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Bone cancer is a sarcoma (type of cancerous tumor) that starts in the bone. Other cancers may affect the bones, including cancers that metastasize, or spread, from other parts of the body, as well as non-Hodgkin's lymphoma and multiple myeloma. The information on this page focuses on cancers that start in the bones (primary bone cancer).
Bones support and give structure to the body. They usually are hollow. The main parts of the bones are:
Matrix is the outer part of bones. It is made of fiber-like tissue and is covered with a layer of tissue called the periosteaum.
Bone marrow is the soft tissue in the space in hollow bones called the medullary cavity. Cells inside bone marrow include:
- Fat cells
- Red blood cells, white blood cells and platelets
- Fibroblasts, a type of cell that helps build connective tissue
- Plasma, in which blood cells are suspended
Cartilage is at the end of most bones. It is softer than bone, but it is firmer than soft tissue. Cartilage and other tissues, including ligaments, make up joints, which connect some bones.
Bone constantly changes as new bone forms and old bone dissolves. To make new bone, the body deposits calcium into the cartilage. Some of the cartilage stays at the ends of bones to make joints.
Bone cancer types
There are several types of bone tumors. They are named according to the area of bone or tissue where they start and the type of cells they contain. Some bone tumors are benign (not cancer), and some are malignant (cancer). Bone cancer also is called sarcoma.
The most commonly found types of primary bone cancer are:
- Osteosarcoma or osteogenic sarcoma is the main type of bone cancer. It occurs most often in children and adolescents, and it accounts for about one-fourth of bone cancer in adults. More males than females get this cancer. About 1,000 people in the United States are diagnosed with osteosarcoma each year. It begins in bone cells, usually in the pelvis, arms or legs, especially the area around the knee.
- Chondrosarcoma is cancer of cartilage cells. More than 40% of adult bone cancer is chondrosarcoma, making it the most prevalent bone cancer in adults. The average age of diagnosis is 51, and 70% of cases are in patients over 40. Chondrosarcoma tends to be diagnosed at an early stage and often is low grade. Many chondrosarcoma tumors are benign (not cancer). Tumors can develop anywhere in the body where there is cartilage, especially the pelvis, leg or arm.
- Ewing's sarcoma is the second most prevalent type of bone cancer in children and adolescents, and the third most often found in adults. It accounts for about 8% of bone cancers in adults. Ewing's sarcoma can start in bones, tissues or organs, especially the pelvis, chest wall, legs or arms.
Less-commonly found types of bone cancer include:
- Chordoma, which is found in 10% of adult bone cancer cases, usually in the spine and base of the skull
- Malignant fibrous histiocytoma/fibrosarcoma, which usually starts in connective tissue
- Fibrosarcoma, which often is benign and found in soft tissue in the leg, arm or jaw
- Secondary (or metastatic) bone cancer is cancer that spreads to the bone from another part of the body. This type of bone cancer is more prevalent than primary bone cancer. For more information about this type of cancer, see the type of primary cancer (where the cancer started).
Bone cancer risk factors
Anything that increases your chance of getting bone cancer is a risk factor. However, having risk factors does not mean you will get bone cancer. In fact, most people who develop bone cancer do not have any risk factors. If you have risk factors, it’s a good idea to discuss them with your health care provider.
Teenagers and young adults are at greatest risk of developing osteosarcoma, a type of bone cancer, because it often is associated with growth spurts.
Some diseases that run in families can slightly increase the risk of bone cancer. These include:
- Li-Fraumeni syndrome
- Rothmund-Thompson syndrome
- Retinoblastoma (an eye cancer of children)
- Multiple osteochondromas
- Genetic counseling may be right for you. Learn more about the risk to you and your family on our genetic
Other risk factors for bone cancer include:
- Paget’s disease
- Prior radiation therapy for cancer, especially treatment at a young age or with high doses of radiation
- Bone marrow transplant
Bone cancer symptoms vary from person to person. They also depend on the size and location of the cancer.
If you have symptoms of bone cancer, they may include:
- Swelling or tenderness in or near a joint
- Difficulty with normal movement
- Weight loss
- Anemia (low red blood cell count)
Having one or more of these symptoms does not mean you have bone cancer. However, it is important to discuss any symptoms with your doctor, since they may indicate other health problems.
Accurate diagnosis is essential to successful treatment of bone cancer. The wrong kind of biopsy may make it more difficult later for the surgeon to remove all of the cancer without having to also remove all or part of the arm or leg. A biopsy that is not done correctly may cause the cancer to spread.
If your doctor thinks you may have bone cancer, it’s important to go to a cancer center with a specialized bone cancer program. You should look for a program that does as many diagnostic procedures as possible.
If you have symptoms that may signal bone cancer, your doctor will examine you and ask you questions about your health and your family history. One or more of the following tests may be used to find out if you have cancer and if it has spread. These tests also may be used to find out if treatment is working.
A biopsy, which removes a tiny piece of bone, is used to confirm the presence of cancer cells. This is the only way to find out for certain if the tumor is cancer or another bone disease. It is very important for the biopsy procedure to be done by a surgeon with experience in diagnosing and treating bone tumors.
There are two types of bone biopsy:
- Needle biopsy: A long, hollow needle is inserted through the skin to the area of bone to be tested. The needle removes a cylindrical sample of bone to look at under a microscope.
- Open or surgical biopsy: An incision (cut) is made, and the surgeon removes a tiny piece of bone for examination under a microscope.
Your doctor will decide which type of biopsy is best for you based on several factors, including the type and location of the tumor. If possible, the surgeon who performs the biopsy should also do the surgery to remove the cancer.
Bone Cancer Staging
If you are diagnosed with bone cancer, your doctor will determine the stage (or extent) of the disease. Staging is a way of determining how much disease is in the body and where it has spread.
This information is important because it helps your doctor determine the best type of treatment for you and the outlook for your recovery (prognosis). Once the staging classification is determined, it stays the same even if treatment is successful or the cancer spreads.
Bone Cancer Stages
AJCC Staging System
(source: National Cancer Institute)
One system that is used to stage all bone cancer is the American Joint Commission on Cancer (AJCC) system.
- T stands for features of tumor (its size)
- N stands for spread to lymph nodes
- M is for metastasis (spread) to distant organs
- G is for the grade of the tumor
This information about the tumor, lymph nodes, metastasis and grade is combined in a process called stage grouping.
The stage is then described in Roman numerals from I to IV (1-4).
T stages of bone cancer
- TX: Primary tumor can't be measured
- T0: No evidence of the tumor
- T1: Tumor is 8 centimeters (around 3 inches) or less
- T2: Tumor is larger than 8 centimeters
- T3: Tumor is in more than one place on the same bone
N stages of bone cancer
- N0: The cancer has not spread to the lymph nodes near the tumor
- N1: The cancer has spread to nearby lymph nodes
M stages of bone cancer
- M0: The cancer has not spread anywhere outside of the bone or nearby lymph nodes
- M1: Distant metastasis (the cancer has spread)
- M1a: The cancer has spread only to the lung
- M1b: The cancer has spread to other sites (like the brain, the liver, etc)
Grades of bone cancer
- G1-G2: Low grade
- G3-G4: High grade
TNM stage grouping
After the T, N and M stages and the grade of the bone cancer have been determined, the information is combined and expressed as an overall stage. The process of assigning a stage number is called stage grouping.
To determine the grouped stage of a cancer using the AJCC system, find the stage number below that contains the T, N and M stages, and the proper grade.
Stage I: All stage I tumors are low grade and have not yet spread outside of the bone.
- Stage 1A: T1, N0, M0, G1-G2: The tumor is 8 centimeters or less.
- Stage 1B: T2 or T3, N0, M0, G1-G2: The tumor is either larger than 8 centimeters or it is in more than one place on the same bone.
Stage II: Stage II tumors have not spread outside the bone (like stage I) but are high grade.
- Stage 2A: T1, N0, M0, G3-G4: The tumor is 8 centimeters or less.
- Stage 2B: T2, N0, M0, G3-G4: The tumor is larger than 8 centimeters.
Stage III: T3, N0, M0, G3-G4: Stage 3 tumors have not spread outside the bone but are in more than one place on the same bone. They are high grade.
Stage IV: Stage IV tumors have spread outside of the bone they started in. They can be any grade.
- Stage 4A: Any T, N0, M1a, G1-G4: The tumor has spread to the lung.
- Stage 4B: Any T, N1, any M, G1-G4 OR Any T, any N, M1b, G1-G4: The tumor has spread to nearby lymph nodes or to distant sites other than the lung (or both).
Even though the AJCC staging system is widely accepted and used for most cancers, bone cancer specialists tend to simplify the stages into localized and metastatic. Localized includes stages 1, 2 and 3, while metastatic is stage 4.
MD Anderson is one of the most active bone cancer treatment programs in the world.
Because MD Anderson’s Sarcoma Center surgeons see only sarcoma patients – and more of them than most programs – they have a high level of expertise and experience that may translate into a higher chance for successful treatment.
If you are diagnosed with bone cancer, your doctor will discuss the
best options to treat it. This depends on several factors, including the
type and stage of the cancer and your general health.
Your treatment for bone cancer will be customized to your particular needs.
One or more of the following therapies may be recommended to treat bone cancer or help relieve symptoms.
Surgery is the main treatment for most bone cancers. Both the biopsy and surgery should be done by a surgeon with extensive experience in these procedures. A biopsy in the wrong location can cause surgical problems and lower your chances of successful treatment.
If at all possible, the same surgeon should perform both the biopsy and surgery. The biopsy will help the surgeon locate the tumor more precisely. The goal of surgery is to remove as much of the cancer as possible. If any cancer cells remain, they may grow and spread. To get as much of the cancer as possible, the surgeon performs a wide-excision surgery. This involves removing the cancer, as well as a margin of healthy tissue around it.
If the tumor is in an arm or leg, the surgeon almost always is able to perform limb-sparing surgery, which removes the cancer cells but allows you to keep full use of your leg or arm. To replace bone that is removed during surgery, a bone graft may be done or an internal device called an endoprosthesis may be implanted.
If this is not possible, an amputation, or removal of the limb, may be performed. Reconstructive surgery and/or a prosthesis will be needed. Rehabilitation is necessary after either procedure.
Chemotherapy may be recommended to treat osteosarcoma or Ewing’s sarcoma. In osteosarcoma, it is often given before surgery to shrink the tumor and make it easier to remove, and after surgery to destroy remaining cancer cells. Chemotherapy is also used for bone cancer that has metastasized (spread) to the lungs or other organs.
Bone cancer is not highly sensitive to radiation, so radiation usually is not a treatment. It sometimes may be given if the tumor cannot be operated on or if cancer cells remain after surgery. Radiation may help relieve symptoms if bone cancer returns.
New radiation therapy techniques and remarkable skill allow MD Anderson doctors to target tumors more precisely, delivering the maximum amount of radiation with the least damage to healthy cells.
Proton therapy delivers high radiation doses directly into the tumor, sparing nearby healthy tissue and vital organs. The Proton Therapy Center at MD Anderson is one of the world’s largest and most advanced centers.
These newer agents are used to help fight some types of bone cancer, including chordoma. Targeted therapies attack cancer cells by using small molecules to block pathways that cells use to survive and multiply.
Why choose MD Anderson for bone cancer treatment?
MD Anderson's Sarcoma Center treats more osteosarcoma, or bone cancer, patients than any other cancer center in the nation. In fact, we are one of the few teams in the world devoted to bone cancer, and our patients have an 80% five-year event-free survival rate.
We bring together a team of experts that includes specialists from many areas to give you personal, customized care. We use specialized therapies and technologies to be sure you receive the most advanced treatment with the least impact on your body.
If possible, it is best to have a biopsy to diagnose bone cancer at the same place you receive treatment. It is essential to go to a specialized cancer center that has experience in osteosarcoma biopsy. If the biopsy is done incorrectly, it may make it more difficult later for the surgeon to remove all of the cancer without having to also remove all or part of the arm or leg. A biopsy that is not done correctly also may cause the cancer to spread.
As one of the world's leading cancer centers, we constantly work to discover new treatments and innovations. We helped pioneer:
- Embolization for localized unresectable giant cell tumor of bone
- Activity of interferon in metastatic giant cell tumor of bone
- Limb-sparing surgery to help save arms and legs
- Targeting a cell receptor known to play a part in the spread of cancer to the bones may enable chemotherapy drugs to be delivered directly to the cells
Cancer is mentally and physically challenging, but don't let it shut you down. Dust yourself off and get back up, even if you have to crawl. This is your life, after all, and it's worth fighting for.
I never realized how many children got cancer until I came to MD Anderson Children’s Cancer Hospital. But the story of how I got there is kind of crazy.
I played volleyball all through middle school. By the eighth grade, I was the setter for our team. During the second-to-last game of the season, another girl stepped on the back of my right leg and injured my knee. We treated the pain with ibuprofen and rest.
But my leg kept hurting and seemed to be getting worse, so my mom took me to an orthopedic surgeon. After looking at the MRI, the doctor said, “Yeah, you have something right there, but what is this?” That’s when we saw a little bump on the end of my femur that we hadn’t even noticed before. It turned out to be osteosarcoma, a type of bone cancer.
My orthopedic surgeon had never diagnosed cancer before — or even seen this type of tumor in real life. So he sent us to MD Anderson. He said we’d find better care there and that the doctors would know exactly what this was and how to treat it. He was right.
Choosing a prosthesis after my osteosarcoma diagnosis
In October 2015, I came to MD Anderson, where my family and I met with Valerae Lewis, M.D., in the Orthopedic Oncology department. She performed a biopsy to confirm my osteosarcoma diagnosis. Then, we decided on a treatment plan. I’d have 14 weeks of chemotherapy before my surgery and 23 weeks afterward.
Dr. Lewis surgically removed my right knee and part of my right femur on Feb. 8, 2016, and replaced them with prosthetic ones. They’re both made of metal now, so I beep whenever I go through a metal detector at the airport.
Dr. Lewis told me I had two options for my prosthesis. One could be adjusted as I grew. The other was stronger, but also permanent, so I’d have to have another surgery at some point to “turn off” the growth plate in my other leg. I’m already 5’7”, so I chose the permanent one. I decided I was tall enough.
I had the surgery to turn off the growth plate in my left leg on March 23, 2017. Now, my legs will always be even, and I won’t have to worry about getting a lift in my shoe.
Learning who my true friends are
Being diagnosed with cancer at age 13 was shocking. But it didn’t really set in until I arrived for my first chemo treatment. Coming into the hospital was mind-blowing. I remember thinking, “Okay, this is for real, not just something that happens to other people.”
At some point during treatment, I lost all my hair. Explaining why to people was hard. And starting my freshman year of high school bald and in a wheelchair was very different. Some people didn’t like it and tried to avoid me. But it really helped me to know who my true friends are. After all, I’m still me. Cancer is just a little bump in the road that I’d gone over.
I met so many other young people with cancer like mine at MD Anderson. And just knowing I was not alone on this journey was so helpful. It gave me hope that I was going to make it through this. And I did. I had my last chemo infusion on July 20, 2016, and I’ve been cancer-free since last August.
Believing in yourself
It’s too risky for me to play volleyball anymore, so now I play golf. It’s great knowing I can play this sport, even with an implant. And being able to go out and play with other kids my age lets me feel kind of normal.
Because of my prosthesis, sometimes people try to tell me, “No, you can’t do that.” But I can still do anything. I just do it in a different way. I could’ve even kept playing volleyball through the Paralympics. I just would’ve done it sitting down.
You can always find a different way of doing something. That’s why I tell other cancer patients to stay positive. Being positive is the best medicine you can take for yourself and the people around you. Think it’s going to be alright, and it will be. Because if you believe you can do something, you can.
Request an appointment at MD Anderson online or by calling 1-877-632-6789.