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Bone Cancer

Bone cancer is a rare form of cancer affecting both children and adults. It can be primary, originating in the bone, or metastatic, spreading to the bones from cancer elsewhere in the body. While screening tests for bone cancer are limited, treatment options like chemotherapy, radiation, and surgery exist, contributing to improving survival rates for individuals with bone cancer.

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What Is Bone Cancer?

While there are a few types of bone cancers, all bone cancers fall into one of two subtypes:

  • Primary bone cancer — cancer that starts in the bone.
  • Secondary bone cancer — cancer that starts in another part of the body and spreads to the bone (metastatic bone cancer).

Many advanced cancers can spread to the bone. But the American Cancer Society estimates that primary bone cancers are less than 0.2 percent of all cancers.

There are about 3,900 new cases of primary bone cancer a year, including children and adults. Some types of bone cancer are more common in children than in adults.

Bone cancer is less common than other forms of cancer. It happens when cancer cells — cells that split with no control or order — grow in the bone.

When cancer cells divide in excess, the body accumulates more cells than it needs. These cells form a mass of tissue called a malignant or cancerous tumor.

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What Are the Types of Bone Cancers UPMC Treats?

Experts from the musculoskeletal oncology program at UPMC Orthopaedic Care treat the following common types of primary bone cancer:

  • Osteosarcoma — most common cancer to come from the bone itself.
  • Ewing’s sarcoma — most common in school-age children and teens.
  • Chondrosarcoma — often found in the pelvic, thigh, or arm bones.
  • Chordoma — commonly found in the skull base and tailbone.

Symptoms and signs of bone cancer depend on the size of the tumor and where it is in the body.

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What Causes Bone Cancer?

No one knows the main cause of bone cancer. We do know that genetics play a role in most cases.

People can inherit genes that put them at risk of getting cancer. But genes can also mutate, or change, during life.

Gene changes are often to blame for bone cancer, because they make cancer cells grow. Scientists are trying to learn more about these gene changes, but they don't yet understand what causes them.

What are risk factors and complications of bone cancer?

Certain factors may raise your risk for getting bone cancer, including:

  • A history of breast, lung, prostate, kidney, or thyroid cancer.
  • Having certain types of benign bone tumors linked to developing bone cancer.
  • Paget's disease (a noncancerous bone condition).
  • Exposure to radiation.
  • Injury to a bone, which has caused a chronic infection.
  • A family history of bone cancer.

If you're at higher risk, your doctor will keep a close watch on you. Catching bone cancer early leads to the best outcomes. If not treated, bone cancer can grow and spread, most commonly to the lungs.

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What Are the Signs and Symptoms of Bone Cancer?

The most common symptom of bone cancer is a dull ache in the affected bone. It may get worse at night or when you're using the bone. As the cancer grows over time, the pain is constant.

Other common symptoms of bone cancer include:

  • Pain at rest.
  • Swelling or a lump where the tumor is.
  • Deep bone pain that wakes you up.
  • Bone fractures.

Signs of bone cancer depend on the size and location of the tumor. For example, bone tumors in your:

  • Spine can lead to numbness or tingling.
  • Leg may cause you to limp.

Cancer can also cause you to lose weight and feel overly tired.

If you experience any of these symptoms for a long time without a known reason, you should consult with a doctor.

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How Do You Diagnose Bone Cancer?

A doctor may suspect you have a bone tumor after doing a physical exam and hearing your symptoms.

But other diseases and infections can look like bone cancer. The musculoskeletal oncology program at UPMC Orthopaedic Care uses advanced imaging technology and techniques to find and confirm you have bone cancer.

Your doctor may order one or more of the following bone cancer diagnostic tests:

  • X-ray — uses radiation to take a picture of the inside of your body, especially the bones. Often, an x-ray is the only test you'll need.
  • Bone scan — involves injecting a small amount of radioactive substance into the bloodstream, which your bone tissue absorbs. The scan tracks it to look for bone tumors.
  • CT scan — uses a computer to make images of your organs and bones.
  • MRI scan — uses magnetic waves to record images of structures inside the body. MRI scanning can sometimes yield an exact diagnosis of soft tissue tumors.
  • Biopsy — involves taking a sample of tissue to test for cancer cells. Doctors perform these simple procedures under local anesthesia and, when they can, opt for minimally invasive biopsy techniques. Most people can go home the same day.

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How Do You Treat Bone Cancer?

Treatment for bone cancer doesn't always mean surgery.

Once your doctor makes a diagnosis of bone cancer, we will run staging tests to find out if the bone cancer has spread and how much.

We then develop a custom treatment plan, based on your overall health and bone cancer:

  • Type
  • Stage
  • Location

Radiation therapy

Radiation therapy shrinks tumors and kills cancer cells. Radiation may be:

  • External (aimed at a tumor from outside the body).
  • Internal (radioactive materials inside the body, near the cancer cells).

Radiation therapy is effective against some bone cancers, like Ewing sarcoma. But it tends to be less effective overall for many types of bone tumors.

Radiation usually takes place over several treatments. It may also happen before and/or after surgery.


Chemotherapy uses drugs to kill cancer cells. The drugs — either pills or injections — enter the bloodstream and travel through the body, killing mostly cancer cells, but some healthy cells too.

Chemo can kill cancer cells anywhere in the body, so doctors use it when cancer has spread.

Chemotherapy drugs work against some bone cancers, like Ewing sarcoma. But doctors don't use it for other types of bone cancer. They may try other medicines first.

Chemotherapy can have short-term side effects, like nausea, vomiting, loss of appetite, hair loss, and mouth sores.

Bone cancer surgery

Bone cancer surgery removes:

  • The cancerous soft tissue or bone tumor.
  • Nearby tissues.
  • Nearby lymph nodes, in some cases.

The goal is to remove every bit of the cancer. This is why surgeons take out the tumor and some of the normal tissue around the tumor.

Whenever they can, our orthopaedic surgeons will remove the cancerous part of the bone without having to amputate. This is called limb-salvage surgery. They will then use state-of-the-art techniques to replace the cancerous tissue they removed.

Adding radiation therapy or chemotherapy can help avoid the need to amputate and prevent the cancer from returning or spreading. But for some people, the best choice is to amputate. Reconstructive surgery can help, and we have many options.

Rehabilitation after amputation can take three to six months, such as to learn to walk with a prosthetic. It can take longer after limb-salvage surgery — as long as a year.

Doctors also remove bone cancer tumors from the skull, spine, pelvis, and jaw. Bone cancer in these areas of the body often requires both surgery and radiation.

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Bone Cancer and Soft Tissue Tumor Frequently Asked Questions

What are the stages of bone cancer?

Cancer stages describe how much cancer is in the body, and help doctors figure out the right treatment plan.

To tell what stage a cancer is, doctors look at how likely the cancer is to grow and spread. They see if the tumor has stayed in the bone or spread to other structures close by. And finally, they see if the tumor has spread to other areas of the body, like other organs.

Doctors take all of this information to assign the bone cancer a stage, from I to III.

Tumors that are only in one area of the body and not likely to spread are stage I. Tumors that are in one area of the body but are likely to spread are stage II. Tumors that have spread are stage III.

Is bone cancer preventable?

Doctors still don't know enough about the causes of bone cancer to have clear steps to take to avoid getting it. You can't control your genetics or your age (two big risk factors). And lifestyle factors don't seem to cause bone cancer, so they can't tell you not to do certain things either.

Radiation is also a risk factor. Someone with another type of cancer has to weigh the risks and benefits of treating that cancer with radiation therapy.

What is a soft tissue tumor?

Soft tissue tumors occur in muscles, fat, and connective tissues.

Soft tissue tumors can range from harmless things, such as a lipoma or simple fatty tumor, to dangerous diseases such as soft tissue sarcomas (cancers).

These tumors can occur all over the body but are most common in the:

  • Thigh
  • Buttock
  • Abdomen
  • Calf

Treatment of soft tissue tumors depends on the exact type.

Benign, noncancerous tumors — such as lipomas — often require no treatment. Doctors can also do surgery to remove them.

Soft tissue sarcomas generally require surgery because they can be much more aggressive. Doctors may use radiation therapy or even chemotherapy to treat some of these tumors.

What are the general symptoms of soft tissue tumors?

Soft tissue tumors are usually a lump. This lump may or may not grow over time, but not changing for months or years doesn't mean the tumor isn't cancerous.

Even though it doesn't seem to make sense, soft tissue tumors that hurt are often not cancerous. They may be due to trauma or other inflammatory issues.

Soft tissue sarcomas (cancers) rarely cause a lot of pain. They're simply painless lumps that may or may not grow.

What are the different types of bone and soft tissue cancers?

There are many kinds of bone cancers and cancers of the supporting or soft tissues. Some cancers are more common in children and others may occur later in life.

The main types of bone and soft tissue cancers we treat at the musculoskeletal oncology program at UPMC Orthopaedic Care are:

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