Most bone tumors are non-cancerous (benign), but some are cancerous
(malignant). Benign tumors are usually not life threatening, but
malignant tumors can spread cancer cells (metastasize) throughout the
body via the blood or lymphatic systems. Cancer that begins
in bone (primary bone cancer) is different from cancer that begins
somewhere else in the body and spreads to bone
(secondary bone cancer). Primary bone cancer affects more
males than females, and is rare. In 2001, doctors were
expected to diagnose about 2,900 new cases of bone and joint
cancer. Some types of bone cancer affect mostly teenagers.
Three main types of bone cancer are involved in about 75
percent of all cases:
Osteosarcoma, the most
common bone cancer, usually develops in tissues in the
growing bones of children and adolescents, age 10-25. It
typically occurs around the knee. Other common locations
include the upper leg and upper arm. Osteosarcoma can also
affect the elderly in association with Paget disease.
Chondrosarcoma develops in cartilage and usually affects
adults, age 50-60. The upper leg, pelvis and shoulder are
common sites.Ewing's sarcoma may begin in immature cells in
the bone marrow and usually affects children and
adolescents, age 10-20. The upper leg, arm, pelvis and ribs
are the main locations.
Diagnosis and treatment:
See your doctor as soon as possible for diagnosis and
treatment if you think you might have a bone tumor. The
doctor will collect detailed information about your general
health and the tumors type, size, location and possible
extent of cancer (stage).
Medical history and physical exam:
Give the doctor your complete medical history including your
age and details about any previous tumors or cancers. Does
anyone in your family have a history of cancer? How is your
health overall? Your doctor will physically examine you,
focusing on the tumor mass, tenderness in bone and any
impact on joints and/or range of motion. In some cases, the
doctor may want to examine other parts of your body to rule
out cancers that can spread to bone.
Imaging and tests:
Your doctor will probably take a series of X-rays to see the
tumors exact location, level of activity and other
characteristics. If the tumor looks like it might be cancer,
you may also need additional imaging studies such as MRI
(magnetic resonance imaging), CT scan (computed tomography)
or ultrasonography plus laboratory tests on blood and urine
samples to provide more details about the extent of disease.
Your doctor will probably need to remove a tissue sample
(biopsy) from the tumor to examine by microscope. Biopsy can
reveal the presence of cancer cells, the type of tumor and
its degree of malignancy (grade). Among various methods of
1) Needle biopsy: The doctor inserts a needle into
the tumor to remove small or larger amounts of tissue. This
may be performed with local anesthesia in the office or with
CT scan guidance with a radiologist.
2) Surgical biopsy: The doctor opens the skin to
remove part of or the entire tumor. This is usually
performed under general anesthesia in an operating room.
Some common benign tumors include giant cell tumor,
unicameral bone cyst, osteoid osteoma and benign cartilage
tumors. In many cases, benign bone tumors need no treatment
other than observation. Certain benign tumors can become
malignant and metastasize. Sometimes, your doctor may
recommend removing the tumor (excision) or using other
treatment techniques to reduce the risk of fracture and
disability. Some tumors may come back after removal.
You might want to get a second opinion to confirm any
diagnosis of a malignant bone tumor. If you have bone
cancer, your treatment team may include several specialists
(i.e., radiologist, chemotherapist, pathologist, surgeon or
orthopaedic oncologist). Treatment goals include curing the
cancer and preserving bodily functions. Doctors often
combine several methods of treatment for malignant bone
tumors depending upon various factors including whether the
cancer has spread.
Localized stage cancer cells are contained to the tumor and
Metastatic stage cancer cells have spread elsewhere in the
body. This stage is more serious and harder to cure.
Local treatments include surgery and radiation therapy:
Limb salvage surgery removes the cancerous section of bone
while preserving nearby tendons, nerves and blood vessels.
If possible, the doctor will excise the entire tumor and a
margin of healthy tissue around it. He or she will replace
the excised bone and joint with a bone transplant or a
metallic replacement (prosthesis).
Amputation removes all or part of an arm or leg when the
tumor is large and/or nerves or blood vessels are involved.
Radiation therapy uses high-dose X-rays to kill cancer cells
and shrink tumors.
Additional treatments are used for cancer that has spread:
Chemotherapy uses drugs to kill cancer cells. You take it by
pill or needle injection into a vein or muscle.
When treatment for a bone tumor is finished, you may need
more X-rays and other imaging studies to confirm that it is
actually gone. You may need to have regular doctor visits
and tests every few months. When the tumor disappears, its
important to monitor your body for its possible return