Bone cancer

What causes bone cancer?

Doctors don't fully know the exact cause of primary bone cancer. It's often seen in teenagers and young adults, which suggests it may be linked to changes that happen while bones are still growing. But for most people who develop bone cancer, there's no clear reason why it happened.

Certain things can raise the chances of developing a bone sarcoma. These are called risk factors. Having a risk factor doesn't mean a person will definitely get sarcoma, and people with no risk factors at all can still develop it.

Macmillan Cancer Support has more information about the causes of bone sarcoma.

You may need a few different tests to find out whether you have bone cancer.

Bone X-ray

You may have an X-ray of the affected bone. This can show whether a cancer:

• started in the bone itself, meaning it is a primary bone cancer, or
• spread there from another part of the body, meaning it is a secondary cancer.

It can also sometimes help the doctor work out which type of bone cancer it is.

MRI scan

An MRI scan uses magnetism to build up a detailed picture of areas inside your body.

Bone biopsy

In a bone biopsy, a doctor takes a small sample of cells from the bone tissue. A specialist doctor called a pathologist, who has experience with bone tumours, examines the sample under a microscope to check for cancer.

Further tests

If these tests show that you have bone cancer, the cancer doctor may carry out further tests to find out if the cancer has spread beyond the bone.

Macmillan Cancer Support have more information on diagnosing bone cancer.

Waiting for test results can be a hard time. Macmillan Cancer Support have more information that can help.

Staging and grading of bone cancer

Your test results give the cancer doctor information about:

• the stage of the cancer, meaning its size and whether it has spread beyond the bone
• the grade of the cancer, meaning how the cancer cells look under the microscope, which gives an idea of how it might grow or spread

Staging and grading primary bone cancer is complex. Your cancer doctor or specialist nurse will talk you through this and explain how it can help plan your treatment.

Macmillan Cancer Support have more information on staging and grading bone cancer.

Primary bone cancer is rare, so treatment is usually planned and given at a specialist sarcoma treatment centre rather than a general hospital. In Bangladesh, this means your doctor may refer you to a major cancer hospital or specialist centre with experience treating bone sarcoma.

A team of specialists will meet to discuss the best possible treatment for you. This is called a multidisciplinary team, or MDT for short.

Your cancer doctor or specialist nurse will explain the different treatment options and their side effects. They will also talk to you about things to consider when making treatment decisions.

The treatments below may be used for bone sarcoma, and most people need a combination of them.

Surgery is usually the main treatment for most types of bone cancer. Some people have reconstructive surgery done at the same time as the main operation. If the bone sarcoma is in an arm or leg, it is usually possible to remove it with limb sparing surgery, keeping the limb intact. Very rarely, the best treatment is to remove the whole affected limb, known as amputation.

Chemotherapy uses anti-cancer drugs, also called cytotoxic drugs, to destroy cancer cells. Most people with primary bone cancer will have chemotherapy as part of their treatment, though this depends on the type of bone cancer you have.

Radiotherapy uses high-energy rays to destroy cancer cells. It is mainly used to treat Ewing sarcoma and may be given together with chemotherapy. Other types of primary bone cancer respond less well to radiation, but if surgery is not possible, radiotherapy may sometimes be used instead.

Targeted therapy uses drugs that find and attack cancer cells. It is not often used for primary bone cancer, though a drug called mifamurtide may be used for some people with osteosarcoma. Some people with rarer types of primary bone cancer may be treated with other targeted therapies as part of a clinical trial.

After treatment for bone cancer, many people recover well. Some take longer and need extra help along the way. Before you go home, the hospital staff will talk to you about your recovery, so if you are worried about going home, it helps to raise this with them before you leave. They can arrange help and support for you at home.

Once your treatment finishes, you will have regular check-ups with your cancer doctor or specialist nurse. They will tell you how often and for how long you will need these visits, depending on the type of treatment you had and the risk of the cancer coming back. You may have regular tests to check for signs of the cancer returning, including chest X-rays, and you may also have regular blood tests. Some people have MRI scans as well. If you have had chemotherapy, you may have regular scans to check your heart for a few years afterward.

If you notice any new symptoms, or have problems between appointments, contact your cancer doctor or specialist nurse for advice. Many people feel nervous before their appointments and worry about the cancer coming back. This is a natural reaction, and it can help to get support from family, friends or your specialist nurse.

Late effects are side effects that do not improve, or that appear years after treatment has finished. Your doctor or nurse will explain any late effects that are likely for your particular treatment, and you should always tell them about any new symptoms or side effects that are not improving. Sometimes you may notice swelling in a limb or another area near where you had treatment. This can be a side effect called lymphoedema, which sometimes develops after surgery or radiotherapy to the lymph nodes, and it may appear months or even years after treatment ends. There are steps you can take to help lower the risk of lymphoedema, and your care team can guide you on these.

If treatment has changed your appearance, it can affect how you think and feel about your body, something often referred to as body image. You may have scars from surgery, or changes in how you move if a limb was operated on. If you have had an arm or leg removed, adjusting to this change can be difficult, and that is completely understandable. Talk to your nurse if you are finding it hard to cope with these changes.

Cancer and its treatment can also affect your sex life and how you feel about yourself sexually. This often improves gradually after treatment ends. If it is troubling you, do not hesitate to talk to your doctor or nurse about it.

Wellbeing and recovery

Even if you already have a healthy lifestyle, you may choose to make some positive lifestyle changes during and after treatment.

Eating well and keeping active can improve your health and well-being. It can also help your body recover.

Getting support

After finishing treatment, you may still be coping with difficult feelings. Talking to your family and friends or health professionals about how you feel can help to support your wellbeing.

Organisations like Sarcoma UK and the Bone Cancer Research Trust can provide information and support. Cancer52 works to improve the quality of life for people with rare cancers.

Macmillan Cancer Support also has further information to support you. You can:

• phone the Macmillan Support Line on 0808 808 00 00
• chat to Macmillan specialists online
• use the Macmillan bone cancer forum – you can talk to others affected by bone cancer, ask questions and share your experience

If bone cancer comes back

For many people with early-stage bone cancer that hasn’t started to spread, it’ll never come back after treatment.

If the cancer comes back in the lungs or in a bone, it’s sometimes possible to have an operation to remove it. Chemotherapy may be given before and after the operation.

If it isn’t possible to cure the cancer, treatments like chemotherapy and radiotherapy may be given. The aim is to control the cancer for as long as possible and to help relieve symptoms.

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