Tumors that originally start in the bone are called primary bone tumors. Primary bone tumors may be noncancerous (benign) or cancerous (malignant).
After cancer is diagnosed, it is staged. Staging is a way of describing how advanced the cancer has become, including such criteria as degree of aggressiveness (how likely it is to spread, based on how the tumor cells appear under a microscope), how big it is, and whether it has spread to neighboring tissues or more distantly to lymph nodes or other organs.
(See also Overview of Bone Tumors and Overview of Cancer.)
Adamantinomas
Adamantinomas are rare tumors that most often develop in the shinbone (tibia). Tumors usually occur in young and middle-aged people, but they can occur at any age. They often cause pain, and people often can feel the tumor beneath the skin when they run their fingers over it.
These tumors grow slowly and are low-grade cancers, which means they are less likely to spread (metastasize) than some other tumors. However, although rare, metastases do occur (mostly to the lungs).
To diagnose adamantinomas, doctors take x-rays and remove a tissue sample for examination under a microscope (biopsy).
To treat adamantinomas, doctors surgically remove them without cutting into the tumor, which risks spilling the tumor cells. If the cells spill, the cancer can return. On rare occasions, surgical removal of the affected leg (amputation) may be necessary depending on the location of the tumor or depending on whether the tumor returns.
Chondrosarcomas
Chondrosarcomas are tumors composed of cancerous cartilage cells. These tumors tend to occur in middle-aged and older adults. These tumors often develop in flat bones such as the pelvis or shoulder blade (scapula) but can develop in any portion of any bone and can also develop in the tissues surrounding the bones. Many chondrosarcomas are slow-growing or low-grade tumors, meaning that they are less likely to spread (metastasize) than some other tumors. However, some chondrosarcomas are fast-growing or high-grade tumors, which tend to metastasize.
To diagnose chondrosarcomas, doctors take x-rays and do a bone scan and magnetic resonance imaging (MRI). Doctors also remove a tissue sample for examination under a microscope (biopsy).
Low-grade chondrosarcomas are often removed from the bone by scraping it with a scoop-shaped instrument (curettage) and by using liquid nitrogen, phenol, bone cement (methyl methacrylate), or an argon beam to kill the surface tumor cells embedded in the bone. Nearly all low-grade tumors are cured with these surgical treatments.Low-grade chondrosarcomas are often removed from the bone by scraping it with a scoop-shaped instrument (curettage) and by using liquid nitrogen, phenol, bone cement (methyl methacrylate), or an argon beam to kill the surface tumor cells embedded in the bone. Nearly all low-grade tumors are cured with these surgical treatments.
High-grade or fast-growing chondrosarcomas are aggressive tumors and are more likely to metastasize than some other tumors. They must be completely removed surgically without cutting into the tumor, which risks spilling the tumor cells. If the cells spill, the cancer can return.
Chondrosarcomas of any grade do not respond to chemotherapy or radiation therapy. Surgical removal of the affected arm or leg (amputation) is rarely necessary.
Chordomas
Chordomas are rare and cancerous and tend to occur at the ends of the spinal column, usually in the middle of the base of the spine (sacrum) or tailbone or near the base of the skull. A chordoma affecting the sacrum or tailbone causes substantial pain. A chordoma in the base of the skull can cause problems in nerves at the base of the skull (the cranial nerves), most commonly in the optic nerve. Symptoms may exist for months to several years before diagnosis. Chordomas do not usually spread (metastasize) to other areas such as the lung unless they are more aggressive, but they may return after treatment.
To help diagnose chordomas, doctors do magnetic resonance imaging (MRI). Doctors also do a biopsy.
Chordomas affecting the sacrum or tailbone may be cured by surgical removal. Chordomas in the base of the skull usually cannot be cured surgically, but radiation therapy may temporarily shrink the tumor and help with pain.
Ewing sarcoma of bone
Ewing sarcoma is a cancerous tumor that affects males more often than females and appears most commonly in people aged 10 to 20 years. Most of these tumors develop in the arms or legs, but they may develop in any bone. Pain and swelling are the most common symptoms. Tumors may become quite large, sometimes affecting the entire length of a bone. The tumor may include a large mass of soft tissue.
To diagnose Ewing sarcoma, doctors take x-rays. Although x-rays can show some details, magnetic resonance imaging (MRI) can help determine the exact size of the tumor. To confirm the diagnosis, doctors do a biopsy.
Image courtesy of Michael J. Joyce, MD, and Hakan Ilaslan, MD.
Treatment of Ewing sarcoma includes various combinations of surgery, chemotherapy, and radiation therapy, depending on whether surgery is practical or, if attempted, successful. These treatment combinations can cure more than 60% of people who have Ewing sarcoma.
Lymphoma of bone
Lymphoma of bone is a cancerous tumor that usually affects adults. It can originate in any bone or elsewhere in the body and then spread diffusely to bone marrow. Usually, this tumor causes pain and swelling and an accumulation of soft tissue. The damaged bone tends to break (fracture).
To diagnose lymphoma of bone, doctors take x-rays and do magnetic resonance imaging (MRI) to get a more accurate picture of the extent of soft tissue and bone involvement.
Treatment of lymphoma of bone usually consists of a combination of chemotherapy with or without radiation therapy, which seems to be as effective as surgical removal of the tumor. Amputation is rarely necessary. If a bone seems as though it may fracture, doctors may stabilize it surgically in an attempt to prevent a fracture.
Osteosarcomas (osteogenic sarcoma)
Osteosarcoma is the most common type of primary cancerous bone tumor if one considers multiple myeloma a hematologic tumor. Although most common in children and teenagers, osteosarcomas can occur at any age. Children who carry the gene for hereditary retinoblastoma and Li-Fraumeni syndrome are at higher risk of developing osteosarcoma. Adults older than 60 years, especially those who have Paget disease of bone, those who have undergone bone radiation therapy for another cancer, or those who have areas of dead bone tissue (called bone infarcts) and other conditions, also sometimes develop this type of tumor.
Osteosarcomas usually develop in or around the knee, but they can originate in any bone. They tend to spread (metastasize) to the lungs or other bones. Usually, these tumors cause pain, swelling or an accumulation of soft tissue, and loss of joint motion.
X-rays are taken, but removal of a tissue sample for examination under a microscope (biopsy) is needed for the diagnosis of osteosarcoma. People need a chest x-ray and a chest computed tomography (CT) scan to detect cancer that has metastasized to the lungs and a bone scan to detect cancer that has spread to other bones. Magnetic resonance imaging (MRI) and positron emission tomography (PET) combined with computed tomography (PET-CT) are other imaging tests that are also done.
Image courtesy of Lukas Nystrom, MD.
More than 65% of people who have this type of tumor survive for at least 5 years after diagnosis when chemotherapy is given and the cancer has not metastasized. If chemotherapy destroys almost all of the cancer, the chance of surviving at least 5 years is greater than 90%. Because surgical procedures have improved, the affected arm or leg can usually be saved and reconstructed. In the past, the affected limb often had to be amputated.
Osteosarcomas are usually treated with a combination of chemotherapy and surgery. Usually, chemotherapy is given first. Pain often subsides during this phase of treatment. Then the tumor is surgically removed without cutting into the tumor. Cutting into the tumor spills its cells, which can cause the cancer to return in the same area. Chemotherapy continues after surgery.
