Bone Cancer

Symptoms

Bone cancer can affect any bone, but most cases develop in the long bones of the legs or upper arms.

The main symptoms include:

• persistent bone pain that gets worse over time and continues into the night
• swelling and redness (inflammation) over a bone, which can make movement difficult if the affected bone is near a joint
• a noticeable lump over a bone
• a weak bone that breaks (fractures) more easily than normal
• problems moving around – for example, walking with a limp

If you or your child are experiencing persistent, severe or worsening bone pain, visit your GP.

While it's highly unlikely to be the result of bone cancer, it does require further investigation.

Causes

In most cases, it's not known why a person develops bone cancer.

You're more at risk of developing it if you:

• have had previous exposure to radiation during radiotherapy
• have a condition known as Paget's disease of the bone – however, only a very small number of people with Paget's disease will actually develop bone cancer
• have a rare genetic condition called Li-Fraumeni syndrome – people with this condition have a faulty version of a gene that normally helps stop the growth of cancerous cells

Diagnosis

If you're experiencing bone pain, your GP will ask about your symptoms and examine the affected area, before deciding whether you need to have any further tests.

They will look for any swelling or lumps, and ask if you have problems moving the affected area.

They may ask about the type of pain you experience – whether it's constant or comes and goes, and whether anything makes it worse.

After being examined, you may be referred for an X-ray of the affected area to look for any problems in the bones.

If the X-ray shows abnormal areas, you'll be referred to an orthopaedic surgeon (a specialist in bone conditions) or bone cancer specialist for a further assessment.

X-rays

An X-ray is a procedure where radiation is used to produce images of the inside of the body. It's a particularly effective way of looking at bones.

X-rays can often detect damage to the bones caused by cancer, or new bone that's growing because of cancer. 

They can also determine whether your symptoms are caused by something else, such as a broken bone (fracture).

If an X-ray suggests you may have bone cancer, you should be referred to a specialist centre with expertise in diagnosing and treating the condition.

As bone cancer is rare, there are a small number of specialist centres, so you may have to travel outside your local area for advice and treatment.

Biopsy

The most definitive way of diagnosing bone cancer is to take a sample of affected bone and send it to a laboratory for testing. This is known as a biopsy.

A biopsy can determine exactly what type of bone cancer you have and what grade it is.

A biopsy can be carried out in two ways:

• A core needle biopsy is performed under anaesthetic (depending on where the bone is located, this could be a local anaesthetic or general anaesthetic). A thin needle is inserted into the bone and used to remove a sample of tissue.
• An open biopsy is performed under a general anaesthetic. The surgeon makes a cut in the affected bone to remove a sample of tissue.

You may need to have an open biopsy if the results of a core needle biopsy are inconclusive.

Further tests

If the results of the biopsy confirm or suggest bone cancer, it's likely you'll have further tests to assess how far the cancer has spread.

MRI scan

An MRI scan uses a strong magnetic field and radio waves to produce detailed pictures of the bones and soft tissues.

An MRI scan is an effective way of assessing the size and spread of any cancerous tumour in or around the bones.

CT scan

A CT scan involves taking a series of X-rays and using a computer to reassemble them into a detailed three-dimensional (3-D) image of your body.

CT scans are often used to check if the cancer has spread to your lungs. Chest X-rays may also be taken for this purpose.

Bone scans

A bone scan can give more detailed information about the inside of your bones than an X-ray. During a bone scan, a small amount of radioactive material is injected into your veins.

Abnormal areas of bone will absorb the material at a faster rate than normal bone and will show up as "hot spots" on the scan.

Bone marrow biopsy

If you have a type of bone cancer called Ewing sarcoma, you may have a test called a bone marrow biopsy to check if the cancer has spread to the bone marrow (the tissue inside your bones).

During the test, a needle is inserted into your bone to remove a sample of your bone marrow. This may be done under either local or general anaesthetic.

Staging and grading

Once these tests have been completed, it should be possible to tell you what stage and grade the bone cancer is. Staging is a description of how far a cancer has spread and grading is a description of how quickly the cancer is likely to spread in the future.

A widely used staging system for bone cancer uses 3 main stages:

• stage 1 – the cancer is low-grade and has not spread beyond the bone
• stage 2 – the cancer has still not spread beyond the bone, but is a high-grade
• stage 3 – the cancer has spread into other parts of the body, such as the lungs

Most cases of stage 1 bone cancer and some stage 2 bone cancers have a good chance of being cured.

Unfortunately, stage 3 bone cancer is more difficult to cure, although treatment can relieve symptoms and slow the spread of the cancer.

Treatment Options

Treatment for bone cancer depends on the type of bone cancer you have and how far it has spread.

Most people have a combination of:

• surgery to remove the section of cancerous bone – it's often possible to reconstruct or replace the bone that's been removed, but amputation is sometimes necessary
• chemotherapy – treatment with powerful cancer-killing medicine
• radiotherapy – where radiation is used to destroy cancerous cells

In some cases of osteosarcoma, a medicine called mifamurtide may also be recommended.

Follow-up

Once your treatment has finished, you'll need to attend regular follow-up appointments to check the cancer hasn't returned.

You'll be asked to attend frequent appointments in the first 2 years after treatment has finished – possibly every 3 months. These will become less frequent as the years go on.

When To See A Doctor

See your GP if you or your child experiences persistent, severe or worsening bone pain, or if you're worried you have any of the other symptoms of bone cancer.

While it's highly unlikely that your symptoms are caused by cancer, it's best to be sure by getting a proper diagnosis.