Our primary bone cancer information is written for patients, their families and friends, and the general public.
We aim to help everyone understand more about primary bone cancer, what it is and the different types.

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Primary bone cancer

Cancer is a disease of the body’s cells. It causes uncontrolled growth of abnormal cells.
This group of abnormal cells is known as a ‘tumour’.

‘Primary bone cancer’ is the name given to cancer that starts in a cell in a bone.

The site at which the cancer starts is known as the ‘primary tumour site’.
If a cancer spreads from its primary site to a new place in the body, this is called a ‘secondary site’.


The symptoms of primary bone cancer

Primary bone cancer is rare, and symptoms can be similar to sports injuries, growing pains, or common conditions such as tendonitis or arthritis.

  • Bone pain
    • it can be constant (there all the time) or intermittent (comes and goes)
    • painkillers might not help
    • it can be worse at night
  • A lump or swelling might be seen or felt if the tumour is near the surface of the body
    • in other places (e.g. the pelvis) a lump or swelling will not be visible
  • Problems with mobility such as stiff joints or reduced movement
  • Easy bruising
  • Tiredness, sweats/fever, weight loss, or fractures
    • these symptoms are less-common, but are still experienced by some patients

Why is early diagnosis so important?

Primary bone cancer is rare, but it is highly malignant.

Because it is rare, many GPs and healthcare professionals are unfamiliar with it and have never seen or treated a case. It is common for patients to visit their doctor many times, and visit many different healthcare professionals, to be diagnosed correctly.

The symptoms of primary bone cancer are easily – and often – mistaken for other conditions.
This can make it difficult to diagnose, with many patients being started on treatment for a condition they don’t have.

Many patients suffer pain and other symptoms for a long time before going to see their doctor. This means the cancer can be at quite an advanced stage before it has even been diagnosed correctly.

The majority of primary bone cancer patients are not referred to the right specialists quickly enough.

This can all lead to a catastrophic diagnostic experience for patients, delay the start of a patient’s treatment, and lead to a poor outlook for survival.


There is more than one type of primary bone cancer

Altogether there are nine different types of primary bone cancer.

85% of all bone cancer cases diagnosed are caused by the four most common types of primary bone cancer.
These are:

Primary bone cancer can occur at any age. However:

  • Osteosarcoma and Ewing sarcoma are types of primary bone cancer that tend to affect children and young people aged 10-24.
  • Chondrosarcoma and chordoma are types of primary bone cancer that tend to affect adults aged 50+.

There are also several rarer kinds of primary bone cancer:

The bone marrow and its functions are considered separate from the other main functions of bone.
For this reason, cancers that begin in the bone marrow (such as myeloma, leukaemia and lymphomas) are not classed as bone cancers.

The table below shows the average number of new cases diagnosed per year, of the four most common kinds of primary bone cancer:

table showing average number of new primary bone cancer cases per year

The numbers relating to cases in the UK were provided by the West Midlands Cancer Intelligence Unit and show the average cases over the last 5 years. The numbers relating to cases in Ireland were provided by the National Cancer Registry of Ireland and show the average number of cases per year from 1994 to 2010.


Who can get primary bone cancer?

Each year around 530 people in the UK, and around 35 people in the Republic of Ireland, will develop primary bone cancer.

Figure 1 shows the average number of cases per year of primary bone cancer in England (2002-2006).
The graph shows that primary bone cancer affects people of all ages. However, two peaks in the number of cases (incidence) can be seen. The largest peak is in the 10-24 age groups. A smaller peak can be seen in more elderly people.

Primary bone cancer is unusual in that it affects children, teenagers and young adults, as well as elderly people.
Most types of cancer only occur in older adults.

Figure 1: Average number of primary bone cancer cases diagnosed per year for different age groups in England, 2002-2006.

bar chart showing the number of primary bone cancer cases in England from 2002 to 2006


What do bones do?

Bones are living structures that grow and can change throughout or lifetimes. Even after our bodies stop growing when we reach adulthood, our bones are constantly being renewed as tiny damaged areas are removed and replaced. All of our bones get renewed in this way, so that every 10 years we have an entirely new skeleton.

Bones do many different useful things to help our bodies to work:

  • They provide shape and support.
  • Protect the internal organs.
  • Act as a store for minerals that the body needs.
  • Aid body movements. In addition, the hollow centre of many bones contains bone marrow.
    The bone marrow is where new blood cells are made.

What is cancer?

Cancer is a disease of cells. All living things are made up of cells.
Cells are the building blocks of tissues and organs that make up our bodies.

Some living things, like bacteria, are made from one single cell. Larger organisms, including animals and humans, are made up of billions or even trillions of cells which work together and communicate with each other to make our bodies work. In humans there are thought to be as many as 100 trillion cells, that’s “100” followed by 12 zeros.

During periods of growth and development, for example, when babies are developing and during puberty and adolescence, the body needs to make more cells to make the body grow. The way that new cells are made is that one cell grows and divides into two cells. This means one cell becomes two; two cells become four and so on. This process of cell division, which is part of what’s called the ‘cell cycle’, carries on throughout life to replace old or damaged cells.

The cell cycle is very tightly controlled; normal body cells ‘know’ when to start and stop dividing, and when to die so that they can be replaced. This means new cells are only made when they are needed. Some cells in the body are replaced in this way very often – this includes the cells that line the mouth and digestive system. Some cells in the body last for a long time, or cannot divide at all, such as nerve cells.

If a cell starts to divide too frequently and in an uncontrolled way, and if the cell does not die when it is supposed to, all of the resulting new cells can form a lump of tissue, which is called a tumour. If this lump grows but does not spread to other areas, the tumour is decribed as ‘benign’.

Sometimes, as well as dividing uncontrollably so that the lump grows bigger, the new cells can also break through into surrounding tissues (called invasion) or break away from the main tumour and spread to other sites of the body though the blood vessels. When this happens, the lump or tumour is called ‘malignant’ and doctors call this condition ‘cancer’.


How can cells become cancerous?

Most kinds of cells in our bodies contain a structure inside called the nucleus, which is protected from the rest of the cell. Inside the nucleus is a set of instructions that tells the cell what its job is and how to do it. These instructions are found on a long molecule (around 2 metres long) called DNA, which stands for deoxyribonucleic acid, (dee-OK-see-RY-boh-new-KLAY-ik acid)>.

The DNA in the nucleus of cells can be seen under powerful microscopes. DNA forms structures called chromosomes, which look like pairs of long socks. DNA is like a library full of manuals that tell the cell what role it will play in the body, how often it should divide and when it should die and be replaced by a new cell. Each individual instruction, like a page of the manual, is called a ‘gene’. There are around 25,000 different genes in each human cell.

Some genes act as ‘brakes’ on the cell division process in order to stop cells dividing too quickly. If damage occurs to these genes it can mean that the brakes fail. This allows cells to divide when they shouldn’t, and causes cells to live longer than they should so they can divide more times. This can lead to cancer.

Damage to genes is called ‘mutation’, and mutated genes are always found in cancer. Scientists have estimated that for a cell to become cancerous, around 5-10 genes in that cell have to be mutated. For some types of cancer we know what causes the gene mutations: Cigarette smoke causes mutations in the DNA of lung cells to cause lung cancer; UV rays in sunlight can mutate the DNA in skin cells to cause skin cancer. In many cases we still don’t know what makes the gene mutations happen.

Cancer can start in any of the different cell types or organs in the body, so there are over 200 different types of cancer. Different types of cancer affect the body in different ways and have different treatments and different outcomes for patients.


There are different kinds of cancer

Cancer can be classified by which organ or tissue the cancer starts in. Another way of classifying cancers is by the type of cells that have become cancerous:

  • Carcinoma is cancer that starts in a type of cell called an epithelial cell, which makes up the epithelium.
    The epithelium is the layer of cells that lines the inside or outside of many organs. Examples of carcinomas include some types of skin, lung or bowel cancers.
  • Leukaemia and Lymphoma are cancers of the white blood cells. In leukaemia the white blood cells divide out of control in the blood. Lymphoma is a solid tumour of white blood cells.
  • Brain tumours. There are many types of cancer that start in the brain or spinal canal. These include glioma, neuroblastoma and meningiomas among others.
  • Sarcoma is a kind of cancer that starts in connective tissue.
    Connective tissue includes the bones, muscles, cartilage, and fat cells.
  • Primary bone cancers are types of sarcoma.

 


Version 2 produced January 2013
Information will be reviewed in 2016

The authors and reviewers of this information are committed to producing reliable, accurate and up to date content reflecting the best available research evidence, and best clinical practice. We aim to provide unbiased information free from any commercial conflicts of interest. This article is for information only and should not be used for the diagnosis or treatment of medical conditions. We can answer questions about primary bone cancers, including treatments and research but we are unable to offer specific advice about individual patients. If you are worried about any symptoms please consult your doctor.

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The Bone Cancer Research Trust shall hold responsibility for the accuracy of the information they publish and neither the Scheme Operator nor the Scheme Owner shall have any responsibility whatsoever for costs, losses or direct or indirect damages or costs arising from inaccuracy of information or omissions in information published on the website on behalf of the Bone Cancer Research Trust.