Bone cancer, or primary bone cancer, is a rare condition that occurs when cells in the bone begin to mutate and grow uncontrollably. These malignant cells can damage healthy bone tissue, weaken bones and increase the risk of fractures, and interfere with the production of blood cells. It is important to note that many cancers can spread to the bones from other parts of the body; however, this information focuses solely on cancers that originate in the bone itself.
In India, many people are diagnosed with primary bone and joint cancer each year, making up approximately 0.2% of all cancers in the country.
Bone tumours are classified based on the cell type in which they originate. They can be benign (non-cancerous) or malignant (cancerous). Common types of primary bone cancer include:
This is the most common bone cancer in children and adolescents, typically developing near the knee in the arms or legs, or in the pelvis. It accounts for about one-fourth of adult bone cancers.
This cancer arises in cartilage cells and is the most common bone cancer in people over 40, accounting for over 40% of adult bone cancers. It is often diagnosed at an early stage.
The second most common bone cancer in children and adolescents and the third most common in adults. It can start in the bone or soft tissue, commonly in the pelvis, chest wall, legs, or arms.
A less common type that typically arises in the spine or at the base of the skull, representing around 10% of adult bone cancers.
Usually begins in the connective tissue but may also originate in the bone.
Primary bone cancer is rare and can affect individuals of all ages:
Osteosarcoma is most common in teenagers and young adults, often coinciding with growth spurts.
Chondrosarcoma primarily affects adults over the age of 40.
Ewing's Sarcoma is more prevalent in children and adolescents.
While having a risk factor does not guarantee you will develop bone cancer, some factors can increase a person's risk:
Inherited conditions such as Li-Fraumeni syndrome, Rothmund-Thompson syndrome, Retinoblastoma (eye cancer in children), and Multiple Osteochondromas (multiple benign bone growths) can increase risk. Genetic counselling may be appropriate for individuals with these conditions or a relevant family history.
Paget's disease of bone, prior high-dose radiation therapy (especially at a young age), and having undergone a bone marrow transplant are also associated with an elevated risk.
Bone cancer symptoms vary depending on the tumour's type, size, and location. Not everyone experiencing bone pain has cancer, as many other conditions can present similar signs.
The most common signs include:
Persistent bone pain that does not improve with rest and often worsens at night or with activity.
Swelling or a noticeable lump near a bone or joint.
Fractures that occur from minimal trauma due to weakened bones.
Decreased mobility in the affected limbs.
General systemic symptoms such as fatigue, fever, or unintended weight loss.
It is important to contact your healthcare provider if you experience:
Persistent or worsening bone pain that is not relieved by rest.
Unexplained swelling or lumps near a bone or joint.
A bone fracture from a minor injury.
Unexplained fatigue, fever, or weight loss.
Early evaluation is vital for a timely and accurate diagnosis, which leads to better treatment outcomes.
Accurate diagnosis is crucial for successful treatment. A diagnosis is typically coordinated by a multidisciplinary team of specialists, including orthopaedic oncologists, sarcoma medical and radiation oncologists, radiologists, and pathologists.
If bone cancer is suspected, it is recommended to seek care at a cancer centre with a specialised bone cancer programme, such as SSCHRC.
Diagnostic tests may include one or more of the following:
Imaging provides the first step in evaluating abnormal bones and planning treatment:
Used initially to identify abnormal bone structures.
Help determine the size, shape, and exact location of the tumour.
Offer detailed images of the bone and surrounding soft tissue, which is essential for surgical planning.
Can detect other areas of abnormal bone activity or potential spread (metastasis).
Blood and urine tests are ordered to check for abnormalities that can be associated with bone cancer or its effects on overall health:
May indicate changes in bone metabolism.
Helps detect anaemia (low red blood cell count) or other blood cell issues.
A biopsy is the only definitive way to confirm the presence of cancer cells. It involves removing a small piece of bone for examination under a microscope. It is critical that the biopsy is performed by a surgeon with experience in bone tumours, as a poorly executed biopsy can complicate later surgery. The two main types are:
A long, hollow needle is inserted through the skin to remove a cylindrical tissue sample.
An incision is made, and a surgeon removes a small piece of the bone tumour.
Bone cancer treatment is highly personalised and depends on the type of cancer, its location, stage, and the patient's overall health. Treatment plans are often a combination of therapies.
For Osteosarcoma and Ewing's Sarcoma, the main treatments are usually surgery and chemotherapy.
For Chondrosarcoma, surgery is the most common treatment.
Often the main therapy, aiming to remove the tumour while preserving as much healthy tissue as possible.
Removal of the tumour along with a margin of surrounding healthy tissue to ensure all cancer cells are removed.
For tumours in an arm or leg, surgeons aim to remove the cancer while preserving the limb. This may involve replacing the bone with a bone graft or an internal device (endoprosthesis).
May be necessary if limb-sparing surgery is not feasible. This is followed by reconstructive surgery, a prosthesis, and rehabilitation.
The use of powerful drugs to kill cancer cells, control tumour growth, or relieve symptoms. It is commonly used for Osteosarcoma and Ewing's Sarcoma, often administered before surgery to shrink the tumour and after surgery to eliminate any remaining cancer cells.
Uses focused, high-energy beams to destroy cancer cells. Although bone cancer is generally less sensitive to radiation than other cancers, it can be used when a tumour cannot be completely removed surgically, if some cancer cells remain after surgery, or for pain relief.
Drugs that specifically interfere with the molecules or genes that promote the growth and spread of cancer cells, often resulting in more limited side effects than traditional chemotherapy.
Also known as "watch and wait," this involves careful monitoring with regular imaging and laboratory tests for slow-growing tumours or those not causing symptoms.
Survival rates are estimates that depend on the tumour type, stage at diagnosis, and response to treatment:
The five-year survival rate is approximately 70% for tumours that remain localised.
The five-year survival rate ranges from 80–90% for slow-growing, low-grade tumours.
The five-year survival rate is approximately 70% for localised disease.