Primary bone cancer is a cancer that starts in a bone. It is 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. This is also called bone metastasis. Your doctor will tell you whether the bone cancer you have is primary or secondary.
We 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. It is slightly more common in men than 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 is hard to tell whether a sarcoma has started in bone or soft tissue. For example, a type of bone sarcoma called Ewing sarcoma can start in either the bone or the soft tissue. Ewing sarcoma is most common in teenagers.
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Types of bone cancer
There are different types of bone cancer. Your doctor or specialist nurse can tell you more about which type you have. The most common types are:
We have more information about different types of bone cancer.
The exact causes of primary bone cancer are not known. Many bone cancers affect teenagers and young adults. This might mean that bone cancer is related to changes that happen in growing bones. But for most people with bone cancer, it is not clear why it has developed.
Certain things can affect the chances of developing a bone sarcoma. These are called risk factors. Having a risk factor does not mean you will get sarcoma and people without risk factors can still develop it.
We have more information about the causes of bone sarcoma.
You may have some of the following tests to diagnose bone cancer:
- Bone x-ray - You may have an x-ray of the affected bone. This can give information about whether a 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. It may also sometimes help the doctor find out which type of bone cancer it is.
- MRI scan - An MRI scan uses magnetism to build up a detailed picture of areas of your body.
- Bone biopsy - A bone biopsy means the doctor takes a sample of cells from the bone tissue to be checked for cancer under the microscope. It is looked at by a specialist doctor called a pathologist with experience in bone tumours.
If the tests show that you have bone cancer, the cancer doctor may do further tests to find out if the cancer has spread outside the bone.
We have further information about diagnosing bone cancer that explains more about these and other tests for bone cancer.
Waiting for test results can be a difficult time. We have more information that can help.
The results of your tests give your cancer doctor information about:
- the stage of the cancer – its size and whether it has spread outside the bone
- the grade of the cancer – how the cancer cells look under the microscope, which gives an idea of how the cancer might grow or spread.
The grading and staging of primary bone cancer is complex. Your cancer doctor or specialist nurse will talk to you about this and explain how it may help plan your treatment.
We have more information about staging and grading bone cancer.
As primary bone cancer is rare, treatment is usually planned and given in a specialist sarcoma treatment centre. There are only a small number of sarcoma treatment centres in the UK.
A team of specialists will meet to discuss the best possible treatment for you. This is called a multidisciplinary team (MDT). Your cancer doctor or specialist nurse will explain the different treatments options and their side effects. They will also talk to you about things to consider when making treatment decisions.
The following treatments may be used to treat bone sarcoma. Most people need a combination of these treatments.
Surgery is usually the main treatment for most types of bone cancer. Some people might have reconstructive surgery at the same time as the operation. If you have a bone sarcoma in an arm or leg, it is usually possible to remove the sarcoma with limb-sparing surgery. Very rarely, the best treatment is to remove the whole of the affected limb (amputation).
Targeted therapy uses drugs to find and attack cancer cells. It is not often used to treat primary bone cancer. A drug called mifamurtide may be used to treat 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.
You might have some treatments as part of a clinical trial.
We have more information about primary bone cancer treatment.
Many people recover well after treatment for primary bone cancer. Some people take longer and need extra help. Before you go home, the hospital staff will talk to you about your recovery.
If you are worried about going home, talk to the hospital staff before you leave. They can arrange any help and support you might need at home.
After 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 to have these. It will depend on the type of treatment you had and the risk of the cancer coming back.
You may have regular tests to check 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 have 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. You may worry about the cancer coming back. This is natural. It can help to get support from family, friends or your specialist nurse. Or you can speak to our cancer support specialists.
We have more information about follow-up care after treatment.
Possible late effects
Late effects are side effects that do not improve, or that develop years after treatment has finished. Your doctor or nurse will explain any likely late effects of your treatment. Always tell them if you have any new symptoms, or if side effects are not improving.
Sometimes you may have swelling of a limb or of another area of the body near to where you have had treatment. This might be due to a side effect of treatment, called lymphoedema. It sometimes happens after surgery or radiotherapy to the lymph nodes and might develop months or years after treatment. There are things you can do to help reduce the risk of lymphoedema.
Coping with body changes
If treatment has changed your appearance it can affect how you think and feel about your body. This is called your body image. You may have scars from surgery, or surgery to a limb may have caused changes in how you move. If you have had an arm or leg removed, the change to your body may be difficult to accept and adapt to.
Talk to your nurse if you are finding it difficult to cope with body changes.
Macmillan is also here to support you. If you would like to talk, you can:
If bone cancer comes back
For many people with early-stage bone cancer that has not started to spread, it will never come back after treatment.
If the cancer comes back in the lungs or in a bone, it is sometimes possible to have an operation to remove it. Chemotherapy may be given before and after the operation.
If it is not possible to cure the cancer, treatments such as chemotherapy and radiotherapy may be given. The aim is to control the cancer for as long as possible and to help relieve symptoms.
Below is a sample of the sources used in our information about primary bone cancer. If you would like more information about the sources we use, please contact us at firstname.lastname@example.org
European Society for Medical Oncology, ESMO. 2021. Bone sarcomas: ESMOeEURACANeGENTURISeERN PaedCan Clinical Practice Guideline for diagnosis, treatment and follow-up. Annals of Oncology. S. J. Strauss1 et al. Available at: https://www.esmo.org/guidelines/guidelines-by-topic/sarcoma-and-gist/bone-sarcomas (accessed July 2023)
UK guidelines for the management of bone sarcomas, Clinical Sarcoma Research (2016) 6:7. Gerrand C et al on behalf of the British Sarcoma Group. Available at: UK guidelines for the management of bone sarcomas - PMC (nih.gov)(accessed July 2023)
British Medical Journal, BMJ Best Practice. Osteosarcoma. Last updated May 2022. Last reviewed 27 Jun 2023. Available at: Osteosarcoma - Symptoms, diagnosis and treatment | BMJ Best Practice (accessed July 2023)
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by senior medical editor Fiona Cowie, Consultant Clinical Oncologist.
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