Bone cancer

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Malignant tumours of the bone

Malignant tumours of the bone are cancerous growths that have the potential to spread (metastasize) to other parts of the body. Most bone cancers are called sarcomas.

Osteosarcoma

Osteosarcoma (osteogenic sarcoma) is the most common primary bone tumour.

  • Osteosarcoma starts in bone cells.
  • It develops most often in the bones of the arms, legs and pelvis.
    • About half of these tumours develop in or around the knee.
  • It occurs most often between the ages of 10 and 30 years.
    • Osteosarcoma occasionally develops in people in their 60s and 70s.
    • It is rare in middle-aged people.
  • It occurs more often in males than in females.
  • Osteosarcoma is seen more often in people with a history of Paget’s disease of the bone, retinoblastoma and previous radiation therapy.

There are several rare subtypes of osteosarcoma, including:

  • parosteal osteosarcoma
    • accounts for 4% of all osteosarcomas
    • usually low grade
  • periosteal osteosarcoma
    • usually intermediate grade
  • high-grade surface osteosarcoma
    • also called peripheral conventional osteosarcoma
  • small cell osteosarcoma
    • resembles Ewing sarcoma
    • often classified as an “atypical” Ewing sarcoma
  • Paget’s sarcoma
    • occurs in approximately 1% of people with Paget’s disease of the bone
  • radiation-induced osteosarcoma
    • occurs in an area that was previously treated with radiation

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Chondrosarcoma

Chondrosarcoma is the second most common primary bone tumour.

  • Chondrosarcoma starts in cartilage cells.
  • It develops most often in the bones of the pelvis, arms or legs.
  • It occurs most often in people over the age of 20 (one-half of all cases occur in people older than 40 years of age).
  • It occurs equally in males and females.
  • In very rare cases, benign tumours, such as enchondromas and osteochondromas, turn into chondrosarcoma.
  • Most chondrosarcomas are low or intermediate grade.
  • Some chondrosarcomas have different features under the microscope.
    • dedifferentiated
      • These tumours start out as typical chondrosarcomas, but some tumour cells change to look like those of an osteosarcoma or fibrosarcoma.
      • They usually occur in older people and are more aggressive than usual chondrosarcomas.
    • clear cell
      • These are rare tumours that grow slowly.
      • They rarely spread to other parts of the body, unless the cancer has already come back quite a few times in the original tumour site.
    • mesenchymal
      • These tumours often grow rapidly but respond well to treatment.

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Ewing sarcoma

Ewing sarcoma is the third most common primary bone tumour in adults, but it occurs more often in children and teenagers.

  • Most Ewing sarcomas develop in bones, but they can start in other organs or tissues.
  • Ewing sarcoma of the bone occurs most often in the pelvis, bones of the chest wall (such as the ribs and shoulder blades) and in the long bones of the arms and legs.
  • It develops most often in people under the age of 20 years, but can occur in adults over the age of 30.
  • It occurs more often in males than females.
  • Ewing sarcoma is an aggressive type of bone sarcoma that responds well to treatment.
    • All people with Ewing sarcoma will be given chemotherapy.

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Rare malignant bone tumours

There are several types of rare malignant bone tumours, including the following.

Fibrosarcoma and malignant fibrous histiocytoma

Fibrosarcoma and malignant fibrous histiocytoma (MFH) of the bone most often develop in the long bones of the arms and legs and in the jaw.

  • They occur most often in middle-aged and older adults.
  • Treatment is similar to that for osteosarcoma and usually includes a combination of surgery and chemotherapy.
    • Radiation therapy is sometimes given after surgery. It may be given instead of surgery if the tumour cannot be completely removed or if the tumour recurs after surgery.

Chordoma

Chordoma tends to develop at the end of the spinal column, usually in the sacrum (middle of the base of the spine), tailbone or near the base of the skull.

  • It is a slow-growing tumour.
  • It does not usually spread to other bones but can recur after treatment.
  • Treatment includes:
    • Surgery is used to completely remove the tumour.
    • Radiation therapy may be given for tumours that cannot be removed by surgery or have recurred. It may also be used to relieve symptoms.
    • Chemotherapy may be given for tumours that have recurred or spread to distant parts of the body.

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Other cancers that develop in bones

Other cancers can develop in bones, but they are not considered to be bone cancer. These cancers are:

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