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The information on this page was reviewed and approved by
Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was updated on April 2, 2021.

About bone cancer

Most cancer found in bones has metastasized from other parts of the body. Primary bone cancer, which starts in the bone, accounts for fewer than 0.2 percent of all cancers, according to the American Cancer Society. Primary bone tumors are called sarcomas and are malignant (cancerous). While malignant tumors may occur in any bone, primary bone cancer most often develops in the long bones of the arms and legs.

Bone cancer that starts in another part of the body is secondary bone cancer and is identified by the area where it originated. For example, multiple myeloma and leukemia begin in the bone marrow and can cause malignant bone tumors, but they are classified as blood cancers rather than primary bone cancers. Secondary bone cancer may have similar signs and symptoms to primary bone cancer, so a biopsy is often needed to determine the cause of the cancer.

What causes bone cancer?

Secondary bone cancer results when cancer cells—such as prostate cancer, lung cancer, or breast cancer—metastasize in the bone. After bone metastasis, the bone begins replicating prostate cancer cells or breast cancer cells, rather than the osteoblast and osteoclast cells that normally comprise healthy bones.

The exact cause of primary bone cancer is unknown, but certain factors may increase a person's risk of developing the disease.

Several genetic disorders (hereditary syndromes) are considered risk factors for bone cancer, including:

  • Li-Fraumeni syndrome, Rothmund-Thompson syndrome and mutation of the retinoblastoma gene, which put children at increased risk of osteosarcoma
  • Multiple exostoses syndrome, also called multiple osteochondromas syndrome, which increases the risk of chondrosarcoma

Some bone cancers run in families, but the underlying genetic mutations have not been identified yet.

Other conditions that increase risk of bone cancer include:

  • Paget’s disease of the bone (medically unrelated to the Paget’s disease of the breast), which causes bones to become thick and brittle
  • Multiple enchondromatosis, which involves benign cartilage tumors known as enchondromas

These previous treatments may also play a role:

  • Radiation therapy, such as the type used in cancer treatments, which may allow radioactive minerals to build up in the bones
  • Bone marrow transplantation, which may increase the risk for developing osteosarcoma

Who gets bone cancer?

There is no definitive understanding of who gets bone cancer. Some forms of the disease affect young people, while others don’t show up until middle age or later years. Several are more common in men than women.

Bone cancer types

Primary bone cancers are a specific subtype of a group of cancers known as sarcomas. Sarcomas are cancers that start in bone, muscle, connective tissue, blood vessels or fat, and may be found anywhere in the body. Types of bone cancers include:

  • Osteosarcoma, also called osteogenic sarcoma, which is the most common type of bone sarcoma and typically starts in bone cells in the arms, legs or pelvis, usually affecting people between the ages of 10 and 30
  • Chondrosarcoma, which forms in cartilage cells and rarely occurs in people under the age of 20
  • Ewing tumor, also called Ewing’s sarcoma, which most frequently occurs in children and teenagers
  • Fibrosarcoma and malignant fibrous histiocytoma, which usually develops in the soft tissue around the bones and tends to occur in older adults
  • Giant cell tumor, which also includes benign tumors (non-cancerous) and usually occurs in the arms or legs of young adults and middle-aged adults
  • Chordoma, which affects bones in the spine and the base of the skull and occurs most frequently in adults 30 or older, particularly men
  • Metastatic bone cancer, which spreads to other parts of the body but is still considered bone cancer

Not all bone tumors are malignant. Benign bone tumors include osteoid osteoma, osteoblastoma, osteochondroma, enchondroma and chondromyxoid fibroma.

Bone cancer symptoms

Many bone cancer symptoms match common symptoms associated with arthritis, osteoporosis or injury. If you’re experiencing one or more of these symptoms, you should discuss them with your doctor in order to identify the cause.

Possible symptoms of bone cancer include:

  • Bone pain
  • welling (or a lump) in the area of the bone pain
  • Fractures resulting from weakened bones
  • Unintended weight loss and fatigue that accompanies bone pain
  • Difficulty breathing, if the cancer has spread to other organs, such as the lungs

Diagnosing bone cancer

Tools frequently used for bone cancer diagnosis include:

  • Needle biopsy, performed with a local anesthetic to numb the injection area
  • Surgical biopsy, typically performed under general anesthesia to remove a bone tissue sample (incisional biopsy) or a whole tumor (excisional biopsy)
  • Radionuclide bone scan
  • X-ray
  • Magnetic resonance imaging (MRI)
  • Computed tomography scan (CT scan)
  • Positron emission tomography scan (PET scan)

Bone cancer treatments

Treatment options for bone cancer include:

  • Orthopedic oncology, such as soft tissue excisions or resections, hip and joint replacement, and reconstructive and palliative surgeries
  • Cancer-removal surgeries
  • Chemotherapy
  • Radiation therapy
  • Targeted therapy, which uses drugs that attach to proteins, receptors or gene mutations found only on specific types of cancer cells