Cancer information fact sheet Understanding Primary Bone Cancer A guide for people affected by cancer This fact sheet has been prepared What is bone cancer? to help you understand more about Bone cancer can develop as either a primary or primary bone cancer, also known as secondary cancer. The two types are different and bone sarcoma. In this fact sheet we this fact sheet is only about primary bone cancer. use the term bone cancer, and include general information about how bone • Primary bone cancer – means that the cancer cancer is diagnosed and treated. starts in a bone. It may develop on the surface, in the outer layer or from the centre of the bone. As a tumour grows, cancer cells multiply and destroy The bones the bone. If left untreated, primary bone cancer A typical healthy person has over 200 bones, which: can spread to other parts of the body. • support and protect internal organs • are attached to muscles to allow movement • Secondary (metastatic) bone cancer – means • contain bone marrow, which produces that the cancer started in another part of the body and stores new blood cells (e.g. breast or lung) and has spread to the bones. • store proteins, minerals and nutrients, such See our fact sheet on secondary bone cancer. as calcium. Bones are made up of different parts, including How common is bone cancer? a hard outer layer (known as cortical or compact Bone cancer is rare. About 250 Australians are bone) and a spongy inner core (known as trabecular diagnosed with primary bone cancer each year.1 or cancellous bone). The bone marrow is found in It affects people of all ages, but is most often seen this spongy core. Cartilage is the tough material at in people aged 10–25 and over 50. If it develops the end of each bone that allows one bone to move later in life, it may be linked to another bone against another. This meeting point is called a joint. condition (see page 2). Bone structure Cartilage Trabecular Cortical Bone marrow Cartilage (cancellous) bone (compact) bone cavity 2 Understanding Primary Bone Cancer Types of bone cancer Other bone conditions – Some people who have There are more than 30 types of primary bone had Paget’s disease of the bone, fibrous dysplasia cancer. The most common types are: or multiple enchondromas are at higher risk of • starts in cells that grow developing bone cancer. Some studies also suggest bone tissue that people who have had a soft tissue sarcoma • often affects the arms, legs have an increased risk of developing bone cancer. and pelvis, but may occur osteosarcoma in any bone Genetic factors – Some inherited conditions such (about 35% of • occurs in children and young as Li-Fraumeni syndrome increase the risk of bone bone cancers) adults with growing bones, cancer. People with a strong family history of certain and older people in their types of cancer are also at risk. Talk to a family 70s and 80s cancer clinic for more information. Some people • most are high-grade tumours develop bone cancer due to genetic changes that • starts in cells that grow happen during their lifetime, rather than inheriting a cartilage faulty gene. Most bone cancers are not hereditary. • often affects the bones in the upper arms and legs, pelvis, chondrosarcoma ribs and shoulder blade What are the symptoms? (about 30% of • most often occurs in middle- The most common symptom is strong pain in the bone cancers) aged and older people affected bone or joint. The pain gradually becomes • slow-growing form of cancer constant and doesn’t improve with mild pain relievers that rarely spreads to other such as paracetamol. It may be worse at night or parts of the body • most are low-grade tumours during activity. • affects cells in the bone or Other symptoms can include: soft tissue that multiply • swelling over the affected part of the bone rapidly and is often • stiffness or tenderness in the bone Ewing’s sarcoma associated with a large lump • problems with moving around, for example, (about 15% of • often affects the pelvis, legs, an unexplained limp bone cancers) ribs, spine, upper arms • common in children and • loss of feeling in the affected limb young adults • unexplained fractured bone • all are high-grade tumours • unexplained weight loss • tiredness. Some types of cancer affect the soft tissues around the bones. These are known as soft tissue sarcomas, Most people who have these symptoms do not have and may be treated differently. For more details, talk bone cancer. If you have symptoms for more than two to your doctor or call Cancer Council 13 11 20. weeks, you should see your general practitioner (GP). Diagnosis What are the risk factors? If you have symptoms that could be caused by bone The causes of most bone cancers are unknown, cancer, your doctor will take your medical history but factors that increase the risk include: and perform a physical examination. Bone cancer can be difficult to diagnose, and it is likely that you Previous radiation therapy (radiotherapy) – will have some of the following tests: Radiation therapy to treat cancer increases the risk • x-rays – can reveal bone damage or the creation of developing bone cancer. The risk is higher for of new bone people who have high doses of radiation therapy • blood tests – help check your overall health at a young age. Most people who have radiation • CT or MRI scans – a special computer is used to therapy will not develop bone cancer. create pictures to highlight any bone abnormality 3 Understanding Primary Bone Cancer • PET scan – you will be injected with a small Selecting the bone site to biopsy amount of radioactive glucose solution to highlight any cancerous areas on the scan A bone biopsy is a highly specialised test. It is best • bone biopsy – removes some cells and tissues that the biopsy is done at a specialist treatment from the outer part of the affected bone for centre (see below), preferably where you would be examination under a microscope. The biopsy may treated if it is cancer. The site to biopsy must be be done in one of two ways. In a core biopsy, a carefully chosen so it doesn’t cause problems if further surgery is needed. It is important that a bone local anaesthetic is used to numb the area, then biopsy is performed by a doctor who is an expert a thin needle is inserted into the bone under CT in bone cancer. This also helps ensure the sample is guidance to take a sample. In an open or surgical useful and reduces the risk of the cancer spreading. biopsy, the surgeon will cut through the skin under general anaesthesia to remove a piece of bone. If Ewing’s sarcoma is suspected, you will have a procedure to examine cells from the inner part of Treatment the affected bone. A thin needle is used to remove The treatment of bone cancers is complex and a sample of fluid (aspirate) from the bone marrow. requires specialist care. Treatment will depend on: • the type of primary bone cancer • the location and size of the tumour Staging • whether or not the cancer has spread (its stage) The test results will help show how far the cancer • your age, fitness, general health and preferences. has spread in the body. This is called staging. Knowing the stage helps your health care team Treatment for primary bone cancer usually includes plan the most suitable treatment for you. surgery, chemotherapy and radiation therapy, or a combination of these treatments. The aim is to control the cancer and maintain the use of the Grading bone cancer affected area of the body. Many people who are Grading describes how quickly a cancer might grow. treated for bone cancer go into remission (when the symptoms of bone cancer decrease or disappear). The cancer cells look similar to low normal cells. They are usually slow- grade growing and less likely to spread. Understanding your treatment options and possible side effects can help you weigh up the pros and The cancer cells look very abnormal. high cons of different treatments. You may want to get They grow quickly and are more grade a second opinion from another specialist to confirm likely to spread. or clarify your first doctor’s recommendations. Stages of bone cancer There are different staging systems used for bone Specialist treatment centres cancer. Ask your doctor to explain your stage to you. Located in major cities throughout Australia, these centres have expert multidisciplinary teams stage 1 The cancer contains low-grade cells; (MDTs) who regularly manage this cancer. The (localised) there is no spread beyond the bone. team will include surgeons, medical oncologists, stage 2 The cancer contains high-grade cells; radiation oncologists, pathologists, radiologists (localised) there is no spread beyond the bone. and clinical nurse consultants, as well as allied There are several high-grade tumours health professionals such as physiotherapists, stage 3 in the same bone; there is no spread occupational therapists and social workers. Some (localised) beyond the bone. centres also have oncologists with experience in treating young people with bone cancer. The cancer is any grade and has stage 4 spread to other parts of the body To find a specialist treatment centre, visit (advanced) (e.g. the lungs). sarcoma.org.au. 4 Understanding Primary Bone Cancer Preparing for treatment A physiotherapist can plan an exercise program to help you regain strength and function in your limb. Some types of chemotherapy and radiation therapy can affect your heart and kidneys. Your doctor may Surgery to remove the limb (amputation) recommend you have some tests to check how In some cases when it is not possible to remove all well your heart and kidneys are working.