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Osteosarcoma:

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also known as osteogenic sarcoma, is the most common type of bone cancer and typically starts in bone cells in the arms, legs or pelvis. It occurs most frequently in individuals between the ages of 10 and 30, and is more common in males than females.

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Chondrosarcoma

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forms in cartilage cells and is the second most common form of the disease. This type of bone cancer rarely occurs in people under the age of 20, and the chances of developing it increase with age.

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Ewing tumor:

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also known as Ewing's sarcoma, typically starts in the bones, but can also start in other tissues and muscles. It is the third most common form of primary bone cancer. It occurs most frequently in children and teenagers, and is rarely seen in adults over the age of 30.

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Fibrosarcoma and malignant fibrous histiocytoma:

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typically develop in the soft tissue around the bones, such as tendons, ligaments, fat or muscle. These types of bone cancer also tend to occur in older adults, and usually affect the arms, legs or jaw.

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Giant cell tumor of bone:

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can have benign and malignant forms, although the malignant form is less common. It usually occurs in the arm or leg bones of young and middle-aged adults, and rarely spreads to distant parts of the body. However, these cancers may return after surgical removal, and the chance of spreading to distant sites increases with each local recurrence.

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Chordoma:

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affects bones in the spine and the base of the skull. This type of bone cancer occurs most frequently in adults 30 or older, particularly men. It tends to be a slow growing tumor with a low risk of spreading to distant sites, but may return at the original site if not removed completely during surgery, and may eventually spread to the lungs, liver or lymph nodes.

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Bone cancer symptoms

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There are several symptoms that may occur as bone cancer develops and grows, with pain being the most frequent symptom. While it can occur in any of the bones of the body, bone cancer occurs most often in the long bones of the arms and legs.

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Bone pain:

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Pain is the most common sign of bone cancer, and may become more noticeable as the tumor grows. Bone pain can cause a dull or deep ache in a bone or bone region (e.g., back, pelvis, legs, ribs, arms). Early on, the pain may only occur at night, or when you are active. As the cancer develops, though, the pain may become more persistent. Other conditions, like osteoporosis or arthritis, may also cause bone or joint pain.

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Swelling:

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The area where the pain is localized may begin to show signs of swelling, or a lump or mass may be present.

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Fractures:

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Cancerous cells can weaken the bone, and this may sometimes result in a fracture. The break may occur in an area of the bone that had previously been sore or painful for a period of time.

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Decreased mobility:

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In some cases, if the location of the tumor is near a joint, it may make normal movements difficult or painful.

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Other symptoms:

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Unintended weight loss and fatigue that accompanies bone pain may be a sign of bone cancer. Other symptoms, such as difficulty breathing, may develop if the cancer has spread to other organs.

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Bone cancer risk factors

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Although the exact causes of bone cancer are unknown, certain factors that may increase a person's risk of developing bone cancer have been identified. Some examples are genetic disorders and previous treatments for other conditions.

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Genetic disorders:

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There are several hereditary syndromes caused by mutations in specific genes that are considered risk factors for bone cancer:

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Paget disease:

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This non-cancerous condition that causes the bones to become thick and brittle, and to break easily, is considered a bone cancer risk factor. This disease has been associated with the development of bone cancer in approximately 1 percent of individuals. (Note: Paget's disease of the breast, a rare form of breast cancer, is medically unrelated to Paget's disease of the bone.)

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Multiple enchondromatosis:

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Patients with many benign cartilage tumors known as enchondromas are at increased risk for developing chondrosarcoma.

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Radiation:

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Exposing bones to high doses of radiation, such as when radiation therapy is used to treat another form of cancer, can increase the risk of a primary bone cancer forming in those areas. This risk is higher in young adults. Radioactive minerals such as radium or strontium can build up in the bones, and may also cause primary bone cancers.

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Bone marrow transplantation:

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Individuals who have undergone a bone marrow transplant for the treatment of another condition may be at an increased risk for developing osteosarcoma.

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TNM system for bone cancer

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The staging guidelines developed by the American Joint Committee on Cancer (AJCC) are often used to stage bone cancers, and allow doctors to communicate important information about the cancer with each other in a standardized way. Bone cancer stages are based on four categories:

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T -

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Describes the size of the primary bone tumor.

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N -

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Indicates whether the bone cancer cells have spread to regional lymph nodes.

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M -

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Refers to whether the cancer has metastasized (spread to distant areas of the body).

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G -

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Grade refers to how abnormal the tumor cells look under the microscope (high-grade tumors look more abnormal, grow more quickly and are more likely to spread).

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Stage I bone cancer

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At this stage, the cancer cells are still localized to the bone, and the tumor is considered low grade. There are two subcategories for stage I bone cancer:

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Stage IA:

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These cancers are less than 8 cm in size.

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Stage IB:

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The tumor is larger than 8 cm or can be found in several places in the same bone.

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Stage II bone cancer

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These cancers are still localized to the bone, but they are considered high grade. There are two subcategories for stage II bone cancer:

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Stage IIA:

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The tumor is less than 8 cm.

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Stage IIB:

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Stage IIB: The tumor is larger than 8 cm.

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Stage III bone cancer

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Primary bone cancers at this stage are still localized to the bone, but they are high grade and have spread to several places within the same bone.

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Stage IV bone cancer

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These bone cancers have spread, or metastasized, outside of the bone. There are two subcategories of stage IV bone cancer:

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Stage IVA:

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The bone cancer cells have spread only to the lung.

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Stage IVB:

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Bone cancer cells can be found in nearby lymph nodes or organs other than the lung (although they may also be found in the lung).

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Bone cancer diagnostics and treatment

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At each of our hospitals, you'll find innovative bone cancer treatments and technologies—all under one roof. Our bone cancer experts use state-of-the-art diagnostic tools, including advanced imaging and laboratory tests, to evaluate bone cancer. This diagnostic evaluation takes about three to five days.

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Diagnostic evaluations

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Biopsy, Bone scanX-rayCT scan, MRI, PET scan

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Physical exam and health history

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Within the first two days of your arrival at our hospital, we will perform a complete array of diagnostic tests, and thoroughly review your medical records and health history. Your doctor will also likely conduct a physical exam. This information helps us formulate treatment recommendations best suited to you.

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Reduced wait times for appointments and test results

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We understand that waiting for test results can create a great deal of stress. To ease anxiety and help you begin your bone cancer treatment sooner, we provide reduced wait times for appointments and test results. Our turnaround time goal—from the time of the scan to providing results so treatment planning can occur—is four hours.

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Comfort equipment

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We also want you to be as comfortable as possible during your imaging tests. Our team uses padding and comfort equipment, as well as a variety of positioning devices, to help you feel more relaxed during scans and procedures.

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Advanced genomic testing

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We use genomic tumor assessment to examine a patient's tumor on a genetic level. This innovative tool can help us find what's driving the cancer's growth and offer patients more precise treatment.

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In addition to a physical examination, the following tests may be used to diagnose bone cancer:

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Blood tests. Some laboratory blood tests may help find bone cancer. Patients with osteosarcoma or Ewing sarcoma may have higher alkaline phosphatase and lactate dehydrogenase levels in the blood.

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In addition to a physical examination, the following tests may be used to diagnose bone cancer:

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Blood tests. Some laboratory blood tests may help find bone cancer. Patients with osteosarcoma or Ewing sarcoma may have higher alkaline phosphatase and lactate dehydrogenase levels in the blood. However, it is important to note that high levels do not always mean cancer. Alkaline phosphatase is normally high when cells that form bone tissue are very active, such as when children are growing or a broken bone is healing.

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Complete Blood Count Tests

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A complete blood count (CBC) is a common blood test that your doctor may recommend for the following reasons:

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A CBC measures the amount of three types of cells in your blood:

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White blood cell count. A white blood cell count, also called a leukocyte count, measures the total number of white blood cells in a sample of blood. These cells protect the body from infection by attacking invading bacteria, viruses, and other foreign materials in the body. Some white blood cells can also attack cancer cells. White blood cell differential. A white blood cell differential is a test that measures the number of each type of white blood cell. There are five major types of white blood cells, and each type plays a different role in protecting the body. Your doctor can learn valuable information about your health by measuring the levels of these cells.

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Red blood cell count.

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Red blood cells carry oxygen throughout your body. A red blood cell count, also called an erythrocyte count, measures the number of red blood cells in a sample of blood. There are several ways to measure red blood cells. Two of the most common are: Hematocrit (Hct), the percentage of your blood that is made up of red blood cells Hemoglobin (Hgb), the amount of the protein in red blood cells that carries oxygen

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Platelet count

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A platelet count measures the number of platelets in a sample of blood. Platelets help to stop bleeding by forming blood clots.

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Low white blood cell count.

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Some cancer treatments, mainly chemotherapy, may cause a decrease in your body's white blood cells. Cancers that affect the blood and bone marrow can also cause a decrease in the count. These types of cancers include leukemia, lymphoma, and multiple myeloma.

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Amounts of different white blood cells.

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Higher-than-normal numbers of lymphocytes or monocytes can indicate the possibility of certain types of cancers. Some cancers and their cancer treatments may cause neutropenia. Neutropenia is a decrease in the number of neutrophils, which increases the chances of a bacterial infection. At times, your doctor may lower your chemotherapy dose to reduce your chance of developing a low neutrophil count. Your doctor may also recommend medication, such as white blood cell growth factors, to increase your body's production of neutrophils, especially if you develop a fever. Learn more about the use of white blood cell growth factors.

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Low red blood cell count.

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Some cancer treatments, mainly chemotherapy and radiation therapy, may cause a decrease in red blood cells. This condition is known as anemia. Blood loss, either from surgery or specific cancers, and cancers that directly involve the bone marrow can also cause or worsen anemia. People whose red blood cell count falls too low may need a blood transfusion or medication to help increase it.

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Low platelet count.

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Some cancer treatments, such as chemotherapy or radiation therapy, may cause a decrease in platelets. Cancers that directly involve the bone marrow can also cause a decrease in platelets. This can result in a condition called thrombocytopenia, which means a person's blood has an unusually low level of platelets. Patients with low platelet levels have a greater risk of serious bleeding or bruising. If your platelet count falls to very low levels, your doctor may recommend platelet transfusions.

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