there are no known ways to prevent them. Making certain lifestyle changes, such as keeping a healthy weight or giving up smoking, may help lower the risk of developing bone cancer in adults.

Do I need to get screened for bone cancer?

While there is currently no available routine screening test for individuals at average risk, most bone cancers are found early due to signs such as bone pain or swelling.

People who are at high risk of developing bone cancer due to certain bone conditions or inherited disorders are advised closely monitor any potential symptoms to detect the disease early.

Bone cancer can cause many complications, including fractures. Hence, it is crucial to detect bone cancer as early as possible and employ the best treatment method. If you have been diagnosed with bone cancer, follow up with your doctor regularly.

Make an appointment at Pantai Hospitals

Early detection of bone cancer makes it easier to treat the disease with effective and appropriate treatment. A dedicated multidisciplinary team of specialists and oncologists at Pantai Hospitals is available for consultation to provide the best care and assistance to patients through screening, diagnosis, and treatment.

Get in touch with us to book an appointment today if you have any concerns or questions about bone cancer treatment options.

Pantai Hospitals have been accredited by the Malaysian Society for Quality in Health (MSQH) for its commitment to patient safety and service quality.