Primary bone cancer refers to cancers which start in the bone. These are different to secondary bone cancers which started in other parts of the body and later spread to the bones.

Bone cancers are tumours which have the potential to spread to other parts of the body. These are different to benign (non-cancerous) bone tumours which do not spread. Benign bone tumours are more common than malignant (cancerous) bone tumours.

This FAQ is primarily about cancers that start in the bone (primary bone cancer).

See also: What are the different types of primary bone cancer ?
See also: What is secondary bone cancer ?

Secondary bone cancer is where malignant cells have spread to the bones from other parts of the body. This is different to cancer that actually started in the bones (primary bone cancer). Virtually all types of cancer can spread to bone. Bone metastases are particularly common in people with breast, lung or prostate cancer. Bone metastases are usually multiple, they cause pain and can can lead to other symptoms such as hypercalcemia (abnormally high levels of calcium in the blood )

This FAQ is primarily about cancers that start in the bone (primary bone cancer).

See also: What is the treatment for secondary bone cancer ?
See also: Other Links about Secondary Bone Cancer
See also: Where can I get more information ?

Symptoms of bone cancer vary from person to person and depending on the location and size of the cancer. The most common symptoms are pain and swelling or tenderness in the affected area. Sometimes bone cancer can interfere with movement and can weaken the bones, occasionally leading to a fracture. Other symptoms of cancer may include tiredness, fever, weight loss, and anemia. None of these symptoms is a sure sign of cancer; if you suspect you have a health problem consult your doctor.

There are over 200 bones in the human body, any of these can be affected by cancer. However, certain types of bone cancer are more common in specific bones. Osteosarcoma is most commonly found in the bones around the knee. Ewing's sarcoma is more common in the upper leg, pelvis and other bones of the trunk. The pelvis is the most frequent location for chondrosarcoma. Nevertheless, it is possible for these cancers to affect any bone in the body.

There are several kinds of cancer that start in the bones. In children and young adults under 30 the most common types are Osteosarcoma and Ewing’s sarcoma. Osteosarcoma develops in new tissue (osteoid) in growing bones, and is most often found in the bones around the knees. Ewing’s sarcoma is is thought to arise from immature nerve tissue in the bones and is seen in many bones, particularly the pelvis and upper leg. In adults other common cancers include chondrosarcoma which starts in cartilage, chordoma, malignant fibrous histiocytoma of bone and fibrosarcoma of bone; these are all rare in children. There are a number of other rare types of bone cancer.

See also: Osteosarcoma FAQ
See also: Ewing's Sarcoma / PNET FAQ
See also: What is chondrosarcoma ?

Treatment will depend on the type of cancer, whether it has spread or not , and the size and location of the main (primary) tumor. Treatment of bone cancers is complex and involves a team of different specialists usually within an institution that is experienced in treating these types of cancers. There are 3 main types of therapy used to treat bone cancers;

• surgery (to take out the tumor in an operation)
• radiotherapy (using high-dose x-rays to kill cancer cells)
• chemotherapy (using drugs to kill cancer cells)

Surgery is often used to remove the primary tumor. For tumors of the arms and legs an amputation of the limb is sometimes necessary, however, limb-sparing surgery may be possible in many cases where only the cancerous part of the bone is removed and it is replaced by a bone graft or metal prosthesis. Radiotherapy may be given as well as or instead of surgery to destroy the cancer cells. Also, chemotherapy (drugs) may also be given to kill malignant cells that may be circulating around the body.

Overall, the chance of recovery (prognosis) for bone cancers has improved significantly since the development of modern chemotherapy.

The chance of recovery will depend on a variety of influences; if the cancer has spread, the type of bone cancer, the size of the tumor, location, the person's general health and other individual factors. Also important is how much of the main tumor can be removed/destroyed by surgery and/or radiotherapy, and how the tumor responds to chemotherapy.

Chondrosarcoma is a type of cancer arising in cartilage cells. Cartilage is a tough flexible material that covers the joints of the bones. It allows the bones to move freely at the joints and prevents the bones from grinding against each other. As well as being found in the cartilage, chondrosarcoma can also grow within a bone or on the surface of a bone.

It is usually found in adults between ages 40-75, though the less common mesenchymal-chondrosarcoma sub-type is more frequent in younger people. Chondrosarcoma accounts for 20% of all cancers starting in bone, it is usually a slow growing tumour. The most common sites of disease are the pelvis, ribs and upper thigh, the tumour is rarely found below the knees or below the elbows. In extremely rare cases the disease can arise in soft tissue (Extraosseous chondrosarcoma).

Malignant fibrous histiocytoma of bone (MFH) is a rare type of cancer which occurs in adults. The most common sites of MFH are the legs and arms. Treatment is often similar to that given for osteosarcoma. MFH can also arise in the soft tissues.

Primary non-Hodgkin's lymphoma of bone (PLB) is a rare type of cancer starting in bone, it accounts for about 7% of all primary bone tumors.

Non-Hodgkin's lymphoma (NHL) usually starts in the lymph nodes and lymph glands (part of the immune system). PLB, however, starts in the bone. This is distinct from NHL which started in the lymph notes and then spread to the bones (bone metastases).

The peak age of people diagnosed with PLB is in the 50-60 yr age group, the disease is slightly more common in men than in women. Symptoms are usually bone pain and sometimes swelling. The majority of people with PLB are diagnosed with a single localized tumor. PLB has higher survival rates compared to other types of non-Hodgkin's lymphoma.

Multiple myeloma (also known as myelomatosis or myeloma) is a cancer in which there is abnormal growth in the number of plasma cells in the bone-marrow and blood. This can suppress the normal production of blood cells, including those associated with the body's immune system. The plasma cells may collect in the bone to make small tumors known as plasmacytomas. Multiple myeloma is most common in people aged over 60, and is less frequent before the age of 40.

See Multiple Myeloma Links in Guide to Internet Resources for Cancer.

There is no single set treatment for bone metastases. Treatment depends on type of cancer, extent of the spread of metastases, prior treatment and other factors. Only a physician who is very familiar with the person's medical details can know what the best treatment is. However, in general terms treatment of bone metastases can be palliative (relief of symptoms) or curative. For many people with advanced cancer there may be no known effective cure so treatment may largely be focused on prolonging life and relieving the symptoms of bone metastases (eg. pain relief). However in certain cases where there is a chance of cure the treatment may include chemotherapy, radiotherapy and possibly bone marrow / stem cell transplantation.

See Cancer Pain and Palliative Care in Guide to Internet Resources for Cancer.

See also: What is secondary bone cancer ?
See also: Where can I get more information ?

• NCI Fact Sheet: Questions and Answers About Metastatic Cancer (CancerNet)
• Bone medications help cancer patients Transcript and webcast with information on the use of bisphosphonates in the treatment of secondary bone cancer.
• When Cancer Spreads to Bone Information on secondary bone cancer and related complications with input from three experts in this area.
• Bone Complications in Breast Cancer Transcript and webcast on secondary bone cancer from breast cancer. The webcast is produced by Advances in Oncology and features Lee Rosen, MD and Gabriel N. Hortobagyi, MD.
• Bone Complications in Lung Cancer. Transcript and webcast on secondary bone cancer from breast cancer. The webcast is produced by Advances in Oncology and features Robert Figlin, MD and Roger Waltzman, MD.
• Bone Complications of Prostate Cancer Transcript and webcast about bone metastases in prostate cancer from two experts on the disease.
• Metastatic Tumors to the Brain and Spine (American Brain Tumor Association)
• Questions and Answers: Bone cancer From the CancerHelp Web site produced by Cancer Research UK.
• Secondary Cancers of the Bone (Cancer Bacup, UK) questions and answers
• What Is Bone Metastasis? Overview from the American Cancer Society.
  
• ********** Information for Health Professionals ***********
• BMJ News: Patients with bone metastases need better care (UK) news of calls from The British Association of Surgical Oncologists for more involvement of orthopaedic surgeons in the treatment of bone metastases (December 2000)
• Bone Metastases (bonetumor.org) a summary with radiology images and pathology slides.
• Breast Cancer Metastases to Bone (bonetumor.org) a summary with radiology images and pathology slides.
• Lung Cancer Metastases to Bone (bonetumor.org) a summary with radiology images and pathology slides.

Radiotherapy for the palliation of painful bone metastases (Cochrane Collaboration) Abstract of a systematic review.