What are bone tumors?
\nSeveral different kinds of tumors can grow in bones: primary bone tumors, which form from bone tissue and can be malignant (cancerous) or benign (not cancerous), and metastatic tumors (tumors that develop from cancer cells that formed elsewhere in the body and then spread to the bone). Malignant primary bone tumors (primary bone cancers) are less common than benign primary bone tumors. Both types of primary bone tumors may grow and compress healthy bone tissue, but benign tumors usually do not spread or destroy bone tissue and are rarely a threat to life.
\nPrimary bone cancers are included in the broader category of cancers called sarcomas. (Soft-tissue sarcomas\u2014sarcomas that begin in muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body, including synovial sarcoma\u2014are not addressed in this fact sheet.)
\nPrimary bone cancer is rare. It accounts for much less than 1% of all new cancers diagnosed. In 2018, an estimated 3,450 new cases of primary bone cancer will be diagnosed in the United States (1).
\nCancer that metastasizes (spreads) to the bones from other parts of the body is called metastatic (or secondary) bone cancer and is referred to by the organ or tissue in which it began\u2014for example, as breast cancer that has metastasized to the bone. In adults, cancerous tumors that have metastasized to the bone are much more common than primary bone cancer. For example, at the end of 2008, an estimated 280,000 adults ages 18\u201364 years in the United States were living with metastatic cancer in bones (2).
\nAlthough most types of cancer can spread to the bone, bone metastasis is particularly likely with certain cancers, including breast and prostate cancers. Metastatic tumors in the bone can cause fractures, pain, and abnormally high levels of calcium in the blood, a condition called hypercalcemia.
\nWhat are the different types of primary bone cancer?
\nTypes of primary bone cancer are defined by which cells in the bone give rise to them.
\nOsteosarcoma arises from bone-forming cells called osteoblasts in osteoid tissue (immature bone tissue). This tumor typically occurs in the arm near the shoulder and in the leg near the knee in children, adolescents, and young adults (3) but can occur in any bone, especially in older adults. It often grows quickly and spreads to other parts of the body, including the lungs. Risk of osteosarcoma is highest among children and adolescents ages 10 and 19. Males are more likely than females to develop osteosarcoma. Among children, osteosarcoma is more common in blacks and other racial/ethnic groups than in whites, but among adults it is more common in whites than in other racial/ethnic groups. People who have Paget disease (a benign bone condition characterized by abnormal development of new bone cells) or a history of radiation to their bones also have an increased risk of developing osteosarcoma.
\nChondrosarcoma begins in cartilaginous tissue. Cartilage is a type of connective tissue that covers the ends of bones and lines the joints. Chondrosarcoma most often forms in the pelvis, upper leg, and shoulder and usually grows slowly, although sometimes it can grow quickly and spread to other parts of the body. Chondrosarcoma occurs mainly in older adults (over age 40). The risk increases with advancing age. A rare type of chondrosarcoma called extraskeletal chondrosarcoma does not form in bone cartilage. Instead, it forms in the soft tissues of the upper part of the arms and legs.
\nEwing sarcoma usually arises in bone but may also rarely arise in soft tissue (muscle, fat, fibrous tissue, blood vessels, or other supporting tissue). Ewing sarcomas typically form in the pelvis, legs, or ribs, but can form in any bone (3). This tumor often grows quickly and spreads to other parts of the body, including the lungs. The risk of Ewing sarcoma is highest in children and adolescents younger than 19 years of age. Boys are more likely to develop Ewing sarcoma than girls. Ewing sarcoma is much more common in whites than in blacks or Asians.
\nChordoma is a very rare tumor that forms in bones of the spine. These tumors usually occur in older adults and typically form at the base of the spine (sacrum) and at the base of the skull. About twice as many men as women are diagnosed with chordoma. When they do occur in younger people and children, they are usually found at the base of the skull and in the cervical spine (neck).
\nSeveral types of benign bone tumors can, in rare cases, become malignant and spread to other parts of the body (4). These include giant cell tumor of bone (also called osteoclastoma) and osteoblastoma. Giant cell tumor of bone mostly occurs at the ends of the long bones of the arms and legs, often close to the knee joint (5). These tumors, which typically occur in young and middle-aged adults, can be locally aggressive, causing destruction of bone. In rare cases they can spread (metastasize), often to the lungs. Osteoblastoma replaces normal hard bone tissue with a weaker form called osteoid. This tumor occurs mainly in the spine (6). It is slow-growing and occurs in young and middle-aged adults. Rare cases of this tumor becoming malignant have been reported.
\nWhat are the possible causes of bone cancer?
\nAlthough primary bone cancer does not have a clearly defined cause, researchers have identified several factors that increase the likelihood of developing these tumors.
\nWhat are the symptoms of bone cancer?
\nPain is the most common symptom of bone cancer, but not all bone cancers cause pain. Persistent or unusual pain or swelling in or near a bone can be caused by cancer or by other conditions. Other symptoms of bone cancer include a lump (that may feel soft and warm) in the arms, legs, chest, or pelvis; unexplained fever; and a bone that breaks for no known reason. It is important to see a doctor to determine the cause of any bone symptoms.
\nHow is bone cancer diagnosed?
\nTo help diagnose bone cancer, the doctor asks about the patient\u2019s personal and family medical history. The doctor also performs a physical examination and may order laboratory and other diagnostic tests. These tests may include the following:
\nHow is primary bone cancer treated?
\nTreatment options depend on the type, size, location, and stage of the cancer, as well as the person\u2019s age and general health. Treatment options for bone cancer include surgery, chemotherapy, radiation therapy, cryosurgery, and targeted therapy.
\nMore information about treatment for specific types of bone cancers can be found in the following PDQ\u00ae cancer treatment summaries:
\n \nWhat are the side effects of treatment for bone cancer?
\nPeople who have been treated for bone cancer have an increased likelihood of developing late effects of treatment as they age. These late effects depend on the type of treatment and the patient\u2019s age at treatment and include physical problems involving the heart, lung, hearing, fertility, and bone; neurological problems; and second cancers (acute myeloid leukemia, myelodysplastic syndrome, and radiation-induced sarcoma). Treatment of bone tumors with cryosurgery may lead to the destruction of nearby bone tissue and result in fractures, but these effects may not be seen for some time after the initial treatment.
\nBone cancer sometimes metastasizes, particularly to the lungs, or can recur (come back), either at the same location or in other bones in the body. People who have had bone cancer should see their doctor regularly and should report any unusual symptoms right away. Follow-up varies for different types and stages of bone cancer. Generally, patients are checked frequently by their doctor and have regular blood tests and x-rays. Regular follow-up care ensures that changes in health are discussed and that problems are treated as soon as possible.
\nCall NCI's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237) for information about clinical trials for treatment of bone cancer.
\nSiegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA: A Cancer Journal for Clinicians 2018; 68(1):7-30.
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\nHakim DN, Pelly T, Kulendran M, Caris JA. Benign tumours of the bone: A review. Journal of Bone Oncology 2015; 4(2):37-41.
\n [PubMed Abstract] \nSobti A, Agrawal P, Agarwala S, Agarwal M. Giant cell tumor of bone - An overview. Archives of Bone and Joint Surgery 2016; 4(1):2-9.
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\n [PubMed Abstract] \nMirabello L, Curtis RE, Savage SA. Bone Cancers. In: Michael Thun M, Linet MS, Cerhan JR, Haiman CA, Schottenfeld D, editors. Schottenfeld and Fraumeni, Cancer Epidemiology and Prevention. Fourth edition. New York: Oxford University Press, 2018.
\nRoman E, Lightfoot T, Picton S Kinsey S. Childhood Cancers. In: Michael Thun M, Linet MS, Cerhan JR, Haiman CA, Schottenfeld D, editors. Schottenfeld and Fraumeni, Cancer Epidemiology and Prevention. Fourth edition. New York: Oxford University Press, 2018.
\nMachiela MJ, Gr\u00fcnewald TGP, Surdez D, et al. Genome-wide association study identifies multiple new loci associated with Ewing sarcoma susceptibility. Nature Communications 2018; 9(1):3184.
\n [PubMed Abstract] \nChen C, Garlich J, Vincent K, Brien E. Postoperative complications with cryotherapy in bone tumors. Journal of Bone Oncology 2017; 7:13-17.
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