Bone Cancer, Including Osteosarcoma and Ewing’s Sarcoma

Primary bone cancer is a general term that refers to several relatively rare malignancies, including osteosarcoma and Ewing’s sarcoma, which develop in the body’s skeletal system. Secondary (metastatic) bone cancer originates in another part of the body, such as a lung, a breast or the prostate, then spreads to a bone. Metastatic bone cancer is more frequently diagnosed than primary bone cancer. Some common bone metastasis sites include the bones in the hips, thighs, shoulders and spine.

Osteosarcoma, the most common type of primary bone cancer, develops in the cells that form new bone tissue (osteoblasts), usually at the ends of the long bones in the legs and arms. Ewing’s sarcoma results from chromosomal changes in certain bone cells that have not yet been conclusively identified by scientists. Another type of bone cancer, chondrosarcoma, originates in the cartilage at the ends of bones—most often in the legs, pelvis and arms. Unlike osteosarcoma and Ewing’s sarcoma, which mainly affect children and young adults whose bones are still growing, chondrosarcoma is usually diagnosed in patients older than 50.

What Causes Bone Cancer?

Researchers have not yet pinpointed the precise causes of the cellular DNA changes that lead to the development of bone cancer. Some known risk factors include:

• Certain inherited conditions, such as Li-Fraumeni syndrome, Rothmund-Thompson syndrome and hereditary retinoblastoma
• Certain noncancerous bone conditions, such as Paget’s disease
• Exposure to high doses of radiation

What Are the Symptoms of Bone Cancer?

The most common sign of bone cancer is pain, which can occur if a growing tumor presses on nearby tissues or if the cancer weakens a bone to the point that it fractures. Some people also experience:

• Bone tenderness
• Stiffness
• Fatigue
• Fever

How Is Bone Cancer Diagnosed?

After performing a physical examination, a physician may order imaging studies or blood work as part of the diagnostic process. For instance, a high level of a specific enzyme known as alkaline phosphatase is often present in the blood when bone-forming cells are very active, such as when a young child’s bones are growing or when a broken bone is mending. In other situations, however, it could be a sign that a tumor is creating abnormal bone tissue. To make a definitive diagnosis, a physician will typically order a biopsy of suspicious bone tissue.

How Is Bone Cancer Treated?

Surgery is the main form of treatment for bone cancer. Some patients also receive chemotherapy or radiation therapy, either alone or in combination with other options. The optimal treatment plan is determined based on the type, size and location of the tumor and whether the cancer has spread.

The multispecialty team in the Cancer Institute at Tampa General Hospital takes a personalized approach to bone cancer treatment, working closely with each patient to achieve the best possible outcome while preserving the form and function of the affected bones.