Primary bone cancer is where a cancer originates in a bone. It is a rare type of cancer. There are several different types. Treatments which may be considered include surgery, chemotherapy and radiotherapy. The type of treatment used, and the outlook depend on various factors including the type, site and stage of the cancer.
Bone is a living tissue. The hard bone tissue is made of collagen fibres (tough, elastic fibres) and minerals (gritty, hard material). There are two main types of cells within the hard bone tissue that make and mould bone. One type (osteoblasts) makes and lays down bone material. Another type (osteoclasts) resorbs (dissolves) particles of bone. These cells are active throughout life. They work in a balanced way to make and mould bone, repair damage and keep the bone structure correctly 'woven'. There is a slow but constant turnover of bone. Chondrocytes are cells which make cartilage, the tissue that covers the ends of bones in joints.
In the centre of some larger bones is the soft bone marrow. This is where blood cells are made (red blood cells, white blood cells, and platelets).
Cancer is a disease of the cells in the body. The body is made up from millions of tiny cells. There are many different types of cell in the body, and there are many different types of cancer which arise from different types of cell. What all types of cancer have in common is that the cancer cells are abnormal and multiply out of control.
A malignant tumour is a lump or growth of tissue made up from cancer cells which continue to multiply. As they grow, malignant tumours invade into nearby tissues and organs which can cause damage.
Malignant tumours may also spread to other parts of the body. This happens if some cells break off from the first (primary) tumour and are carried in the bloodstream or lymph channels to other parts of the body. These small groups of cells may then multiply to form secondary tumours (metastases) in one or more parts of the body. These secondary tumours may then grow, invade and damage nearby tissues, and spread again.
Some cancers are more serious than others, some are more easily treated than others, some have a better outlook (prognosis) than others.
So, cancer is not just one condition. In each case it is important to know exactly what type of cancer has developed, how large it has become, and whether it has spread. This will enable you to get reliable information on treatment options and outlook.
See separate leaflet called What causes cancer? for further details about cancer in general.
Bone cancer can be divided into primary bone cancer and secondary bone cancer.
The rest of this leaflet is only about primary bone cancer. See the separate leaflets for other types of cancer which may spread to one or more bones, and for information about leukaemias, lymphomas and myeloma.
There are different types of primary bone cancer. They are classified by the type of cell which occurs in the cancer. Most types of primary bone cancer end with -'sarcoma'. A sarcoma is a cancer that originates from cells which occur in and make connective tissues (supporting tissues) of the body - for example, bone, muscle, cartilage, ligaments, etc.
This is the most common type of primary bone cancer, but even this is rare. It only affects around 150 people a year in the UK. It arises from bone-forming cells. Most cases occur in young people between the ages of 10 to 25, but it can occur at any age. It typically develops in the growing ends of the bone in young people, most commonly in bones next to the knee and the upper arms. However, any bone can be affected.
The cells of this cancer look different to the more common osteosarcoma. It only affects around 100 people a year in the UK. Most cases occur in young people between the ages of 10 to 20, but it can occur at any age. It most commonly affects the pelvis (hips) and long bones in the leg.
This type of cancer arises from cartilage-forming cells. As well as occurring in the cartilage, a chondrosarcoma may also develop within a bone, or on the surface of a bone. Most cases occur in people between the ages of 40 and 75. It most commonly affects the pelvis, scapula (shoulder blade), ribs, and the bones of the upper parts of the arms and legs.
Other rare types of primary bone tumour include fibrosarcoma, leiomyosarcoma, malignant fibrous histiocytoma, angiosarcoma and chordoma.
A cancerous tumour starts from one abnormal cell. The reason why a cell becomes cancerous is unclear. It is thought that something damages or alters certain genes in the cell. This makes the cell abnormal and multiply 'out of control'. In most cases of primary bone cancer it is not known why cells become cancerous.
The most common types, osteosarcoma and Ewing's sarcoma, mainly occur in young people. The cause of these may have something to do with changes in the bone as it is growing.
In some cases, there is a known risk factor. For example, your risk of developing a primary bone tumour is increased if you have:
There is no evidence that having a previous injury to a bone increases your risk of developing bone cancer in the future.
General symptoms may occur as the cancer becomes larger - for example, tiredness, weight loss, sweats. If the cancer spreads to other parts of the body, various other symptoms can develop.
If a doctor suspects that you may have primary bone cancer, you are likely to have a number of tests. These may include one or more of the following:
If you are confirmed to have primary bone cancer then further tests are usually advised to assess if the cancer has spread. This may include various blood tests, X-rays and scans.
The results of the biopsy can show the type of the cancer. Also, by looking at features of the cells, the cancer can be graded. For primary bone cancers, two grades are used:
The stage of primary bone cancer is based on the grade of the cancer, and how much it has grown or spread. The staging system commonly used is:
The staging is important, as the treatment options and outlook differ depending on the stage of the cancer.
See separate leaflet called Staging and grading cancer for more details.
The main treatments used for primary bone cancer are surgery, chemotherapy and radiotherapy. The treatment or combination of treatments advised in each case depends on various factors such as:
You should have a full discussion with a specialist who knows your case. They will be able to give the pros and cons, likely success rate, possible side-effects, and other details about the possible treatment options for your type of cancer. You should also discuss with your specialist the aims of treatment. For example:
The types of operation vary depending on the type and site of the cancer. If the cancer is in an arm or leg, it is often possible to remove it with 'limb-sparing' surgery. This means surgery where just the affected part is removed, and is replaced with an artificial metal fitting (prosthesis) or a bone graft. Amputation (removing a limb) used to be the main operation, but this is done less often these days due to the improved surgical techniques with limb-sparing surgery. However, amputation is still needed in some cases, depending on the size, spread or site of the tumour. Your specialist will advise on whether surgery is possible, and the types of operation which can be done.
Radiotherapy is a treatment which uses high-energy beams of radiation which are focused on cancerous tissue. This kills cancer cells, or stops cancer cells from multiplying. See separate leaflet called Radiotherapy for more details.
Radiotherapy is usually used in combination with surgery and chemotherapy. Radiotherapy is not usually used for osteosarcomas or chondrosarcoma, as they are not very sensitive to radiation.
Chemotherapy is a treatment which uses anti-cancer medicines to kill cancer cells, or to stop them from multiplying. Chemotherapy may be given in addition to surgery or radiotherapy, depending on the type and stage of the bone cancer. This may be before surgery to shrink the size of the cancer so a smaller operation can then be performed. Chemotherapy may also be given after surgery or radiotherapy. This aims to kill any cancer cells which may have been left in the body.
See separate leaflet called Chemotherapy with cytotoxic medicines for more details.
It is difficult to give an overall outlook. Every case is different, and the success of treatment depends on the type, site and stage of the cancer - the earlier the stage, the better the outlook. In general, the outlook for primary bone tumours has improved in the last 10-20 years. This is due to improved surgical techniques and improved chemotherapy.
The treatment of cancer is a developing area of medicine. The information on outlook above is very general. New treatments, including gene therapy, are being investigated and may improve the outlook in the future. The specialist who knows your case can give more accurate information about your particular outlook, and how well your type and stage of cancer is likely to respond to treatment.
Tel: 0113 262 1852 Web: www.bcrt.org.uk
Promotes research into the causes and treatment of primary bone cancer.
Tel: 0808 808 0000 Web: www.macmillan.org.uk
Provides information and support to anyone affected by cancer.
Web: http://cancerhelp.cancerresearchuk.org/ provides facts about cancer, including treatment choices.
See www.patient.co.uk/selfhelp.asp for a list of self-help and support groups.