What Is a Bone Tumor?
When cells divide abnormally and uncontrollably, they can
form a mass or lump of tissue. This lump is called a tumor. Bone tumors form in
your bones. As the tumor grows, abnormal tissue can displace healthy tissue.
Some tumors are benign, meaning they aren’t cancerous. While
benign bone tumors won’t spread to other parts of the body and are unlikely to be
fatal, they can still be dangerous and may require treatment. Benign tumors can
grow and could compress your healthy bone tissue.
Other tumors are malignant, meaning they’re cancerous.
Malignant bone tumors can cause cancer to spread throughout the body.
Types of Benign Bone Tumors
Benign tumors are more common than malignant ones. According
to the American
Academy of Orthopaedic Surgeons (AAOS), the most common type of benign bone
tumor is an osteochondroma.
This type accounts for between 35 and 40 percent of all benign bone tumors. Osteochondromas
develop in adolescents and teenagers.
These tumors form near the actively growing ends of long
bones, such as arm or leg bones. Specifically, these tumors tend to affect the
lower end of the thighbone (femur), the upper end of the lower leg bone (tibia),
and the upper end of the upper arm bone (humerus).
These tumors are made of bone and cartilage. Osteochondroma
has been considered to be an abnormality of growth. A child may develop a
single osteochondroma or many of them.
Nonossifying Fibroma Unicameral
Nonossifying fibroma unicameral is a simple solitary bone
cyst. It’s the only true cyst of bone. It’s usually found in the leg and occurs
most often in children and adolescents.
Giant Cell Tumors
Giant cell tumors grow aggressively. They occur in adults,
and they’re found in the rounded end of the bone and not in the growth plate. These
are very rare tumors.
An enchondroma is a cartilage cyst that grows inside the
bone marrow. When they occur, they begin in children and persist as adults.
They tend to be part of syndromes called Ollier’s and Mafucci’s syndrome.
Enchondromas occur in the hands and feet as well as the long bones of the arm
Fibrous dysplasia is a gene mutation that makes bones
fibrous and vulnerable to fracture.
Aneurysmal Bone Cyst
bone cyst is an abnormality of blood vessels that begins in the
bone marrow. It can grow rapidly and can be particularly destructive because it
affects growth plates.
Types of Malignant Bone Tumors
There are also several types of cancer that produce malignant
bone tumors. Primary bone cancer means
that the cancer originated in the bones. According to the National Cancer
Institute (NCI), primary bone cancer accounts for less than 1 percent of all
types of cancer. The three most common forms of primary bone cancers are
osteosarcoma, Ewing sarcoma family of tumors, and chondrosarcoma.
Osteosarcoma, which occurs mostly in children and
adolescents, is the second most common type of bone cancer. This usually
develops around the hip, shoulder, or knee. This tumor grows rapidly and tends
to spread to other parts of the body. The most common sites for this tumor to
spread are areas where the bones are most actively growing (growth plates), the
lower end of the thighbone, and the upper end of the lower leg bone.
Osteosarcoma is also sometimes known as osteogenic
Ewing Sarcoma Family of Tumors (ESFTs)
Ewing sarcoma family of tumors (ESFTs) strikes adolescents
and young adults, but these tumors can sometimes affect children as young as 5
years old. This type of bone cancer usually shows up in the legs (long bones),
pelvis, backbone, ribs, upper arms, and the skull. It begins in the cavities of
the bones where the bone marrow is produced (the medullary cavities). In
addition to thriving in bone, ESFTs can also grow in soft tissue, such as fat,
muscle, and blood vessels. According to the NCI, African-American
children very rarely develop ESFTs. Boys are more likely to develop ESFTs than
girls. ESFTs grow and spread rapidly.
Middle-aged people and older adults are more likely than
other age groups to develop chondrosarcoma. This type of bone cancer usually
develops in the hips, shoulders, and pelvis.
Secondary Bone Cancer
The term “secondary bone cancer” means that the cancer
started somewhere else in the body and then spread to the bone. It usually
affects older adults. The types of cancer most likely to spread to your bones
- lung (particularly osteosarcoma)
- thyroid gland
The most common type of secondary bone cancer is called
multiple myeloma. This shows up as tumors in the bone marrow. Multiple myeloma
most commonly affects older adults.
Cause of Bone Tumors
The cause of bone tumors isn’t known. The tumors often occur
when parts of the body are growing rapidly. A few possible causes are genetics,
radiation treatment, and injuries to the bones. Osteosarcoma has been linked to
radiation treatment (particularly high doses of radiation) and other anticancer
drugs, especially in children. However, a direct cause hasn’t been identified.
People who have had bone fractures repaired with metal implants are also more
likely to develop osteosarcoma later.
Recognizing Potential Symptoms of Bone Tumors
A dull ache in the affected bone is the most common symptom
of bone cancer. The pain starts off as occasional and then becomes severe and
constant. The pain may be severe enough to wake you up in the night. Sometimes,
when people have an undiscovered bone tumor, what seems like an insignificant
injury breaks the already weakened bone, leading to severe pain. This is known
as a pathologic fracture.
Sometimes there may be swelling at the site of the tumor.
Tumors can cause night sweats or fevers. Or you might not
have any pain, but you’ll notice a new mass of tissue on some part of your
People with benign tumors might not have any symptoms, and
the tumor might not be detected until an imaging scan reveals it while
receiving other medical testing. A benign bone tumor, such as an
osteochondroma, may not require treatment unless it starts to interfere with your
function and movement.
Diagnosing a Bone Tumor
Fractures, infections, and other conditions might resemble
tumors. To be sure you have a bone tumor, your doctor might order a variety of
First, your doctor will do a physical exam with a focus on
the area of your suspected tumor. They’ll check for tenderness in your bone and
test your range of motion. Your doctor will also ask you questions about your
family medical history.
Blood and Urine Tests
Your doctor might order tests, including blood or urine
samples. A lab will analyze these fluids to detect different proteins that may
indicate the presence of a tumor or other medical problems.
An alkaline phosphatase test is one common tool used in
diagnosing bone tumors. When your bone tissue is especially active in forming
cells, large quantities of this enzyme show up in your blood. This could be
because a bone is growing, such as in young people, or it could mean a tumor is
producing abnormal bone tissue. This test is more reliable in those who have
Your doctor will probably order X-rays to determine the size
and exact location of the tumor. Depending on the X-ray results, these other
imaging tests might be necessary:
- A CT
scan is a series of detailed images of the inside of your body that are
taken from several angles.
- An MRI
scan gives detailed pictures of the area in question.
- In a positron
emission tomography (PET) scan, your doctor will inject a small amount
of radioactive sugar into your vein. Since cancer cells use more glucose than
regular cells, this activity helps your doctor locate the site of the tumor.
- An angiogram
is an X-ray of your blood vessels.
Your doctor might want to perform a biopsy. In this test, a
sample of the tissue that makes up your tumor will be removed. The sample is
examined in a laboratory under a microscope. The main types of biopsies are a
needle biopsy and an incisional biopsy.
A needle biopsy may
be done in your doctor’s office or by a radiologist along with one of the
previously mentioned imaging tests. Either way, you’ll have local anesthetic to
block the pain. The doctor will insert a needle into your bone, using it to
remove a small bit of tumor tissue. If a radiologist does the needle biopsy, they’ll
use the image from the X-ray, MRI, or CT scan to help find the tumor and know
where to insert the needle.
biopsy, also called an open biopsy, is done in an operating
room under general anesthesia so you’ll sleep through the procedure. The doctor
makes an incision and removes your tissue through the incision.
The bone biopsy is important to make a definite
determination of the condition.
Treatment for Benign Bone Tumors
If your tumor is benign, it may or may not require action.
Sometimes doctors just keep an eye on benign bone tumors to see if they change
over time. This requires coming back periodically for follow-up X-rays. Bone
tumors can grow, stay the same, or eventually disappear. Children have a higher
likelihood of having their bone tumors disappear as they mature.
Benign tumors can sometimes spread or transform into
malignant tumors. Since bone tumors can also lead to fractures, your doctor
might want to surgically remove a benign tumor.
Treatment for Malignant Bone Tumors
If your tumor is malignant, you’ll work closely with a team
of doctors to treat it. Although malignant tumors are a cause of concern, the
outlook is improving as treatments are developed and improved.
Your treatment will depend on what type of bone cancer you
have and whether it has spread. If your cancer cells are confined to the tumor
and its immediate area, this is called the localized stage. In the metastatic
stage, cancerous cells have already spread to other parts of the body. This
makes curing the cancer more difficult.
Surgery, radiation, and chemotherapy are the main strategies
for treating cancer.
Bone cancer is usually treated with surgery. Your entire
tumor is removed. The surgeon carefully examines the margins of your tumor to
make sure no cancer cells are left after surgery. If your bone cancer is in an
arm or leg, your doctor may use what is known as limb salvage surgery. This
means that while the cancerous cells are removed, your tendons, muscles, blood
vessels, and nerves are spared. Your surgeon will replace the cancerous bone
with a metal implant. Advances in chemotherapy have greatly improved recovery
and survival. New drugs are being introduced on an ongoing basis.
Surgical techniques have improved greatly, making it much
more likely that doctors can spare your limbs. However, you might need
reconstructive surgery to retain as much limb function as possible.
Radiation is often used in conjunction with surgery.
High-dose X-rays are used to shrink tumors before surgery and kill cancer
cells. Radiation can also reduce pain and decrease the chance of bone
If your doctor thinks your cancer cells are likely to spread
or if they already have, they might recommend chemotherapy. This therapy uses
anticancer drugs to kill the rapidly growing cancer cells.
The side effects of chemotherapy include:
- hair loss
- extreme fatigue
another possibility. This treatment involves killing cancer cells by freezing
them with liquid nitrogen. A hollow tube is inserted into the tumor, and liquid
nitrogen or argon gas is pumped in. In some cases, cryosurgery can be used to
treat bone tumors instead of regular surgery.
Recovery from Bone Tumor Treatment
Your doctor will want you to stay in close contact while you
recover. Follow-up X-rays and blood tests will be necessary to make sure the
whole tumor is gone and that it doesn’t return. You may need to have follow-up
tests every few months.
How quickly you recover will depend on what type of bone
tumor you had, how big it was, and where it was located.
Many people find cancer support groups helpful. If your bone
tumor is malignant, ask your doctor for resources or inquire about groups like
the American Cancer Society (ACS).
If your tumor is benign, your long-term outcome will
probably be good. However, benign bone tumors can grow, recur, or turn into cancer,
so you’ll still benefit from regular checkups.
The outlook varies according to the type of cancer, size,
location, and your general health.
Your outlook is also good if the bone is localized.
Both malignant and benign bone tumors can recur. People who
have had bone cancer, especially at an early age, are at higher risk of developing
other types of cancer. If you have any symptoms or health concerns, be sure to
discuss them with your doctor promptly.
The outlook is poorer if the bone cancer has spread. But
there are treatments, and technology continues to advance. Many people with
bone cancer join clinical trials on new drugs and therapies. This benefits both
current cancer patients and those who’ll be diagnosed and treated in the
future. If you’re interested in participating in clinical trials, talk to your
doctor or call the NCI at 1-800-422-6237.