Bone Cancer

Understanding your diagnosis

Bone Cancer What is cancer?
Understanding your diagnosis Cancer is a disease that starts in our cells.
Our bodies are made up of millions of cells,
When you first hear that you have cancer grouped together to form tissues and organs
you may feel alone and afraid. You may be such as muscles and bones, the lungs and the
overwhelmed by the large amount of liver. Genes inside each cell order it to grow,
information you will have to take in and work, reproduce and die. Normally, our cells
the decisions you will need to make. obey these orders and we remain healthy.

The introductory information in this brochure But sometimes the instructions in some
can help you and your family take the first cells get mixed up, causing them to behave
step in learning about bone cancer. A better abnormally. These cells grow and divide
understanding may give you a sense of control uncontrollably. After a while, groups of
and help you work with your healthcare team abnormal cells form lumps, or tumours.
to choose the best care for you.
Tumours can be either benign (non-cancerous)
or malignant (cancerous). Benign tumour
cells stay in one place in the body and are
not usually life-threatening.

Malignant tumour cells are able to invade

nearby tissues and spread to other parts of
the body. Cancer cells that spread to other
parts of the body are called metastases.

The first sign that a malignant tumour has

spread (metastasized) is often swelling of
nearby lymph nodes, but cancer can spread
to almost any part of the body. It is important
to find and treat malignant tumours as early
as possible.

Cancers are named after the part of the body

where they start. For example, cancer that
starts in the bone but spreads to the lungs is
called bone cancer with lung metastases.

Cover photograph: © Getty Images

Licensed material is for illustrative purposes only; persons depicted are models. 1
 What is bone cancer?
Primary bone cancer* starts in the cells of
your bones. Primary bone cancer is rare and
is not the same disease as cancer that started
somewhere else in the body and spread to
the bones (called secondary bone cancer,
or bone metastases).
Bones are made up of cells called osteocytes,
osteoclasts and osteoblasts. These cells are
held together by a hard, calcium-like material
that makes the bone strong and rigid. The
joints of the bones are covered in cartilage.
Cartilage is a tough, flexible material that is
more elastic than bone. It stops the bones
from rubbing against each other and lets them
move freely at the joints, like levers.
* This brochure is about primary bone cancer. Tumours that have
spread to the bones from other cancer sites (secondary bone cancer,
or bone metastases) may be treated differently. For information
about secondary bone cancer, contact our Cancer Information Service
at 1-888-939-3333.
2 Bone Cancer Understanding your diagnosis
The skeleton is made up of 206 bones of
different shapes and sizes. The skeleton is
the inner framework that supports your
body. Bones also protect the organs inside
the body. They store and release minerals
(such as calcium and magnesium) that are
important for your body. They also make and
store blood cells in the marrow. Marrow is a
soft, spongy material that fills most bones.
Throughout your life, bones constantly renew
themselves by breaking down old bone cells
and replacing them with new ones. If an
abnormal cell develops, a tumour (benign
or malignant) may start to grow in the bone.
There are several types of bone cancer.
Each type behaves differently and is treated
differently.
• Osteosarcoma is the most common type
of bone cancer. It starts in new tissue in
growing bones, most often in the knee
area. Osteosarcomas tend to spread to
other parts of the body, especially the lungs.
• Chondrosarcoma begins in the cartilage. It
usually grows slowly and rarely spreads
to other parts of the body.
• Ewing’s sarcoma begins in the cavity of the
bone*, most often in the leg, arm or pelvis.
It tends to grow quickly and spread to
other parts of the body.
* Ewing’s sarcoma can also start in the soft tissues rather than the
bone. For information about Ewing’s sarcoma that starts outside
the bone, call our Cancer Information Service at 1-888-939-3333.
© Canadian Cancer Society 2008 3
 Causes of bone cancer
Osteosarcoma and Ewing’s sarcoma are more
common in children, teenagers and young
adults.* Chondrosarcoma is more common
in adults. There is no single cause of bone
cancer, but some factors increase the risk of
developing it:
• previous treatment with radiation,
especially at a young age
• previous treatment with chemotherapy,
especially at a young age
• having a genetic condition, such as Li-
Fraumeni syndrome, retinoblastoma or
Rothmund-Thompson syndrome
• having Paget’s disease (a non-cancerous
disease of the bone)
• having had osteochondroma or chondroma
(non-cancerous bone tumours)
Bone cancer is not caused by injury or a
knock to the bone. Sometimes, a doctor finds
bone cancer when examining or treating a
person for another reason, such as an injury
that doesn’t heal or pain that doesn’t go away.
Some people develop bone cancer without
any of these risk factors.
* The information in this brochure is about bone cancer in adults.
For information on bone cancer in children, contact our Cancer
Information Service at 1-888-939-3333.
4 Bone Cancer Understanding your diagnosis
Symptoms of bone cancer
Pain is the most common symptom of bone
cancer. Symptoms may vary depending on
where the cancer is and the size of the tumour.
Symptoms may include:
• pain or tenderness in the area of the tumour
• persistent ache that may feel worse at night
• swelling or a lump
• problem moving the affected joint
• broken bone
Other health problems can cause some of the
same symptoms. Testing is needed to make a
diagnosis.
Diagnosing bone cancer
After taking your medical history and
completing a physical examination, your
doctor may suspect you have bone cancer.
To confirm the diagnosis, your doctor will
arrange special tests. These tests may also be
used to “grade” and “stage” the cancer. You
may have one or more of the following tests.
Imaging studies: Imaging studies allow tissues,
organs and bones to be looked at in more
detail. Using x-rays, bone scans, CT scans or
MRIs, your healthcare team can get a picture
of the size of the tumour and see if it has
spread. These tests are usually painless and
do not require an anesthetic.
Blood tests: Blood is taken and studied to see
if the different types of blood cells are normal
in number and appearance. The results show
© Canadian Cancer Society 2008 5
 how well your organs are working and may
suggest whether or not you have cancer.
Blood tests can also show if there are abnormal
levels of enzymes or other signs of disease in
your blood.
Biopsy: A biopsy is usually necessary to make
a definite diagnosis of cancer. Cells are
removed from the body and checked under
a microscope. If the cells are cancerous, they
may be studied further to see how fast they
are growing. There are many ways to do a
biopsy.
• For a core needle biopsy, your doctor inserts
a needle through a small cut in the skin to
remove one or more samples of tissue
from the tumour. The doctor may use
ultrasound or CT images to help guide the
needle to the right spot. A local anesthetic
(freezing) will be used to numb the area.
• An incisional biopsy is an operation to
remove part of the tumour. This may be
done with a local anesthetic or under a
general anesthetic (you will be unconscious).
The kind of anesthetic used depends on
where the tumour is and how deep it is
within the body.
Further testing: If the initial diagnostic tests
show that you have bone cancer, your doctor
may order more tests to find out if the
cancer has spread outside the bone.
6 Bone Cancer Understanding your diagnosis
Grading and staging
Once a definite diagnosis of cancer has been
made and your healthcare team has the
information it needs, the cancer will be given
a grade and a stage.
To find out the grade of a tumour, the biopsy
sample is examined under a microscope. A
grade is given based on how the cancer cells
look and behave compared with normal cells.
This can give your healthcare team an idea
of how quickly the cancer may be growing.
There are several grading systems that may
be used for bone tumours. A 2-grade system
is used most often.
Grade Description
Low grade Grows slowly, less likely to spread
High grade Tends to grow quickly, more likely to spread
For bone cancer, the stage includes the tumour
grade and tells whether it has spread beyond
the place where it started to grow. There are
four stages.
Stage Description
1 The cancer is low grade. It has not spread to
lymph nodes or any other part of the body.
2 The cancer is high grade. It has not spread to
lymph nodes or any other part of the body.
3 The cancer is any grade. It has spread to
other parts of the same bone, but not to
lymph nodes or other parts of the body.
4 The cancer is any grade. It has spread to
lymph nodes, the lung or other parts of the
body.
© Canadian Cancer Society 2008 7
 It is important to know the grade and stage
of the cancer. This information helps you
and your healthcare team choose the best
treatment for you.
Treatments for bone cancer
Your healthcare team will consider your
general health and the location, type, grade
and stage of the cancer to recommend what
treatments will be best for you. You will work
together with your healthcare team to make
the final treatment choices. Talk to them if
you have questions or concerns.
Treatments affect everyone in different ways.
It’s hard to predict which side effects you
will have. Your healthcare team will tell you
what to expect with each treatment. They
will also let you know what side effects you
should report right away and which ones
you can wait to tell them about at your next
appointment. If you notice any side effects or
symptoms that you did not expect, talk to a
member of your healthcare team as soon as
possible.
Patients often worry about the side effects of
cancer treatment. However, side effects can
often be well managed and even prevented.
Be open with your healthcare team. Tell them
your concerns and ask questions. They will
help you get the care and information you
need.
For bone cancer, you might receive one or
more of the following treatments.
8 Bone Cancer Understanding your diagnosis
Surgery: A decision to have surgery depends
on the size of the tumour and where it is.
During the operation, all or part of the tumour
and some healthy tissue around the tumour
are removed. Surgery is done under general
anesthetic (you will be unconscious) and
you will stay in the hospital for several days
after the surgery.
Surgery is often the main treatment for bone
cancer. Sometimes it is necessary to remove
(amputate) the limb. However, it is often
possible to remove the cancerous part of
the bone and replace it with an internal
prosthesis (such as artificial bone) or a bone
graft (bone from another part of the body).
These operations are types of limb-sparing
surgery.
The type of surgery you have depends on
a number of factors specific to you. Your
surgical team will discuss the different types
of surgery and reconstruction with you.
Chemotherapy: Chemotherapy may be given
as pills or by injection. Chemotherapy drugs
interfere with the ability of cancer cells to
grow and spread, but they also damage healthy
cells. Although healthy cells can recover over
time, you may experience side effects from
your treatment like nausea, vomiting, loss of
appetite, fatigue, hair loss and an increased
risk of infection.
Chemotherapy for bone cancer may be given
before surgery to help shrink the tumour
enough to allow for limb-sparing surgery.
© Canadian Cancer Society 2008 9
 More chemotherapy may be given after
surgery to destroy any remaining cancer cells
and prevent the cancer from spreading.
Radiation therapy: In external beam radiation
therapy, a large machine is used to carefully
aim a beam of radiation at the tumour. The
radiation damages the cells in the path of
the beam – normal cells as well as cancer cells.
Side effects will be different depending on
what part of the body receives the radiation.
You may feel more tired than usual, have some
diarrhea, or notice changes to the skin (it may
be red or tender) where the treatment was
given.
Radiation therapy may be given after
chemotherapy and before or after surgery.
Sometimes, it is used instead of surgery when
surgery is not possible.
Clinical treatment trials: Clinical treatment trials
investigate new approaches to treating cancer,
such as new drugs, new types of treatments
or combinations of existing treatments. They
are closely monitored to make sure they are
safe for the participants. Ask your doctor if
there is a clinical trial suitable as a treatment
option for you. You may benefit and so may
future cancer patients.
Complementary therapies: Complementary
therapies are used together with conventional
treatments. More research is needed to
understand if these therapies are effective
and how they work.
10 Bone Cancer Understanding your diagnosis
Alternative therapies are used instead of
conventional treatments. Alternative therapies
haven’t been tested for safety or effectiveness.
It is still unknown whether they will harm
you or be effective in the treatment of cancer.
If you are thinking about using a
complementary or alternative therapy, it is
important to find out as much as you can
about the therapy and talk to your healthcare
team. It’s possible that the therapy might
interfere with test results or regular treatments.
After treatment
Follow-up care helps you and your healthcare
team monitor your progress and your recovery
from treatment. At first, your follow-up care
may be managed by one of the specialists
from your healthcare team. Later on it may
be managed by your family doctor.
The schedule of follow-up visits is different
for each person. You might see your doctor
more often in the first two years after treatment,
and less often after that. After treatment has
ended, you should report new symptoms and
symptoms that don’t go away to your doctor
without waiting for your next scheduled
appointment.
The end of cancer treatment may bring mixed
emotions. You may be glad the treatments
are over and look forward to returning to
your normal activities. But you could feel
anxious as well. If you are worried about your
treatment ending, talk to your healthcare
team. They are there to help you through
this transition period.
© Canadian Cancer Society 2008 11
 Rehabilitation: Rehabilitation is very important
after amputation or limb-sparing surgery.
Shortly after the operation, you will be given
some exercises to do in bed. A physiotherapist
may also plan and supervise an exercise
program with you to help regain mobility.
An occupational therapist can design and
provide devices to help you regain your
independence if you need it.
Living with cancer
There are many sources of help available for
people with cancer and for their caregivers.
Your healthcare team: If you need practical
help or emotional support, members of your
healthcare team may be able to suggest
services in your community or refer you to
cancer centre staff or mental health
professionals.
Family and friends: Those closest to you can
be very supportive. Accept offers of help.
When someone says “Let me know how I
can help,” tell them what they can do. Maybe
they can run errands, cook a meal or give
you a ride to your doctor’s office.
People who have had a similar experience:
Consider visiting a support group or talking
with a cancer survivor in person, over the
telephone or online. Talking with and
learning from others who have had similar
experiences can be helpful. Try more than
one option to see which one suits you best.
12 Bone Cancer Understanding your diagnosis
Yourself: Try to stay positive. Staying positive
is about figuring out how to deal with cancer
in the best way that you can – and everyone
will do this their own way. It doesn’t mean
that you must seem happy or cheerful all the
time or avoid talking or thinking about the
difficulties of having cancer. But it can mean
looking after yourself by finding relaxing,
enjoyable activities that refresh you mentally,
spiritually or physically.
The Canadian Cancer Society
Helping you understand cancer
Now that you have been introduced to the
basics of bone cancer, you may want to learn
more. Please contact the Canadian Cancer
Society for more detailed information on
bone cancer.
If you would like to talk to someone who
has had a similar cancer experience, we can
help you connect with a trained volunteer –
in person, over the phone or in a group setting.
To contact the Canadian Cancer Society:
• Call us toll-free Monday to Friday at
1-888-939-3333 (TTY 1-866-786-3934).
If you need help in another language,
interpreters are available.
• Email info@cis.cancer.ca.
• Visit cancer.ca.
• Contact your local Canadian Cancer
Society office.
Our services are free and confidential.
© Canadian Cancer Society 2008 13
 Notes Notes

14 Bone Cancer Understanding your diagnosis © Canadian Cancer Society 2008 15

 Notes We’d like to hear from you
Email us at publicationsfeedback@cancer.ca if you
have comments or suggestions to help us make this
brochure more useful for you and other readers.

16 Bone Cancer Understanding your diagnosis

 What we do
The Canadian Cancer Society fights
cancer by:
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• empowering, informing and supporting
Canadians living with cancer
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the health of Canadians
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fight against cancer

Contact us for up-to-date information about

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This is general information developed by the Canadian Cancer Society.

It is not intended to replace the advice of a qualified healthcare provider.

The material in this publication may be copied or reproduced without permission;

however, the following citation must be used: Bone Cancer:
Understanding Your Diagnosis. Canadian Cancer Society 2008.

© Canadian Cancer Society 2008 | Revised May 2012 | Printed May 2015 | 311-003