Primary bone cancer is a rare cancer that starts in bone itself. The main types are osteosarcoma and Ewing sarcoma, which mostly affect children, teenagers and young adults, and chondrosarcoma, which is more common in middle age and later.
It is quite different from cancer that has spread to bone from the breast, prostate, lung or elsewhere, which is far more common and is treated as the original cancer. Primary bone cancers need a specialist sarcoma team, because the biopsy and the operation must be planned together.
Symptoms
- Deep bone pain that is persistent, worse at night and not explained by injury
- A firm swelling or lump over a bone, most often near the knee, hip or shoulder
- A limp or reduced movement in a nearby joint
- A bone that breaks after a minor knock
- Fever, tiredness or weight loss, particularly with Ewing sarcoma
Causes and risk factors
In most people no cause is identified. Osteosarcoma tends to arise during the rapid growth of adolescence. Risk is raised by previous radiotherapy to the area, Paget's disease of bone in older adults, and rare inherited conditions such as Li-Fraumeni syndrome and hereditary retinoblastoma. Ewing sarcoma is driven by a specific gene rearrangement inside the tumour cells that is not inherited. Injuries do not cause bone cancer, although a knock often draws attention to a lump already there.
How it is diagnosed
- X-ray: The first test. Many bone tumours have a recognisable appearance, and many lumps turn out to be benign.
- MRI of the whole bone: Shows the extent within the bone, nearby muscles, nerves and vessels, and is needed to plan surgery.
- Biopsy: A needle or small open biopsy performed by, or in agreement with, the surgeon who will operate, since a badly placed biopsy track can compromise limb-sparing surgery.
- Staging scans: CT of the chest and a bone scan or PET-CT to look for spread, most often to the lungs.
- Blood tests and molecular pathology: General health checks, plus genetic analysis of the tumour to confirm the exact type.
Treatment options
- Chemotherapy: Given before and after surgery for osteosarcoma and Ewing sarcoma, over many months. Chondrosarcoma generally does not respond to it.
- Limb-sparing surgery: Removal of the tumour with a margin of healthy tissue, and reconstruction with a metal prosthesis or bone graft. Possible in most people.
- Amputation or rotationplasty: Needed when the tumour cannot be removed safely in any other way.
- Radiotherapy: Important in Ewing sarcoma and for tumours in places where complete removal is not possible, such as the pelvis or spine. Proton therapy may be considered.
- Rehabilitation: Physiotherapy, prosthetic fitting and psychological support are part of treatment, not an extra.
When it is urgent
Go to a local emergency department for a suspected fracture through a painful bone, for fever during chemotherapy, which can signal a dangerous infection within hours, or for new leg weakness, numbness or loss of bladder control with back pain. A child or teenager with unexplained night-time bone pain lasting more than 2 weeks should have an X-ray promptly near home.
Travelling to Türkiye for treatment
Treatment for osteosarcoma and Ewing sarcoma runs for the better part of a year, with chemotherapy cycles that are unsafe to interrupt with long journeys. It is best delivered by a sarcoma centre within reach of home. A trip can be useful for an expert pathology and imaging review, or for a planned limb-sparing operation with a custom prosthesis, if your home oncologists agree the timing between chemotherapy cycles and will continue care afterwards. Do not have a biopsy done casually before seeing a sarcoma surgeon.
Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.
Frequently Asked Questions
Is every bone lump cancer?
No. Benign bone tumours and cysts are much more common than cancers, especially in young people. An X-ray is usually enough to tell which need further tests.
Will the limb have to be removed?
Usually not. Most people can have limb-sparing surgery. The decision depends on whether the tumour can be removed with a safe margin while leaving a working limb.
Is cancer in my bones from breast or prostate cancer the same thing?
No. That is secondary cancer in the bone and is treated according to where it started. This page is about cancers that begin in bone.
Why does the biopsy matter so much?
The biopsy track has to be removed with the tumour. If it crosses the wrong tissues, a larger operation may be needed.