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Where Does Bone Cancer Usually Start?

Usually, bone cancer in adults starts somewhere else in the body and then spreads (metastasizes) to the bones. These advanced types of cancer include breast cancer, prostate cancer, and lung cancer. Primary bone cancer, however, is cancer that starts in the bone.
Usually, bone cancer in adults starts somewhere else in the body and then spreads (metastasizes) to the bones. These advanced types of cancer include breast cancer, prostate cancer, and lung cancer. Primary bone cancer, however, is cancer that starts in the bone.

Bone cancer is an uncommon type of cancer that begins when cells in the bone become abnormal and grow out of control.

Primary bone cancers are those that start in the bone. Usually, when adults have cancer in the bones, it refers to cancer that started somewhere else and then spread to the bones, called bone metastasis. This can occur with many different types of advanced cancer, including breast cancer, prostate cancer, and lung cancer. 

When other types of cancer spread (metastasize) to the bone, the cancer cells come from and act like the cancers from the organ from which they originated. Metastatic cancers that have spread to the bone are treated using treatments for the original cancer, not the metastases. 

There are many kinds of primary bone cancer. Primary bone cancer is uncommon, and some types are very rare.

Primary Bone Cancer Types
Type of Cancer Symptoms/Characteristics
Osteosarcoma (also called osteogenic sarcoma)
  • The most common primary bone cancer
  • Tumors tend to develop in bones of the arms, legs, or pelvis
Chondrosarcoma
  • Second most common primary bone cancer
  • Can start in any place there's cartilage, most commonly the pelvic bones, legs, or arms but can also originate in the trachea, larynx, chest wall, shoulder blades, ribs, or skull

Ewing tumor (Ewing sarcoma)
  • Second-most common type of primary bone cancer in children, teens, and young adults, and the third most common type of bone cancer overall
  • Usually develops in the pelvic bones, the bones in the chest wall (such as the ribs or shoulder blades), the bones of the spine, and the long bones of the legs
High-grade undifferentiated pleomorphic sarcoma (UPS) of bone, previously called malignant fibrous histiocytoma (MFH) of bone
  • Rare in bones, but when it does occur, it usually affects the legs (often around the knees) or arms
Fibrosarcoma of bone
  • Develops more often in soft tissues than it does in bones
  • Bones in the legs, arms, and jaw are affected most often
Giant cell tumor of bone
  • More commonly, these tumors are benign (not cancer) but they can be malignant (cancerous)
  • Typically affects the legs (usually near the knees) or arms

Chordoma
  • Uncommon type of bone tumor occurs in the bones of the spine, most often at the bottom of the spine (sacrum) or the base of the skull

What Are Symptoms of Bone Cancer?

Signs and symptoms of primary bone cancer depend mainly on the type, location, and extent of the cancer.

  • Pain in the area of the tumor is the most common sign of primary bone cancer
    • May worsen at night or when the bone is used, such as when walking for a tumor in a leg bone
    • Pain can become more constant over time and might worsen with activity
    • Can weaken a bone to the point where it breaks (fractures)
  • Lump or swelling
  • Fractures
  • Other symptoms
    • Numbness and tingling or even weakness in different parts of the body, depending on where the tumor is
    • Weight loss 
    • Fatigue

If bone cancer spreads to other organs, it can cause other symptoms. 

Primary bone cancer is uncommon, and symptoms are usually due to other conditions such as injuries or arthritis, so it’s important to see a doctor for a proper diagnosis and treatment.

What Causes Bone Cancer?

The causes of primary bone cancer are often unknown but, in some cases, people inherit gene mutations (changes) from a parent that increase their risk of bone cancer.

Risk factors are different for different types of primary bone cancers. 

Osteosarcoma risk factors include: 

  • Age: risk is highest between the ages of 10 and 30, especially during the teenage growth spurt
  • Height: children are usually tall for their age which suggests it may be related to rapid bone growth
  • Gender: more common in males than in females
  • Race/ethnicity: slightly more common in African Americans and Hispanics/Latinos than in whites
  • Radiation to bones
  • Certain bone diseases
    • Paget disease of the bone
    • Hereditary multiple osteochondromas
    • Fibrous dysplasia
    • Inherited cancer syndromes
      • Retinoblastoma 
      • Li-Fraumeni syndrome 
      • Rothmund-Thomson syndrome 
      • Bloom syndrome
      • Werner syndrome
      • Diamond-Blackfan anemia

Risk factors for chondrosarcoma include:

  • Older age
  • Benign bone tumors
  • Multiple exostoses (also known as multiple osteochondromas), an inherited condition in which a person has many benign bone tumors called osteochondromas, made mostly of cartilage

Risk factors for Ewing tumors (Ewing sarcoma) include:

  • Race/ethnicity: less common among African Americans and Asian Americans than among Whites (either non-Hispanic or Hispanic)
  • Gender: slightly more common in males than in females
  • Age: most common in older children and teens, less common in young adults and young children 

Risk factors for chordoma risk factors include:

  • Run in families (known as familial chordoma)
  • Tuberous sclerosis

How Is Bone Cancer Diagnosed?

Primary bone cancer is diagnosed with a medical history and physical examination, along with tests, such as:

  • Imaging tests
  • Biopsy
    • Needle biopsy
    • Surgical (open) biopsy
  • Lab tests
    • Testing biopsy samples
    • Blood tests
      • Alkaline phosphatase 
      • Lactate dehydrogenase (LDH) 
      • Blood cell counts 
      • Blood chemistry tests 

What Is the Treatment for Bone Cancer?

The main ways to treat primary bone cancer are:

  • Surgery 
    • To remove the tumor
    • May involve removing surrounding bone
    • In some cases, amputation may be needed, such as with a limb
  • External beam radiation therapy
  • Chemotherapy 
    • Most of the time, two or more drugs are given together
      • Doxorubicin (Adriamycin)
      • Cisplatin
      • Etoposide (VP-16)
      • Ifosfamide
      • Cyclophosphamide
      • Methotrexate
      • Vincristine
  • Targeted therapy and other drugs 
    • Kinase inhibitors
    • Imatinib (Gleevec)
      • Dasatinib (Sprycel)
      • Sunitinib (Sutent)
      • Erlotinib (Tarceva)
      • Lapatinib (Tykerb)
      • Sorafenib (Nexavar)
      • Regorafenib (Stivarga)
      • Pazopanib (Votrient)
  • Drugs that affect bone cells
    • RANKL inhibitor: denosumab (Xgeva) 
  • Immunotherapy drugs
  • Pembrolizumab (Keytruda)
  • Interferon alfa-2b

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References
https://www.cancer.org/cancer/bone-cancer.html