Bone cancer develops in the skeletal system and destroys tissue. It can spread to distant organs, such as the lungs. The usual treatment for bone cancer is surgery, and it has a good outlook following early diagnosis and management.

The two main types are primary and secondary bone cancer. In primary bone cancer, cancer develops in the cells of the bone. Secondary bone cancer occurs when cancers that develop elsewhere spread, or metastasize, to the bones.

According to the National Cancer Institute, primary bone cancer accounts for of all cancers. Secondary bone cancer is more common.

In this article, we will discuss the survival rates, types, causes, and symptoms of bone cancer, as well as possible treatments.

There are several types of bone cancer.

Primary bone cancers

a man with bone cancer holds his shoulder
The outlook for a person with bone cancer is good if they receive an early diagnosis.

Tumors in the bone are either benign (noncancerous) or malignant (cancerous). Benign tumors do not spread beyond their original site. Malignant tumors are more aggressive and have a higher risk of growing and spreading.

Examples of benign bone tumors include:

Osteoblastoma and giant cell tumor of bone may become malignant after starting as benign. They will usually become aggressive without spreading to distant sites and cause damage to the bone near the tumor.

Examples of malignant primary bone tumors include:

  • osteosarcoma
  • chondrosarcoma
  • Ewing's sarcoma
  • malignant fibrous histiocytoma
  • fibrosarcoma
  • chordoma
  • other sarcomas

Multiple myeloma is a blood cancer that may lead to one or more bone tumors.

Certain bone cancers develop in . For example, teratomas and germ cell tumors mainly occur in the tailbone.

Osteosarcoma

This type of cancer develops in osteoblasts, which are the cells that form bones.

Osteosarcoma is the most common type of bone cancer. According to St. Jude's Children's Research Hospital, children and adolescents aged have the highest risk of osteosarcoma, and it is the third most common cancer among teens in the United States.

Having Paget's disease of the bone, which is a disease that causes excessive bone growth, also increases the risk of osteosarcoma.

Ewing sarcoma

Ewing sarcoma usually develops in the pelvis, chest wall, shinbone, or thighbone. However, it might also develop in supporting soft tissue, such as fat, muscle, or blood vessels.

This is a rapidly growing tumor that often spreads to distant sites in the body, such as the lungs. It is most common in adolescents between 10–19 years of age. Although it is the type of bone cancer in children and teenagers, it is very rare.

Chondrosarcoma

Chondrosarcoma usually develops in adults. It starts in cartilage, a type of connective tissue that lines the joints, and then spreads to the bone.

Most commonly, it develops in the upper leg, pelvis, and shoulders. Chondrosarcoma usually grows slowly.

This is most common in adults over the age of 40 years.

Chordoma

This is a very rare cancer of the spine. It usually develops at the bases of the spine and skull in older adults.

Children and adolescents can also develop chordoma. When this occurs, chordoma usually begins to grow at the base of the neck and skull.

Secondary bone cancers

These are the most common bone cancers in adults.

They develop when a cancer spreads to the bone from elsewhere in the body. Most cancers can spread to the bones. However, people with breast and prostate cancer have a particularly high risk of developing secondary bone cancer. Doctors know this as bone metastases.

This type of cancer can cause pain, fractures, and hypercalcemia, which is an excess of calcium in the blood.

The type of treatment for bone cancer depends on several factors, including:

There are several approaches to treating bone cancer.

Surgery

surgeons performing gastrectomy in operating theatre
During surgery for bone cancer, a surgeon may take bone from another part of the body to replace lost bone.

Surgery aims to remove the tumor and some of the bone tissue that surrounds it. It is the most common treatment for bone cancer.

If a surgeon leaves some of the cancer, it may continue to grow and eventually spread.

Limb sparing surgery, or limb salvage surgery, means that surgical intervention occurs without having to amputate the limb. However, for a person to use the limb again, they may need reconstructive surgery.

The surgeon may take bone from another part of the body to replace lost bone, or they may fit an artificial bone.

In some cases, however, a doctor may need to amputate a limb to remove the presence of cancer altogether. This is becoming increasingly rare as surgical methods improve.

Radiation therapy

Radiation therapy is common in the treatment of many cancers.

A specialist targets cancer cells with high-energy X-rays to destroy them.

A person may receive radiation therapy alongside surgery. People who do not need surgery for bone cancer might also be candidates for radiation therapy.

It is a standard treatment for Ewing sarcoma and a regular part of combination treatment for other bone cancers.

Combination therapy is radiation therapy combined with another type of treatment. This may be more effective in some cases.

Chemotherapy

Chemotherapy involves using medications to destroy cancer cells.

People with Ewing sarcoma or a new diagnosis of osteosarcoma usually receive chemotherapy.

A doctor may also recommend a combination of chemotherapy and radiation therapy.

Cryosurgery

This technique sometimes replaces surgery to remove tumors from bone tissue. A surgeon targets cancer cells with liquid nitrogen to freeze and destroy them.

Targeted therapy

This treatment uses a drug that scientists have designed to interact specifically with a molecule that causes cancer cells to grow.

Denosumab (Xgeva) is a monoclonal antibody that doctors use in targeted therapy. The U.S. Food and Drug Administration (FDA) have approved it for use in adults and adolescents with fully developed skeletons.

Denosumab prevents osteoclasts, which are a type of blood cell, from destroying bone tissue.