What is bone cancer?

Bone cancer is cancer that begins in or spreads to your bones. Bone cancer can grow in any of the more than 200 bones in your body, although some bones are affected more commonly than others. Bone cancer can affect both adults and children.

Bone cancer can be either primary or secondary. Each one is treated differently.

Primary bone cancer starts in the bone and is a rare cancer. The cancer cells can grow on the surface of the bone, in its outer layer or in the centre. It gradually destroys the healthy bone and it can spread to other parts of the body. Primary bone cancer is sometimes called bone sarcoma.

Secondary bone cancer is cancer that starts somewhere else in the body and spreads to the bones. It is more common than primary bone cancer. Any type of cancer can spread to the bone, but the most common types are breast, lung, kidney, thyroid and prostate cancers as well as myeloma and melanoma.

Secondary bone cancers are usually found in the hip, thighbone, shoulder or spine.

What are the types of bone cancer?

There are many different types of primary bone cancer. The most common is osteosarcoma, which usually affects children, young adults or older adults in their 70s and 80s.

The second most common type is chondrosarcoma, which starts in the cartilage located at the ends of your bones. It's usually affects adults over 40 years of age and commonly affects the pelvis, shoulder, upper parts of the arms or legs or the ribs.

Ewing sarcoma is cancer that grows in the bone or soft tissues around the bone. They usually affect children or young adults and can grow quickly. They are often found in the pelvis, the ribs, legs, upper arms or spine.

Some other types of cancer grow in the marrow inside the bones, including leukaemia, multiple myeloma and lymphoma. Treatment for these types of cancers is usually different to treatment for cancers that affect other parts of the bone.

What are the symptoms of bone cancer?

The most common symptom of bone cancer is pain in the bone or joint that isn't relieved by taking pain medicines. It may be there most of the time and get worse at night or after physical activity.

Other symptoms may include:

• swelling over the bone
• stiff bones
• bones that break easily
• problems moving around, such as an unexplained limp
• losing feeling in a limb

What causes bone cancer?

We don't fully understand why some people develop primary bone cancer, but some things can increase your risk:

• having an existing bone disease, such as Paget's disease of the bone
• a history of radiation therapy in the past
• some chemotherapy medicines
• some genetic conditions genes
• a family history of certain cancers

How is bone cancer diagnosed?

Your doctor will examine you and refer you for some tests. These might include a bone scan, or an x-ray, CT, MRI or PET scan.

Your doctor may remove a small sample of tissue to be examined in a laboratory (a biopsy) to make a definite diagnosis. This can either be done with a small needle inserted into the tissue or during surgery.

How is bone cancer treated?

The type of treatment will depend on the type of bone cancer and how far it has spread (known as its stage).

Treatment for primary bone cancer may involve one or more of these options:

• surgery to remove the tumour
• chemotherapy
• radiotherapy

Secondary bone cancer often can't be cured, but it may be kept under control for many years in some people. The aim of secondary bone cancer treatment is to shrink the cancer and reduce your symptoms. As well as chemotherapy and/or radiotherapy, you may be offered hormone therapy, immunotherapy or targeted therapy.

If you have surgery, your surgeon will try to remove the cancer while ensuring you can still use the affected part of your body. Usually, the operation will remove the part of the bone affected by the cancer and a small amount of normal bone around it. Your doctor will try to leave the rest of the bone in place. The gap may be filled with artificial bone, which could be made from metal or a healthy piece of bone taken from another part of your body. This is called a bone graft.

In about 1 in 10 cases, the whole limb must be removed. This is called an amputation. Afterwards, an artificial limb, called a prosthesis, may be fitted.

If it is not possible to operate — for example, in some parts of the spine or face — radiation and chemotherapy can be used.

Living with bone cancer

Many people who have primary bone cancer treatment go into remission. That means your symptoms get better or disappear. If you are in remission, you will still need to go for regular checks with your specialist and have monitoring for any recurrence.

If you had part of the bone removed, the remaining limb might look and feel different. A physiotherapist will work with you to strengthen the limb and help it work better.

If you had an amputation, you will need to wait for the wound to heal and the swelling to go down before you can have an artificial limb fitted. Then you will need rehabilitation to learn how to use your new limb. An occupational therapist can help you adapt your daily activities so you can manage them after an amputation or with a prosthesis. Some people may choose to use a wheelchair.

After having treatment for cancer, many people feel afraid that the cancer will return. If you are struggling, it is important to seek support from your doctor, a therapist or other people who have gone through cancer.

Resources and support

For more information and support, try these resources:

• Cancer Council Australia provides services and support to all people affected by cancer — 13 11 20
• Limbs4Life provides information and support for amputees — 1300 782 231
• CanTeen provides support for young people (aged 12 to 24) living with cancer and their families — 1800 835 932
• Beyond Blue provides support for people with depression and anxiety — 1300 22 4636
• General information about cancer is available online in many community languages.
• Read all about cancer for Aboriginal and/or Torres Strait Islander people.