Bone cancer

Primary bone cancer is a cancer that starts in a bone. It's sometimes called a bone sarcoma. This is different from secondary bone cancer.

Secondary bone cancer is cancer that has spread to the bone from a cancer elsewhere in the body. It's also called bone metastasis.

Your doctor will tell you whether the bone cancer you have is primary or secondary.

Macmillan Cancer Support have separate information about secondary bone cancer.

Primary bone cancer is rare. About 550 people are diagnosed with it in the UK each year. It can affect people of any age, and it's slightly more common in men than in women.

Certain types of bone sarcoma can develop in children and teenagers. The Children's Cancer and Leukaemia Group (CCLG) has more information about children's cancers.

Sometimes it's hard to tell whether a sarcoma has started in bone or in soft tissue. Ewing sarcoma, a type of bone sarcoma, is one example, because it can start in either the bone or the soft tissue. Ewing sarcoma is most common in teenagers.

To find out whether you have bone cancer, your doctor may ask you to have some of the following tests.

Your doctor may ask for an X-ray of the affected bone. It can show whether the cancer:

• started in the bone and is a primary bone cancer, or
• has spread from another part of the body and is a secondary cancer.

Sometimes an X-ray also helps the doctor work out which type of bone cancer it is.

An MRI scan uses magnetism to build up a detailed picture of the areas inside your body that the doctors want to look at.

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

If your tests show that you have bone cancer, the cancer doctor may do further tests. These find out whether the cancer has spread outside the bone.

Waiting for test results can be a difficult time, and support can help you through it.

The results of your tests give your cancer doctor information about your bone cancer, including:

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

Grading and staging of primary bone cancer is complex. Your cancer doctor or specialist nurse will talk it through with you. They will explain how it can support the planning of your treatment.

Primary bone cancer is rare, so treatment is usually planned and given in a specialist sarcoma treatment centre.

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

Your cancer doctor or specialist nurse will explain the different treatment options and their side effects. They'll also talk with you about what you should consider when you make decisions about treatment.

The following treatments may be used for bone sarcoma. Most people need a combination of them.

Surgery is usually the main treatment for most types of bone cancer. Some people have reconstructive surgery at the same time as the operation.

If you have a bone sarcoma in an arm or leg, the doctors can usually remove it with limb-sparing surgery. Very rarely, the best treatment is to remove the whole of the affected limb (amputation).

Chemotherapy uses anti-cancer (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. Doctors mainly use it to treat Ewing sarcoma, and they may give it together with chemotherapy.

Other types of primary bone cancer don't respond as well to radiation. But if surgery isn't possible, radiotherapy may sometimes be used instead.

Targeted therapy means using drugs that find and attack cancer cells. Doctors don't often use it to treat primary bone cancer.

One drug, called mifamurtide, may be used for some people with osteosarcoma.

People with some of the rarer types of primary bone cancer may be given other targeted therapies, but only as part of a clinical trial.

Most people recover well after treatment for primary bone cancer. Some take longer and need extra help. Before you go home, the hospital staff will talk with you about how your recovery is likely to go.

If you're worried about going home, tell the hospital staff before you leave. They can arrange any help and support you might need at home.

After your treatment for bone cancer finishes, you'll have regular check-ups with your cancer doctor or specialist nurse. They'll tell you how often you'll need these and for how long. That depends on the type of treatment you had and the risk of the cancer coming back.

You may have regular tests to look for any signs of the cancer coming back, including chest X-rays. You may also have regular blood tests. Some people may have MRI scans.

If you've had chemotherapy, you may have regular scans to check your heart for a few years.

If you notice any new symptoms, or have any problems between appointments, contact your cancer doctor or specialist nurse for advice.

Many people find they get nervous before their appointments, and you may worry about the cancer coming back. This is natural. It can help to get support from family, friends or your specialist nurse.

Some side effects of bone cancer treatment don't get better, and others only appear years after treatment has finished. These are called late effects. Your doctor or nurse will tell you about any late effects your treatment is likely to cause. If you notice any new symptoms, or if a side effect isn't improving, always tell them.

You may sometimes get swelling in a limb, or in another part of the body near where you had treatment. This can be a side effect of treatment called lymphoedema.

Lymphoedema can happen after surgery or radiotherapy to the lymph nodes. It may develop months or even years after treatment. There are things you can do to help lower the risk of lymphoedema.

If treatment for bone cancer has changed how you look, it can change how you think and feel about your body. This is called your body image.

You may have scars from surgery, or surgery on a limb may have changed the way you move. If you've had an arm or leg removed, the change to your body can be hard to accept and get used to.

If you're finding it difficult to cope with these changes, talk to your nurse.

Even if you already live a healthy life, you may want to make a few positive changes during and after your bone cancer treatment. Eating well and staying active can improve your health and well-being, and they can help your body recover too.

For many people with early-stage bone cancer that hasn't started to spread, the cancer never comes back after treatment.

If the cancer does come back in the lungs or in a bone, an operation to remove it is sometimes possible. Chemotherapy may be given before and after the operation.

If the cancer can't be cured, treatments like chemotherapy and radiotherapy may be given. The aim is to keep the cancer under control for as long as possible and to relieve symptoms.