Bone cancer can affect people of all ages, but this section is specifically for teenagers and young adults. While there are various types of bone cancer, the information provided here applies to the most common forms. If you have a rare type and need additional information, consider speaking with the Macmillan Support Line.
For general information about bone cancer across all age groups, check out our general bone cancer section.
Types of Bone Cancer
Different types of bone cancer can affect teenagers, with the most common being osteosarcoma and Ewing sarcoma.
Osteosarcoma
Osteosarcomas primarily affect bones in the leg, particularly around the knee joint, but can develop in any bone.
Ewing Sarcoma
Ewing sarcoma can develop in any bone but is most common in the pelvis (including the tail bone and hip bones) or in leg bones. In some cases, Ewing sarcoma may originate outside the bone in soft tissue (called soft tissue Ewing sarcoma) but is treated similarly. Sarcoma refers to cancers that begin in connective tissue, including muscle, fat, or cartilage.
Note: The term bone tumour is sometimes used interchangeably with bone cancer.
Causes of Bone Cancer
The exact cause of bone cancer is unknown. However, because it often affects young people, some doctors believe it may be linked to changes occurring during bone growth. Research into potential causes is ongoing.
Important Reminder: There is no evidence that injuries, such as a knock or fall, cause bone cancer. Nothing you’ve done has caused it.
Signs and Symptoms of Bone Cancer
Bone cancer symptoms can vary, and not everyone will experience the same symptoms. Because many symptoms resemble everyday aches and pains, they may be mistaken for things like strains, sports injuries, or growing pains.
Main Symptoms
- Pain or tenderness: This often begins as a persistent ache and may worsen with exercise or during the night.
- Swelling around the affected bone area: Swelling might not appear until the tumor is large, and it may not be visible or palpable if the affected bone is deep within the body.
- Reduced movement: If near a joint (e.g., elbow or knee), a tumor may restrict joint motion, cause a limp if in the leg, or lead to tingling or numbness if pressing on spinal nerves.
- Broken bone: Bones weakened by cancer may break suddenly or after minor falls or accidents.
Additional Symptoms
- Tiredness
- High temperature (fever)
- Loss of appetite
- Weight loss
When to See a Doctor
If you experience any of these symptoms or are concerned about a possible bone tumour, visit your GP. They will discuss your symptoms and may arrange further tests if necessary.
Reminder: Most people with these symptoms do not have bone cancer, but it is always best to seek medical advice.
Understanding Bones and Their Role in Bone Cancer
Bones are crucial structures in the human body, acting like a scaffolding that keeps us upright and allows for movement. The human skeleton comprises over 200 bones of varying shapes and sizes, each serving important functions that help maintain our health and mobility.
What Do Bones Do?
Bones play a variety of roles, including:
- Movement: They work in conjunction with joints and connective tissues to enable movement.
- Protection: Bones protect vital organs from injury. For example, the ribs shield the heart and lungs.
- Calcium Storage: Bones store calcium, an essential mineral for bodily functions.
- Blood Cell Production: Some bones contain bone marrow, which produces blood cells.
How Joints Work
Joints connect bones, allowing for flexible movement. Different types of joints perform different functions:
- Lever-like Joints: Such as the finger joints.
- Ball-and-Socket Joints: Examples include the hip joint.
Connective Tissues That Aid Movement
- Ligaments: Tough cords that attach bones to each other, providing stability.
- Cartilage: A slippery material covering bone ends, preventing friction during movement.
- Muscles: Made of tough, stretchy tissue that enables strength and mobility.
- Tendons: Strong cords connecting muscles to bones.
More Information About Bone Cancer
For general information about bone cancer in all age groups, visit our general bone cancer section.
Tests for Diagnosing Bone Cancer: What to Expect
If you are experiencing symptoms that may indicate bone cancer, it is important to undergo specific tests to determine the cause. Here’s what you can expect when visiting your GP and during hospital evaluations.
Visiting Your GP
If you suspect you have symptoms of bone cancer, speak to your GP. During your visit:
- Symptom Discussion: Your GP will ask about your symptoms and medical history.
- Examination: A physical examination may be performed.
- Initial Tests: Your GP may arrange for X-rays or blood tests to explore possible causes.
It may take time to reach a diagnosis as there are many potential reasons for feeling unwell. If the cause remains unclear, you may be referred to a specialist at the hospital for further evaluation.
Tests at the Hospital
The type of specialist you see will depend on your initial test results. You may either see a bone cancer specialist directly or meet with more general specialists first. At the hospital, you may undergo the following tests:
Common Tests for Bone Cancer
- X-Rays: X-rays provide images of the bones and can detect abnormalities or changes in the bone structure.
- Bone Scans: These scans offer a detailed view of the inside of the bones using a small amount of radioactive material injected into the bloodstream.
- Biopsies: A biopsy involves removing a small sample of tissue from the affected bone to confirm the diagnosis.
- MRI and CT Scans: These imaging tests produce detailed images of bones, soft tissues, and any tumors present.
If a bone cancer diagnosis is confirmed and you haven’t been referred to a specialist bone doctor, you will be referred for specialized care.
Additional Tests for Comprehensive Assessment
Once diagnosed with bone cancer, additional tests may be necessary to check overall health and ensure your body is prepared for treatment:
- Blood Tests: To assess general health and organ function.
- Heart Tests: To check for heart health and ensure it is strong enough for treatment.
- Chest X-Rays: To evaluate lung health.
- Kidney Function Tests: You may be asked to provide a urine sample to assess kidney function.
Coping with Tests and Results
Undergoing numerous tests and waiting for results can be a stressful and anxious time. It’s important to talk about your feelings and seek support from family, friends, your specialist nurse, or your doctor.
For more information, you can explore these sections:
Visit our general bone cancer section for comprehensive information about bone cancer in all age groups.
Treating Bone Cancer: Ewing Sarcoma and Osteosarcoma
The primary treatments for bone cancer, including Ewing sarcoma and osteosarcoma, involve a combination of chemotherapy, surgery, and radiotherapy. Your treatment plan will be tailored based on:
- The type and location of your bone cancer.
- Whether the cancer has spread beyond the bone.
- How fast-growing the cancer is.
- Your general health.
Chemotherapy for Bone Cancer
Chemotherapy uses anti-cancer drugs to target and destroy cancer cells. It can:
- Shrink tumors before surgery or radiotherapy.
- Target cancer cells that have spread outside the bone.
- Be administered after surgery or radiotherapy to prevent recurrence.
Administration: Chemotherapy is typically delivered through a vein using a central line, port, or PICC line. Treatment is given in cycles—periods of drug administration followed by rest periods to allow the body to recover. Hospital stays may be required during some of these cycles.
Chemotherapy for Ewing Sarcoma
The standard drugs for Ewing sarcoma are vincristine, ifosfamide, doxorubicin, and etoposide (VIDE). Treatment often involves six cycles of VIDE, followed by surgery or radiotherapy, depending on tumor response.
Chemotherapy for Osteosarcoma
Treatment usually involves three drugs: methotrexate, doxorubicin (Adriamycin), and cisplatin (MAP). You will typically undergo six cycles of chemotherapy, with surgery scheduled after the first two cycles. If cancer has spread to other areas, such as the lungs, additional surgery may be necessary.
Side Effects
Common side effects of chemotherapy include:
- Sore mouth, hair loss, fatigue, nausea, and increased infection risk.
- Mifamurtide may cause fever or chills after administration.
Surgery for Bone Cancer
Surgical removal of the cancerous tissue is a critical component of treatment. The aim is to eliminate the cancer while preserving as much limb function as possible.
Limb-Sparing Surgery
In limb-sparing surgery, the cancerous tissue is removed, and the bone is often reconstructed with a prosthesis or bone graft. Joints affected by cancer may be replaced with artificial ones.
Amputation
If limb-sparing surgery is not feasible, amputation may be necessary. This is considered when:
- Cancer has spread to blood vessels or nerves.
- Infection occurs after limb-sparing surgery.
- Tumor location prevents successful limb-sparing surgery.
Recovery: Physiotherapy is crucial after surgery to regain strength and mobility.
Radiotherapy for Bone Cancer
Radiotherapy uses high-energy X-rays to destroy cancer cells. It is often used for Ewing sarcoma and may be given before or after surgery. Osteosarcoma patients may receive radiotherapy if surgery is not possible.
Treatment Schedule
Radiotherapy is typically given every weekday for five weeks, with each session lasting a few minutes.
Side Effects
While radiotherapy itself is painless, side effects can include:
- Skin irritation, fatigue, and stiffness around the treated area.
For more information, explore these topics:
Visit our general bone cancer section for comprehensive information about bone cancer across all age groups.
Life After Bone Cancer Treatment: Recovery and Moving Forward
After surgery for bone cancer, adjusting to life can present both challenges and opportunities. Whether you’ve had limb-sparing surgery or amputation, it’s important to understand the recovery process, long-term effects, and available support.
Life After Limb-Sparing Surgery
The long-term effects of limb-sparing surgery depend on the type of surgery and body part affected. It’s best to discuss potential outcomes with your surgeon. Physiotherapy is essential for regaining limb function. Exercises may be challenging, but they play a crucial role in your recovery journey.
Joint Replacements
- Knee Joint Replacement: You can walk and swim post-surgery, but high-impact sports like hockey, football, tennis, or rugby should be avoided to prevent damage or loosening of the new joint. Running short distances is generally fine, but regular jogging may wear out the joint, requiring replacement.
- Hip Joint Replacement: Most everyday activities are possible, though running and high-impact sports should be avoided.
- Shoulder Replacement: You should have normal movement below shoulder height, but lifting above the shoulder may be limited.
Bone Grafts and Growing Implants
If you’ve received an implant during growth, it may need lengthening. Some implants can be adjusted without surgery, while others require further operations. Your specialist can provide specific information.
Life After Amputation
Following an amputation, an artificial limb (prosthesis) will typically be fitted. Various prostheses exist to support different activities, including walking, swimming, running, cycling, and sports. Many people use a day-to-day prosthesis and have a specialized one for activities like swimming or athletics.
Coping with Emotional Changes
Adjusting to life after surgery can bring up a mix of emotions. You may experience feelings of tearfulness, anger, sadness, or loss of confidence. It’s crucial to seek support when needed. Consider talking to:
- Your specialist nurse or key worker.
- Family and friends.
- A counsellor, which can be arranged through your care team.
- Support groups with young people facing similar challenges.
Navigating Social Reactions
The reactions of others may be difficult. Concerns about friends’ perceptions or returning to school, college, or work are normal. Even close family members may struggle to find the right words. Choosing a few trusted people to confide in and speaking openly about your feelings with a specialist nurse, key worker, or counsellor can be helpful.
Follow-Up Care
After treatment, your doctor will outline the next steps, including any long-term risks of bone cancer and its treatment. Regular clinic visits will be scheduled to monitor your progress and address any concerns.
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