Bone cancer can be either primary or secondary.

• Primary bone cancer starts in the cells of the bone.
• Secondary bone cancer. This cancer starts in another organ of your body but has spread to the bones. This cancer behaves like the original cancer that it spread from and not like bone cancer.

There are many types of primary bone cancer. The main ones are listed below.

• Osteosarcoma. This is the most common type of bone cancer. Children and young people between the ages of 10 and 20 are more commonly affected, but it can occur at any age. It is slightly more common in males than females.
• Ewing's sarcoma. This cancer also tends to develop between the ages of 10 and 20. Like osteosarcoma, it is slightly more common among males than females. This cancer can also occur in soft tissues in the body such as muscle.
• Chondrosarcoma. This is the second most common type of bone cancer. It is more common in adults between the ages of 40 and 60. It starts in the cartilage cells in joints.
• Spindle cell sarcoma. There are four types of bone cancer: undifferentiated sarcoma of the bone, malignant fibrous histiocytoma, fibrosarcoma and leiomyosarcoma. They all behave like osteosarcoma but are more common in adults.

No one knows exactly what causes bone cancer, but research is ongoing. But there are some things that increase your chances of getting bone cancer.

• Previous treatment with radiotherapy. If you have had a lot of radiotherapy for cancer in the past, you have a slightly increased risk of getting bone cancer in that area.
• Paget's disease. This bone disease gradually deforms your bones, causing pain and fractures. Having Paget's disease for a long time increases your risk of developing bone cancer.
• Having a previous benign bone tumour. If you have had a benign (non-spreading) type of bone cancer, you are more likely to develop chondrosarcoma.
• Retinoblastoma. Inheriting the gene that causes this rare type of eye cancer also makes you more likely to develop osteosarcoma.
• Having certain other rare inherited conditions, such as Li-Fraumeni syndrome, can increase your risk of developing bone cancer.

The symptoms of bone cancer vary depending on where it develops and how severe it is. Different types of bone cancer tend to form in different areas. For example:

• Osteosarcoma is most common in the lower thigh, shins and arms.
• Ewing's sarcoma most commonly occurs in the pelvis, thigh and shins.
• Chondrosarcoma is most common in the thigh, pelvis, ribs, upper arm and shoulder bone.
• Spindle cell sarcoma most commonly develops in the lower thigh, shins and arms.

Bone cancer often causes pain and tenderness in the affected area. This is often worse at night. As the cancer grows it can also cause swelling in the affected area. If it is near a joint it may make movement in that area difficult.

Less common symptoms of bone cancer include:

• tiredness
• fever
• weight loss

It's important to remember that these symptoms can be caused by many problems other than bone cancer. So although not necessarily a result of bone cancer, if you have these symptoms you should visit your doctor.

Bone cancer can be diagnosed by many different tests.

X-ray
Doctors are often able to diagnose bone cancer from an X-ray image of the affected area. X-rays can sometimes be useful for finding out the type of bone cancer it is.

Bone scan
For having a bone scan a small amount of harmless radioactive dye is injected into a vein. This collects in areas of the bone that may have cancer, and is picked up by the scan.

Bone scans are better than X-ray images at showing up a bone cancer. But other diseases, such as arthritis, can also cause a positive result. So if you have a positive bone scan, you may need further tests to make sure you have bone cancer.

MRI scan
Magnetic resonance imaging (MRI) scans use magnets and radio waves to produce images of the inside of your body. Tumours growing inside bones can be seen with MRI scans.

Biopsy
Often your doctor will want to take a biopsy to check if a tumour is non-cancerous. A biopsy is a small sample of tissue. This will be sent to a laboratory for testing.

The biopsy is usually done using a long needle, under local anaesthesia. The procedure is called a core needle biopsy. Sometimes doctors do an operation called a surgical biopsy. This can be done under local or general anaesthetic.

Further tests
If you are diagnosed with bone cancer, you will have more tests to check if the cancer has spread. This is called staging. You are likely to have a chest X-ray, to see if it has spread to your lungs, or a computerised tomography (CT) scan to look for signs of cancer elsewhere in your body.

How bone cancer is treated depends on the type of bone cancer you have, how far it has spread, your age and your general health. The treatment for these rare tumours is carried out in expert centres where cancer specialists (oncologists) and surgeons are familiar with the special treatments required. There are three main types of treatment for bone cancer.

Surgery
The type of surgery you have depends on how far the cancer has spread.

• Limb salvage surgery involves removing the area of bone where the tumour is. Because of the recent advances in surgery, this method of treating bone cancer is becoming more common. The area of bone removed is replaced with either a metal prosthesis (an artificial replacement part) or a piece of healthy bone taken from another part of your body (a bone graft).
• Despite ongoing improvements in surgical technique, sometimes a limb salvaging operation isn't possible. If the cancer has spread into surrounding tissues, amputating the limb may be the only way to get rid of the cancer. Support from the medical staff looking after you can help you come to terms with this news. Advances in prosthetics (artificial limbs) mean that you can often have a fully active life after this surgery. A specialist in artificial limbs will visit you at hospital to arrange one for you. A physiotherapist will be able to teach you how to adapt to and best use it.

Non-surgical treatments

Chemotherapy
Chemotherapy uses medicines to destroy cancer cells. However, they can also have side effects such as making you feel tired or ill, or causing nausea or hair loss. Chemotherapy is particularly good at treating Ewing's sarcoma, but it can also treat other types of bone cancer such as osteosarcoma.There are lots of different types of chemotherapy drugs. They are usually injected into a vein but sometimes tablets are used.

Chemotherapy is often given before and after surgery to make it easier to remove the tumour and to prevent it coming back.

Radiotherapy
Radiotherapy uses radiation to kill cancer cells. A beam of radiation is targeted on the cancerous cells, which shrinks the tumour.

Radiotherapy is especially useful for Ewing's sarcoma but it's sometimes used for osteosarcoma. It can be used before surgery to make it easier to remove the tumour, or afterwards to prevent it coming back.

After your treatment
If you have had an operation you may need physiotherapy and other support to help get you back to functioning well. You will also be seen regularly by a specialist to make sure the cancer hasn't returned.

This information was published by Bupa Group's Health Content Team and has been reviewed by appropriate medical or clinical professionals. To the best of their knowledge the information is current and based on reputable sources of medical evidence, however Bupa (Asia) Limited makes no representation or warranty as to the completeness or accuracy of the Content.

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