Bone Cancer (Osteosarcoma) | Symptoms, Stages, Types, Diagnoses, Chances of Surviving, Treatments

Hip bone cancer

What is bone cancer?

Bone cancer (osteosarcoma) starts in the cells of the bones or cartilage. It is also called primary bone cancer. Cancerous (malignant) tumor is a group of cancer cells that can invade and destroy nearby tissue. It can also spread (metastasize) to other parts of the body. Primary bone cancer is very rare in adults over 40 years old. It is seen more often in children, adolescents and young adults.

Other types of cancer can spread to the bones, but this is not the same disease as primary bone cancer. Cancer that starts in another part of the body and then spreads to the bones is called bone metastasis or secondary bone cancer. It is much more common than primary bone cancer. Find out more about bone metastases.

Types of bone tumors

Bone or cartilage cells sometimes undergo changes that make the way they grow or behave abnormally. These changes can lead to non-cancerous (benign) conditions such as bone cysts. They can also cause non-cancerous tumors such as osteochondroma, osteoma and osteoclastoma (also called a giant cell tumor of the bone) to form.

But in some cases, changes in bone or cartilage cells can cause bone cancer.

The most common types of cancerous bone tumors in adults over the age of 30 are chondrosarcoma and osteosarcoma. They most often appear on the legs or arms. Chordoma is another type of cancerous tumor that starts in the bones of the skull or spine.

Rare types of bone cancer can also occur. These include fibrosarcoma, angiosarcoma and high-grade undifferentiated polymorphic sarcoma. Ewing’s sarcoma is much more common in children and young adults than in older adults.


The adult human skeleton is made up of 206 bones. Together, the groups of bones and cartilage make up the skeleton, which gives shape to the body.

Bone cells

A bone is made up of 3 types of cells.

  • Osteoblasts make new bones.
  • Osteoclasts break down old bones and get rid of them.
  • Osteocytes carry nutrients from the blood to the bones, and waste products away from the bones.

A bone is a very active tissue. Bones are constantly being remodeled, that is, old bone tissue is replaced by new bone tissue. Certain hormones, minerals and bone cells play a role in the process of bone remodeling. The bones respond to changes in the level of calcium in the blood as well as to the gravity and pulling of muscles on the skeleton.

Types of bones

We can classify bones according to their shape.

A long bone is longer than it is wide. It usually includes a body with a head at each end. It is mostly made of compact bone. Examples of long bones are the thigh and arm bones.

A short bone is often smaller and cube-shaped. It is mostly made of cancellous bone. Examples of short bones are the wrist and ankle bones.

A flat bone is thin, flat, and often curved. It is made of 2 thin layers of compact bone between which is a layer of cancellous bone. Ribs and breastbone are examples of flat bones.

Irregular bone is complex in shape and cannot be categorized into the above categories. Examples of irregular bones are vertebrae and pelvic bones.


Bones are one of the hardest materials in the body. They are made of collagen and various minerals, like calcium, which make them strong and hard. Although bones vary in shape and size, they essentially have the same structure and function.

A bone is made up of different layers of material. Several terms are used to describe the characteristics of the bones in the body.


The periosteum is the layer of fibrous tissue that covers the bone, except at its ends.

Compact bone

Compact bone forms the dense, hard, and smooth outer layer of bones. It surrounds the yellow bone marrow located in the body of the bones and strengthens the hollow part of the bones.

Compact bone is made up of many channels (passageways) that contain blood vessels and nerves. Blood vessels supply blood to bone cells. The blood provides them with oxygen and nutrients, and removes carbon dioxide and wastes from them.

Nerves are found in and around the bones.

Medullary canal

The medullary canal is the space inside the body of the bone that contains the yellow bone marrow. The yellow pith serves mainly as a storage place for fatty tissue.

Cancellous bone

Cancellous, or trabecular, bone is made up of small fragments of bone and lots of open space, much like a honeycomb. The red bone marrow is stored in cancellous bone, where blood cells are made. In adults, the red marrow is found mostly in the spongy bone of the skull, breastbone, ribs, pelvic bones, collarbones and spine (vertebrae).


Cartilage covers the ends of the bones. It is a tough, fibrous connective tissue that is mixed with a gelatinous substance. Cartilage is softer than bone tissue but firmer than most other tissue. It prevents the bones from rubbing against each other and acts as a shock absorbing cushion.

Long bones

Cancer is more likely to start in long bones.

Diagram of the structure of a long bone

A long bone is made of 4 main parts.

  • The shaft, or body, of the long bone runs almost the entire length of the bone.
  • The metaphysis is the part of the long bone located just after the shaft.
  • The epiphysis is the end of the long bone. The epiphysis is made up of compact bone tissue and spongy bone tissue. There is an epiphysis at each end of the bone.
  • The mating cartilage, or cartilage plate, is a thin layer of cartilage between the metaphysis and the epiphysis that allows bone to grow. He passed away around the age of 20.
Bone functions

Bones have many functions including:

  • give the body its shape and support its tissues;
  • protect important organs such as the heart, lungs and brain;
  • working with muscles, tendons and ligaments to allow the body to move;
  • store fat and minerals and release minerals like calcium, phosphorus and magnesium when the body needs them;
  • make blood cells in the red bone marrow of certain bones.

Cancerous bone tumors

A cancerous tumor in the bones can invade and destroy nearby tissue. It can also spread (metastasize) to other parts of the body. Cancerous tumors are also called malignant tumors.

Cancer that starts in the bones (primary bone tumor) is rare. It is more common in children and young adults than in older adults. Cancer that spreads to the bones from another part of the body, called bone metastases or secondary bone cancer, is much more common in older adults.

Most bone cancers are called sarcomas. The following sarcomas are seen in adults.


Chondrosarcoma is the most common type of primary bone cancer found in adults over the age of 50. It originates in cartilage, which is the tough, flexible tissue that covers the joints. It is most often found in the bone of the arm (humerus) or thigh (femur). But it can also be seen in the ribs, pelvic bones and scapula. Usually, chondrosarcoma is a cancer that grows slowly.

There are different subtypes of chondrosarcoma:

  • central, primary or secondary
  • peripheral
  • dedifferentiated
  • clear cell
  • mesenchymal

Osteosarcoma is the second most common type of primary bone cancer found in people who are in their 60s or 70s. This is the type of bone cancer that most commonly affects children and young adults. Although osteosarcoma can appear in any bone in the body, it is most commonly seen at the ends of the bones of the knee, shin, leg and arm. In older adults, it is also detected in the hips and jaws.

Osteosarcoma more often affects people with a history of retinoblastoma (a type of childhood eye cancer), Paget’s disease of bone, or radiation therapy.

There are several different subtypes of osteosarcoma:
  • low grade central
  • conventional (which can be osteoblastic, chondroblastic or fibroblastic)
  • small cell
  • high grade surface
  • telangiectatic
  • secondary (caused by radiation therapy or Paget’s disease of bone)
  • parosteal osteosarcoma
  • periosteal osteosarcoma

Chordoma is a cancer that grows slowly at the base of the skull, at the base of the spine (sacrum), and in other bones of the spine (vertebrae). It is more common in men than in women and in adults over 30 years old.

High-grade, undifferentiated polymorphic sarcoma

High-grade, undifferentiated polymorphic sarcoma is present in the bones of the leg, arm, and jaw. It is more common in people over the age of 40. It is also called malignant fibrous histiocytoma (HFM). High-grade, undifferentiated polymorphic sarcoma is treated like osteosarcoma.

Rare bone cancer

The following bone cancers are rare.

Ewing’s sarcoma is very rare in adults over 40 years old. It is much more common in adolescents and young adults. It most commonly affects the bones of the pelvis and the bones of the leg, arm, ribs, spine, and skull. Find out more about Ewing’s sarcoma.

Fibrosarcoma is a type of primary bone cancer that is aggressive. It is very rare in people under 40 and more common in those over 40. It is most often found in the bones of the leg. The main treatments for fibrosarcoma are surgery and radiation therapy, but sometimes chemotherapy is used.

Angiosarcoma is an aggressive type of primary bone cancer. It appears in the bones of the leg and pelvis, sometimes in multiple places in the same bone. Surgery is the main treatment for angiosarcoma. Chemotherapy may be used to treat angiosarcoma that has spread to other parts of the body.

Other cancers that can start in the bones

The following cancers can start in the bones, but they are not considered bone cancers:

  • multiple myeloma
  • non-Hodgkin lymphoma

Non-cancerous bone tumors

A non-cancerous (benign) bone tumor is a lump that does not spread to other parts of the body (not metastasize). The non-cancerous tumor is usually not life threatening. Some non-cancerous bone tumors can invade and destroy nearby bones and tissues (locally aggressive tumors), but they do not spread outside of the bones.

Most non-cancerous bone tumors are removed by surgery or curettage, and they usually do not come back (recur).


Osteochondroma is the most common non-cancerous bone tumor. It originates in the strong and flexible tissue that covers the joints (cartilage). This tumor is usually seen near the ends of long bones in the leg, but it can also appear in the bones of the pelvis or the shoulder blades. Osteochondroma is usually detected in people who are older than 40 years.

Multiple inherited osteochondromas are a rare inherited disorder characterized by the formation of numerous osteochondromas, usually before the age of 12 years. In people who have it, one of the osteochondromas is more likely to develop into a cancerous tumor called chondrosarcoma.


Osteoma is a non-cancerous tumor found in the bones of the paranasal sinuses and skull, as well as in the long bones of the leg and arm. Since osteoma usually does not cause symptoms, it can be difficult to diagnose. People who have more than one osteoma can have an inherited disorder called Gardner syndrome. Surgery is offered to people who have more than one osteoma as well as to those who are experiencing symptoms.

Osteoid osteoma

Osteoid osteoma is a very small, non-cancerous tumor that is usually seen in the bones of the leg. It is usually less than 1.5 cm. This type of tumor most often appears in men under the age of 40. Osteoid osteoma can cause pain and swelling.


Enchondroma is a non-cancerous bone tumor that can appear at any age, but is most commonly seen in children and young adults. It originates mostly in the bones of the hand and foot. If you find many enchondromas, then it is a disorder called enchondromatosis or Ollier’s disease.

Most enchondromas do not need to be removed by surgery unless they cause pain, get bigger, or if the bone is at risk of breaking.

Giant cell tumor of bone

Giant cell tumor of the bone most often starts in the long bones of the leg, around the knee. It is more likely to be detected in people between the ages of 20 and 30. This tumor is sometimes called an osteoclastoma.

Giant cell tumor of bone is locally aggressive. It often causes pain by spreading through bone to nearby tissue. In rare cases, it can spread to the lungs, even if it is not cancerous.

Giant cell tumor of bone often comes back (recurs) after being removed by surgery. To reduce the risk of recurrence, the surgeon may use chemicals to heat the end of the bone where the tumor was removed or freeze the area with extremely cold fluids such as nitrogen.

Denosumab (Xgeva) is a monoclonal antibody that finds and binds to RANKL. RANKL is a substance on the surface of bone cells that helps break down bones. When RANKL is targeted and blocked, bones do not break down as quickly. Denosumab can be offered as a treatment for giant cell tumor of the bone because it has been shown to slow the progression of bone changes and delay the need for surgery.

Chondroblastoma and osteoblastoma

Chondroblastoma and osteoblastoma are 2 types of so-called intermediate bone tumors. This means that they fall between non-cancerous tumors and cancerous tumors. Although they can grow and spread to nearby tissues, they very rarely spread to other parts of the body. These tumors are unlikely to become cancerous.

Rare non-cancerous bone tumors

The following non-cancerous bone tumors are rare:

  • chondroma
  • giant cell lesion of small bones
  • benign fibrous histiocytoma
  • non-ossifying fibroma
  • benign notochordal tumor
  • atypical cartilage tumor (locally aggressive)
  • chondromyxoid fibroma (locally aggressive)
  • osteochondromyxoma
  • bizarre parosteal osteochondromatous proliferation (Nora’s lesion)
  • subungual exostosis
  • synovial chondromatosis

Non-cancerous bone disorders

Non-cancerous, or benign, bone disease is a change in the cells of the bones, but it is not cancer. The non-cancerous condition does not spread to other parts of the body (no metastases) and is usually not life threatening.

Bone cysts are the most common non-cancerous bone disease. Bone cyst is a space filled with fluid in a bone. It is most often seen in the long bones of the leg and arm, but it can also originate in the bones of the pelvis and spine. The bone cyst affects children and adolescents more often, although it can also appear in adults.

There are 2 types of bone cysts
  • The unilocular cyst is the most common type of bone cyst. It is seen twice as much in men as in women. Unilocular bone cyst can cause a fracture.
  • Aneurysm cyst is not as common as a unilocular cyst. It can be locally aggressive. As it grows, it may cause pain, swelling, and fracture.

Usually, all you need to do is check for small bone cysts that don’t cause symptoms and that don’t increase your risk of a fracture to see if they are undergoing any changes. Large cysts that cause symptoms or weaken bone are usually removed by surgery.

Risk factors for bone cancer

A risk factor is something, like a behavior, substance, or condition that increases your risk for developing cancer. Most cancers are caused by many risk factors, but bone cancer can develop in people who do not have any of the risk factors described below.

Some people may have a higher than average risk of developing bone cancer. Discuss your risk with your doctor. If it is above average, you may need a personalized screening plan.

The following are risk factors for bone cancer. Not all known risk factors are modifiable. It means you can’t change them. Until we know more about these risk factors, there is no specific way to reduce your risk.

Risk factors are usually ranked from most important to least important. But in most cases, it is impossible to rank them with absolute certainty.

Research shows that there is no link between the fluoride in drinking water and an increased risk of bone cancer.

Known risk factors

There is convincing evidence that the following factors increase your risk for bone cancer.

Radiation exposure

People exposed to high doses of radiation are more likely to develop bone cancer. Bone cancer usually starts about 5 to 20 years after exposure.

High dose radiation therapy given to treat a person with cancer at a young age may increase the risk of bone cancer. The risk is higher in the area treated with radiotherapy. People whose whole body has received radiation therapy (total body radiation) before a stem cell transplant are at greatest risk of developing bone cancer.

The ionizing radiation from the atomic bomb poses a high risk of bone cancer, especially in people who were children when exposed.

Exposure to radium increases the risk of bone cancer.

People who have bone disease, such as ankylosing spondylitis and tuberculosis of the bone, and who have been treated with intravenous radium are at high risk for bone cancer.
Paint that contains radium is used on the face of watches and clocks. Workers who used their lips to place brushes in desired locations are at high risk for bone cancer.
Exposure to plutonium can increase the risk of bone cancer. People who work in or live around a plutonium or nuclear weapons plant are at increased risk of developing bone cancer.

Bone ailments or disorders

Having any of the following bone conditions or any of the following bone disorders can increase your risk for bone cancer.

Paget’s disease of bone causes the formation of abnormal bone tissue. Bones become denser, thicker, weaker, and more likely to fracture than normal. Paget’s disease occurs mostly in people over the age of 50.

Fibrous dysplasia is a chronic condition characterized by bones that grow unevenly and break easily.

Osteogenesis imperfecta is a disorder characterized by easily broken bones.

Chondroma and osteochondroma are non-cancerous (benign) bone tumors that slightly increase the risk of chondrosarcoma, a type of bone cancer.

Genetic disorders

The following rare inherited genetic disorders increase your risk for bone cancer.

Retinoblastoma is a rare eye cancer that occurs in children. It can be hereditary (familial retinoblastoma). People who have the inherited form of retinoblastoma as a child have a higher risk of developing bone cancer. Their risk is even greater if they have received chemotherapy and radiation therapy as treatment for retinoblastoma.

Li-Fraumeni syndrome greatly increases the risk of developing many types of cancer, including bone cancer.

Werner’s syndrome is a very rare condition that causes the body to age very quickly after puberty. People with Werner Syndrome usually have cancer of the bones, often in the ankle, in their mid-thirties.

Rothmund-Thomson syndrome is characterized by short stature, skeletal disturbances, and rashes. People with this genetic disorder are more likely to have osteosarcoma, especially in childhood and adolescence.

Bloom syndrome is characterized by dwarfism, a rash born, have an immune deficiency and the risk of developing different types of cancer, including bone cancer.

Multiple exostosis disease is a rare disorder that causes many non-cancerous lumps, called exostoses, to form on the bones. These lumps can be painful and cause a deformity or fracture of the bones. People with this disease have a slightly higher risk of developing bone cancer.

Previous chemotherapy

Children with cancer who are treated with a type of medicine called an alkylating agent are at a higher risk of developing bone cancer. This risk increases with the dose administered.

Unknown risk factors

It is not yet clear whether the following factors are linked to bone cancer. This may be because researchers are unable to definitively establish this link, or the studies have yielded different results. More studies are needed to find out if the following are risk factors for bone cancer:

  • pre-existing injuries or fractures
  • surgical implants and other foreign bodies
  • exposure to chemicals
  • SV40 virus (member of viruses called Polyomaviruses found in the rhesus macaque. SV40 is a DNA virus that has been used in polio vaccines)

Symptoms of bone cancer

Bone cancer may not cause any signs or symptoms in the very early stages of the disease. Signs and symptoms often appear when the tumor grows and causes changes in the body such as pain or the appearance of a lump. Other medical conditions can cause the same symptoms as bone cancer.

The most common symptom of bone cancer is bone or joint pain that does not go away and can be made worse with exercise. The pain may be more present in the evening.

Here are some other signs and symptoms of bone cancer:

swelling or palpable mass on a bone
difficulty moving or using a limb (lameness when walking, for example)
bone that breaks because it is weakened by cancer (pathological fracture)
Here are some rare symptoms of bone cancer:

  • tired
  • sweat
  • fever
  • weightloss

Diagnosis of bone cancer

Diagnosis is a process of identifying the cause of a health problem. The diagnostic process for bone cancer usually begins with a visit to your family doctor. The doctor will ask you about your symptoms and do a physical exam. Based on this information, your doctor may refer you to a specialist or order tests to check for bone cancer or other health problems.

The diagnostic process can seem long and overwhelming. It’s okay to worry, but try to remember that other medical conditions can cause symptoms similar to bone cancer. It is important that the healthcare team rule out any other possible cause of the condition before making a diagnosis of bone cancer.

The following tests are usually used to rule out or diagnose bone cancer. Many tests that can diagnose cancer are also used to determine its stage, that is, how far the disease has progressed. Your doctor may also give you other tests to check your general health and help plan your treatment.

Health history and physical examination

Your health history consists of a checkup of your symptoms, risk factors, and any medical events and conditions you may have had in the past. Your doctor will ask you questions about your personal history:

  • symptoms that suggest bone cancer
  • inherited diseases that increase the risk of bone cancer
  • exposure to ionizing radiation at work or at home or during radiation therapy previously administered
  • chemotherapy with an alkylating agent received when you were a child
  • bone disorders

Your doctor may also ask you questions about your family history:

  • bone cancer
  • risk factors for bone cancer
  • retinoblastoma (a type of eye cancer)
  • other cancers

The physical exam allows your doctor to look for any signs of bone cancer. During the physical exam, your doctor may:

  • check for a lump, swelling or pain in an area;
  • check the mobility of a leg, arm or joint;
  • feel the lymph nodes in an area;
  • listen to your lungs.

In an x-ray, low-dose radiation is used to produce images of parts of the body on film. This is usually the first test to find out if there is bone cancer. Most bone tumors show up clearly on an x-ray.

A chest x-ray can also be done to see if the bone cancer has spread to the lungs.

Magnetic resonance imaging

Magnetic resonance imaging (MRI) uses powerful magnetic forces and radio waves to produce cross-sectional images of the body’s organs, tissues, bones, and blood vessels. A computer assembles the images into 3-dimensional snapshots.

MRI can confirm a diagnosis of bone cancer found on x-rays. It can also be used to check if the cancer has spread to nearby tissue and other parts of the bone.

CT scan

A computed tomography (CT) scan uses special x-ray machines to produce 3-dimensional and cross-sectional images of the body’s organs, tissues, bones and blood vessels. A computer assembles the photos into detailed images.

CT is used if the MRI cannot confirm that an area in a bone is a tumor. It can also be used to find out how far the tumor has spread inside the bone, into the soft tissue around the tumor, or into the lymph nodes.


During a biopsy, the doctor removes tissue or cells from the body for analysis in the laboratory. The pathologist’s report confirms whether or not there are cancer cells in the sample. A biopsy is used to confirm a diagnosis of bone cancer and to find out the type of cancerous tumor.

The biopsy is often guided by imaging using X-ray, MRI or CT. CT is most often used to guide a biopsy of bones that are deeper in the body, such as pelvic or hip bones.

In a core biopsy, a needle or a hollow probe is used to remove tissue from the body. This is the main type of biopsy used to diagnose bone tumors.

During a surgical biopsy, an operation is done to remove tissue from a lump in order to examine under the microscope. This test can also be called an open biopsy. It may be used if the core biopsy does not reveal whether an area is cancerous.

When the bone marrow is punctured, a needle is used to remove some bone marrow. Bone marrow is the soft, spongy tissue found inside bones. A bone marrow puncture can be done in the presence of Ewing’s sarcoma since this tumor can spread to the bone marrow.

Cell and Tissue Studies

Cell and tissue studies look closely at tumor cells to determine the type of bone cancer. The cells can be taken from the tissue taken during a biopsy or surgery.

Sometimes, changes in the chromosomes can also be observed. One of these changes is a chromosomal abnormality called a translocation, where one segment of a chromosome changes places with a segment of another chromosome. Ewing’s sarcoma has the translocation of chromosome 11, or sometimes chromosome 21, along with chromosome 22.

Read also: Down syndrome (Trisomy 21), Trisomy 18 (Edwards syndrome), Trisomy 13 (Patau syndrome), Trisomy 9, Trisomy 8 (Warkany syndrome 2)

Bone scan

In a bone scan, radioactive materials that attach to the bones (radiopharmaceuticals) and a computer are used to create an image of the bones. It is used to find out if bone cancer has spread to other bones. A bone scan can also be done in people over the age of 40 if doctors think the cancer has spread to the bones from another organ (bone metastases) since bone metastases are more common in adults. older than cancer that starts in the bones (primary bone cancer).

Blood biochemical analyzes

A blood chemistry test measures the level of chemicals in the blood. It is used to assess the quality of functioning of certain organs and also to detect abnormalities but not to diagnose bone cancer.

Blood urea nitrogen and creatinine levels can be measured to see if the kidneys are functioning normally. This is done before giving chemotherapy.

Alanine aminotransferase (ALT) and alkaline phosphatase levels may be elevated in the presence of bone cancer. Knowing these levels can help your doctor to predict your outcome (prognosis).

Complete blood count

The complete blood count (CBC) is used to assess the quantity and quality of white blood cells, red blood cells and platelets. She informs your healthcare team about your general state of health.

Heart function tests

Heart function tests are done to make sure your heart is healthy enough for you to receive chemotherapy, if it is needed. Some types of chemotherapy drugs used for bone cancer can cause heart problems. The main types of heart function tests are isotope ventriculography (MUGA), echocardiogram (echo), and electrocardiogram (ECG).

Hearing test

You may be given a hearing test to tell your healthcare team about your ability to hear well and to detect any hearing problems before chemotherapy starts. Some types of chemotherapy drugs used for bone cancer can cause hearing damage.

Histological classification of bone cancer (grading)

The grade is defined by the appearance of cancer cells compared to normal cells. To determine the grade of bone cancer, the pathologist examines a sample of tissue taken from the bone under a microscope. The pathologist determines whether the bone cancer is low grade or high grade, either grade 1 to 3 or 1 to 4, depending on the histological classification system used. The lower this number, the lower the rank.

Knowing the grade gives your healthcare team an idea of ​​how quickly cancer can grow and how likely it is to spread. It helps him plan your treatment. The grade can also help the healthcare team determine the possible outcome of the disease (prognosis) and predict how the cancer might respond to treatment.

The term differentiation is used to refer to how different cancer cells are. For the 2-grade system, the following categories are used:

  • Low-grade cancer cells are well differentiated. They almost look like normal cells. They tend to grow slowly and are less likely to spread.
  • High-grade cancer cells are poorly differentiated or undifferentiated. Their appearance is less normal, or more abnormal. They tend to grow faster and are more likely to spread than low-grade cancer cells.

Stages of bone cancer

Staging describes or categorizes cancer based on how much cancer is in the body and where it was initially diagnosed. This is often referred to as the extent of cancer. Information from tests is used to find out how big the tumor is, which parts of the bone have cancer, whether the cancer has spread from where it started and where it has spread. Your healthcare team uses the stage to plan your treatment and predict the outcome (your prognosis).

The most frequently used staging system for bone cancer is the TNM staging system. In the case of bone cancer, there are 4 stages. For stages 1 to 4, the Roman numerals I, II, III and IV are often used. But in order to make the text clearer, we will use the Arabic numerals 1, 2, 3 and 4. In general, the higher the stage number, the more cancer has spread. Talk to your doctor if you have questions about staging.

The stages of bone cancer also depend on the grade. The grade describes how much cancer cells differ in appearance from normal cells, how quickly they grow and divide, and how likely they are to spread.

A stage is assigned only to bone tumors that have started in the shoulder, arm, hip and leg (appendicular skeleton), central part of the body (trunk), skull, and facial bones. There is no stage for tumors of the spine and pelvis. They are grouped into a category (category T) according to their size, their location in the spine or pelvis and their invasion of neighboring regions.

When doctors describe the stage, they sometimes use the words localized or metastatic.

Localized bone cancer is only found in the bone where it started and it has not spread to other parts of the body. It includes stages 1, 2 and 3.

Metastatic bone cancer has spread to another part of the body, such as the lungs. This cancer is stage 4.

Stage 1

Stage 1A
The tumor is 8 cm or less and is low grade.

Stage 1B
The tumor is larger than 8 cm and there are tumors in several different parts of the same bone (fragmented tumors). She is low grade.

Stage 2

Stage 2A
The tumor is 8 cm or less and is high grade.

Stage 2B
The tumor measures over 8 cm and is of high grade.

Stage 3

Tumors are found in several different parts of the same bone. She is high grade.

Stage 4

The cancer has spread to other parts of the body, such as the lungs, brain, other bones or nearby lymph nodes. This is called metastatic bone cancer. It is low grade or high grade.

Recurrence of bone cancer

When bone cancer comes back, the cancer comes back after treatment. If it reappears where it first started, it is called a local recurrence. If it reappears in tissues or lymph nodes near where it first started, it is called a regional recurrence. It can also reappear in another part of the body: this is called a recurrence or distant metastasis.

If bone cancer spreads

Cancer cells can spread from the bone to other parts of the body. This spread is called metastasis.

Understanding how a type of cancer usually grows and spreads helps your healthcare team plan your treatment and future care. If bone cancer spreads, it can spread to the following parts of the body:

  • lungs – the place where bone cancer most often spreads
  • brain
  • other bones

Bone cancer does not often spread to the lymph nodes around the tumor (regional nodes).

Prognosis and survival for bone cancer

If you have bone cancer, you may be wondering about your prognosis. A prognosis is the act by which the doctor best assesses how cancer will affect a person and how they will respond to treatment. The prognosis and survival depend on many factors.

Only a doctor who is familiar with your medical history, the type of cancer you have, the stage and other characteristics of the disease, the treatments chosen and the response to treatment can review all of this data together with survival statistics. to arrive at a prognosis.

A prognostic factor is an aspect of the cancer or a characteristic of the person, such as smoking, that the doctor considers when making a prognosis.

The following are the prognostic factors for bone cancer.

Spread of cancer

Cancer can spread from where it started to other parts of the body. This spread is called metastasis. Whether or not the cancer has already spread at the time of diagnosis is the most important prognostic factor for bone cancer. The presence of metastases is linked to a poorer prognosis.

Where the cancer has spread is also an important prognostic factor. Bone cancer that has spread only to the lungs has a better prognosis than metastasizing to other parts of the body.

Location of the tumor

A tumor that starts in a bone in the leg or arm (distal tumor) has a better prognosis than a tumor that starts in a bone in the pelvis, thorax, skull or spine (proximal tumor), possibly be because tumors in the arms and legs are easier to remove completely with surgery.

Tumors in the chest, pelvis or spine are usually detected later, they are often larger and closer to important organs. These factors make it more difficult to have them completely removed with surgery.

Tumor grade

The low grade tumor has a better prognosis than the high grade tumor.

Tumor size

A cancerous bone tumor that is less than 8 cm has a better prognosis than a tumor that is more than 8 cm.


Someone who is diagnosed with bone cancer when they are under 40 has a better prognosis than someone over 40.

Reaction to chemotherapy before surgery

Chemotherapy given before surgery is neoadjuvant chemotherapy. It is used to reduce the size of the tumor to make it easier to remove. It is often taken to treat osteosarcoma, the most common type of bone cancer.

The extent of tumor reduction associated with chemotherapy affects the prognosis. A tumor that responds well to chemotherapy and shrinks in size as a result of this treatment has a better prognosis than a tumor that does not respond very well to chemotherapy.

Treatments for bone cancer

If you have bone cancer, your healthcare team will make a treatment plan just for you. It will be based on your health and specific cancer information. When your healthcare team decides what treatments to offer you for bone cancer, they consider the following:

  • The type of bone cancer
  • The stage and grade of the cancer
  • Your lifestyle and what you prefer or want
  • Your overall health

You may be offered one or more of the following treatments for bone cancer.


Most people with bone cancer will have surgery. The type of surgery you will have depends mostly on the location of the tumor, the size of the tumor, the stage of the cancer and the type of bone cancer. Any of the following types of surgery can be done.

Wide excision removes the bone tumor as well as a large margin of normal bone and tissue around the tumor. This type of surgery is also called monoblock resection.

Limb conservation surgery involves removing the tumor without removing, or amputating, the entire arm or leg (limb). Surgeons remove all of the tumor and any soft tissue in which the cancer has spread. After this type of surgery, the limb is reconstructed using bone and skin grafts.

Amputation involves removing all or part of the arm or leg where the tumor is located. Most people who have an amputation will wear an artificial limb (prosthesis) after surgery.

Curettage involves scraping the tumor from the bone using a sharp-edged spoon-shaped tool (curette). There is a hollow space left where the tumor was removed.

Bone cement is a type of chemical called poly (methyl methacrylate) that can be used after curettage to fill the hollow space in the bone. This special cement emits heat as it hardens, which destroys any remaining cancer cells.

Cryosurgery involves using a very cold liquid to destroy cancer cells. It can be used after curettage to destroy any remaining cancer cells.


Chemotherapy is not used for low-grade bone cancer because it is usually not very effective or has a poor prognosis. Usually, it is given before and after surgery for high-grade osteosarcoma. Chemotherapy may also be offered for chordoma, mesenchymal chondrosarcoma, dedifferentiated chondrosarcoma, and undifferentiated high-grade polymorphic sarcoma.

For bone cancer, two or three different chemotherapy drugs are usually combined. The drugs used depend on the type of bone cancer.

Find out more about chemotherapy.


External beam radiation therapy can be given before and after surgery for bone cancer. It may be used to treat a bone tumor that cannot be removed with surgery. It can also be used to treat pain or metastases to the lungs.

Intensity-modulated conformational radiation therapy (IMRT) is a type of external beam radiation therapy that emits radiation from many different angles towards the tumor. It can be used to treat bone tumors that are in hard-to-reach places like the skull, spine and pelvis.

If you cannot or do not want to be treated for cancer

You may want to consider care that aims to make you feel better without treating the cancer itself, perhaps because cancer treatments no longer work, or they are no longer likely to improve your condition, or cause them to work. secondary are difficult to tolerate. There may be other reasons why you cannot or do not want to be treated for cancer.

Talk to members of your healthcare team. They can help you choose advanced cancer care and treatment.


Follow-up after treatment is an important part of caring for people with cancer. You will need to have regular follow-up visits, especially during the first 5 years after treatment. These visits allow the healthcare team to monitor your progress and to know how you are recovering from treatment. The reconstructed limb will also be checked if you have had limb conservation surgery. If you have had an amputation, your prosthesis will be checked to see if it is working properly and if you are having difficulty using it.

Clinical tests

Talk to your doctor about clinical trials in bone cancer if it is available in your country. Clinical trials aim to find new methods of preventing, detecting and treating cancer.

Follow-up after treatment for bone cancer

Follow-up after treatment for bone cancer is an important part of caring for people with cancer. Cancer specialists and your family doctor often share this responsibility. Your healthcare team will talk to you to decide which follow-up meets your needs.

Don’t wait until your next scheduled appointment to report any new symptoms and any symptoms that don’t go away. Tell your healthcare team if you have:

  • a new lump or swelling;
  • pain or increased pain;
  • a cough that does not get better or go away;
  • headaches that don’t go away.

The risk of bone cancer coming back (recurring) is higher in the first 5 years after treatment, so close monitoring is necessary during this time.

Planning of follow-up visits

Follow-up visits for bone cancer are usually scheduled as follows:

  • every 3 to 6 months for 3 years after initial treatment
  • then every 6 to 12 months for 2 years
  • then every year

High-grade bone tumor is more likely to come back than low-grade bone tumor, so follow-up visits may be more frequent.

Progress of follow-up visits

During a follow-up visit, your healthcare team will usually ask you questions about the side effects of treatment and your ability to cope. We can also ask you about your prosthesis, if you had one after your surgery.

Your doctor may do a physical exam, including:

  • observe the area where the cancer was removed;
  • feel the lymph nodes closest to the tumor;
  • listen to your lungs;
  • check for swelling or infection in the area where the limb was removed (stump);
  • check for any changes in leg, arm, or hip movements.

Examinations are often ordered as part of the follow-up. We could ask these:

  • computed tomography (CT) or chest x-ray to see if bone cancer has come back in the lungs (lung metastases)
  • bone scan to look for changes or tumors in the bones
  • complete blood count to check your general health
  • blood chemistry tests to look for changes in how your organs are working

If your healthcare team finds out that the cancer has come back, they will talk to you to plan your treatment and care.

Supportive care for bone cancer

Supportive care empowers people to overcome the physical, practical, emotional and spiritual barriers of bone cancer. It is an important component of the care of people with this disease. There are many programs and services that help meet the needs and improve the quality of life for these people and their loved ones, especially after treatment is over.

Recovering from bone cancer and adjusting to life after treatment is different for everyone, depending on the location of the cancer in the body, the stage of the cancer, the organs and tissues removed during the surgery, and many other factors. . The end of cancer treatment can lead to mixed emotions. Even if treatment is complete, there may be other issues to work out, such as coping with long-term side effects. A person who has been treated for bone cancer may be concerned about the following.

Rehabilitation after bone cancer surgery
Rehabilitation is an important part of healing after bone cancer surgery. The type of rehabilitation you will undergo depends on the operation being performed, whether limb conservation surgery or amputation.

Self-esteem and body image

Self-esteem is how we feel about ourselves. Body image is how we perceive our own body. Bone cancer and its treatments can affect a person’s self-esteem and body image. Often this is because treatments for bone cancer can cause permanent changes in the body such as the following:

  • loss of a limb
  • changes in the ability to move or lift things
  • wearing an artificial limb (prosthesis)

What is limb?

The limbs describes the anatomy of the upper limb — divided into the arm between shoulder and elbow; the forearm between elbow and wrist; and the hand below the wrist — and the lower limb, which is divided into the thigh between hip and knee; the leg between knee and ankle; and the foot below the ankle.

For many people, body image and how other people look is closely related to self-esteem and can be a source of real concern and significant distress. They may be afraid to go out or fear being rejected by others, or be angry or upset, even though the effects of treatment may not be visible.


Bone cancer and its treatment can affect the way you think about sex and have sex. They can also affect your sexual partners and your relationships.

Changes that affect how your body looks and works can make you feel less attractive. Wearing a prosthesis can affect your intimacy with your partner.

There are many things you can do to have a healthy sex life during and after treatment for bone cancer. Most people still enjoy sex and intimacy after cancer treatment, even if they need to make changes.

Phantom pain

Phantom pain can start after a person’s arm or leg has been amputated. Phantom pain is the feeling that the amputated limb is still present. It occurs because the nerves that were cut and damaged during the surgery send abnormal sensations to the area where the limb was amputated, which is the stump. Symptoms of phantom pain can include the following:

  • pain
  • burning sensation
  • throbbing sensations
  • itching
  • cramps

Phantom pain usually begins 1 to 4 weeks after surgery. It usually subsides within the first year, but in some cases this pain can become a long-term problem.

If you experience phantom pain, your healthcare team will make a treatment plan just for you. It will be based on your health needs and any other treatments you have received. A pain specialist may be able to help you treat problems caused by phantom pain over the long term.

Treatment options for phantom pain may include the following:

  • medicines to relieve pain or relax muscles
  • non-drug treatments, such as massages or applying heat to the stump; since phantom pain may be made worse by stress, your healthcare team may recommend relaxation methods to help you cope with the pain
  • surgery to remove the part of the limb above the stump if the phantom pain lasts a long time and other treatments are not effective

Lymphedema is the swelling that occurs when lymph cannot flow normally and collects in the soft tissues of the limb. It may appear after ad radiation therapy administered to treat bone cancer, if the radiation has damaged the lymph nodes in that area. As a result of this treatment, lymphedema occurs more often in the leg or pelvis than in the arm.

Symptoms of lymphedema include the following:

  • swelling of the leg or stump
  • feeling of fullness, heaviness, or continuous pain in the limb
  • skin on which the fingerprint does not remain
  • prosthesis that is no longer suitable for the stump

If lymphedema is not treated, it can damage the tissues in the area and increase the risk of infection.

Once you have been diagnosed with lymphedema, your healthcare team will tell you how to treat it by reducing the swelling as much as possible to prevent the lymph from building up further. This can be done in several ways:

lift arm or leg
  • wearing a compression stocking or sleeve or wrapping the stump
  • receive massages or undergo physiotherapy

List of all Cancers

The word “cancer” is a generic term for a large group of diseases that can affect any part of the body. We also speak of malignant tumors or neoplasms. One of the hallmarks of cancer is the rapid multiplication of abnormal growing cells, which can invade nearby parts of the body and then migrate to other organs. This is called metastasis, which is the main cause of death from cancer. Types of cancer (in alphabetical order of the area concerned):

Types of Cancer | List all of Cancers | Adult, Children, Head and neck, Digestive and Types of Blood Cancer

Information: Cleverly Smart is not a substitute for a doctor. Always consult a doctor to treat your health condition.

Sources: PinterPandai, American Cancer SocietyWeb MDCancer CenterCleveland Clinic

Photo credit: Photo credit: Mikael Häggström / Wikimedia Commons

Photo explanations: 3D rendered CT scan of bone metastases of the hip bone, in a 60 year old woman with parotid gland cancer. Large lesions are seen on the ilum on the more distant side. Involvement of the vertebral column has caused a compression fracture.

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