Cancer that is discovered in bones can either represent cancer which has spread from a distant site (i.e., breast, prostate, lung) or can be a cancer which originates in bone (sarcoma). Cancers which spread to bone represent 98% of all bone cancers. Cancers that start in the bone are rare. Only about 2,000 new cases of primary bone cancers (as opposed to cancers that spread to the bone from other areas) are diagnosed in the United States each year. Approximately 5,000 to 6,000 new cancers in the soft tissues of the body are diagnosed annually.

Primary bone cancers (sarcomas) tend to be more common in children and adolescents than in adults. Most adults with a bone cancer have cancer that has spread to the bone from its primary site, such as the breast, lung or prostate. Less commonly, the bone cancer will have actually originated from the bone itself.

Sarcomas in children

Bone and soft tissue sarcomas, particularly osteosarcoma, Ewing's sarcoma, and rhabdomyosarcomas most often occur in children. Their symptoms and treatment may differ in some ways from the same sarcoma occurring in an adult. Read more about pediatric tumors.

Common types of bone cancers (sarcomas)

On this page:

• Osteosarcoma
• Chondrosarcoma
• Ewing's sarcoma
• Fibrosarcoma
• Malignant fibrous histiocytoma

Osteosarcoma (also called osteogenic sarcoma)

This is the most common type of primary malignant bone cancer. Osteosarcomas have subtypes, which include conventional osteosarcoma, parosteal, juxtacortical, Paget's or secondary-induced bone sarcomas (radiation-induced). Although it can occur at any age, osteosarcoma is typically found in teenagers and young adults and is slightly more common in males. Any bone in the body can be affected but the most common sites are the arms or legs, particularly around the knee and shoulder.

Osteosarcoma treatment includes chemotherapy for any tumor that has greater than 10% chance of spreading elsewhere in the body. After a course of chemotherapy called induction therapy, the local disease is then managed by surgical removal of the primary tumor and reconstruction. If the primary tumor cannot be completely removed, amputation is occasionally required.

After the management of the primary tumor, additional chemotherapy is focused on the possibility of microscopic disease in the bloodstream and lung that is undetectable. The principle behind the chemotherapy is to eradicate this disease before it begins growing. The course of treatment for osteosarcomas generally takes 10-12 months from the time of diagnosis, with chemotherapy followed by local control of the primary tumor, and then post-surgical control of any residual microscopic disease with additional chemotherapy for a total of 8-10 months.

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Chondrosarcoma

This is a cancer of the cartilage although can also grow within a bone or on its surface. It is most typically found in middle-aged adults. Chondrosarcoma is usually a slow-growing tumor and the most common sites are the pelvis, shoulder and the upper part of the arms and legs.

The treatment for chondrosarcomas relies heavily on surgical removal, since there is limited response to radiation and/or chemotherapy. One of the reasons for aggressive treatment is that 10% of low-grade tumors have been reported to develop a much more aggressive biologic behavior, a process called dedifferentiation.

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Ewing's sarcoma

This is a tumor that occurs primarily in younger patients between the ages of 5 and 30 years of age. Any bone can be affected, but the pelvis, thigh bone and shin bone are the most common sites. Like osteosarcoma, this cancer is slightly more common in males than females.

The prognosis for Ewing's sarcoma depends on the stage of the disease. If there is no evidence of disease outside of the local site, overall 60% of those patients will be cured. If the tumor is in a long bone such as the femur or humerus, is smaller than 8 centimeters in diameter and confined to the local site, the cure rate is 80+%. Even patients with metastatic disease to the lung may be cured.

Patients with Ewing's sarcoma usually respond dramatically to chemotherapy. A major difference between osteosarcoma and Ewing's sarcoma is treatment of the local disease may be done with radiation therapy rather than surgery alone. Our center believes that the complications of radiation therapy are sufficient that when we can use surgery with an acceptable result to the patient and family, we prefer surgical treatment over primary radiation in Ewing's sarcoma.

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Fibrosarcoma

This type of bone cancer is also most commonly found in adults, particularly during middle age. A typical site is the thigh bone.

Malignant fibrous histiocytoma

This is a very rare type of bone cancer that occurs in adults. It is usually found in the arms and legs, especially around the knee joint.

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Content development for the Bone & Soft Tissue Cancers (Sarcomas) section was supported by the Karen Wyckoff Rein in Sarcoma Fund.