Mayo Clinic
Does a bone tumour always mean cancer? Here’s what you need to know
Hearing that an X-ray or other imaging test has revealed a bone tumour or lesion can be frightening. For many people, the first thought is cancer.
But a tumour in the bone does not necessarily mean cancer.
Bone tumours are abnormal growths of cells within the bone, and they can be either benign, meaning noncancerous, or malignant, meaning cancerous. While some require treatment because they can grow, damage the bone or spread to other parts of the body, others can simply be monitored over time.
“Hearing that an imaging test found a bone tumor or bone lesion can be frightening. Fortunately, most bone tumors aren’t cancerous,” says Wendy Allen-Rhoades, M.D., Ph.D., a paediatric oncologist at Mayo Clinic Comprehensive Cancer Centre.
“The key is finding out exactly what type of tumor or lesion you have, so your healthcare team can recommend the right care.”
Primary bone cancer is also different from cancer that has spread to the bone from another part of the body.
Cancers are named for where they begin. So, if lung cancer spreads to the bone, it remains lung cancer, not bone cancer. Likewise, if a cancer that begins in the bone spreads to the lungs, it remains bone cancer.
Pain can be a warning sign
Bone, muscle and joint pain is common and, in most cases, is caused by conditions other than cancer. But persistent or worsening pain should not always be dismissed, particularly when it is accompanied by other symptoms.
Pain that does not improve, wakes a person from sleep or occurs alongside swelling, fever, weight loss or limping warrants medical evaluation.
“In children and teenagers, persistent pain shouldn’t automatically be dismissed as growing pains,” Allen-Rhoades says.
“While growing pains are common, ongoing pain that interferes with sports, school or daily activities should be evaluated by a healthcare professional.”
Persistent back pain in children is another symptom that should be checked, as it is uncommon. A fracture following little or no trauma can also be a warning sign because some bone tumours can weaken the bone.
But bone tumours do not always cause symptoms.
“Sometimes bone tumors don’t cause symptoms. Instead, they’re discovered when an X-ray or other imaging test is performed after a sports injury or another unrelated problem,” Allen-Rhoades says.
“In these cases, the injury didn’t cause the tumor; the imaging revealed something that was already there.”
The cancers to know
The most common bone cancers vary by age, with some occurring predominantly in children and young adults and others more frequently affecting middle-aged and older adults.
Osteosarcoma begins in cells that form bones and is the most common type of bone cancer. It tends to occur most often in teenagers and young adults, particularly in the long bones of the legs and, sometimes, the arms. Treatment most often involves surgery and chemotherapy.
Chondrosarcoma usually begins in bone but can sometimes occur in soft tissue. It most often affects the pelvis, hip and shoulder and is more common in middle-aged and older adults. Treatment often involves surgery to remove the cancer.
Small, slow-growing chondrosarcomas in the arms and legs may sometimes be treated with a procedure in which cancer cells are scraped from the bone. The surgeon may then apply cold gas or a chemical to kill any remaining cancer cells. If necessary, the bone can be repaired with a bone graft or bone cement.
Ewing sarcoma begins in bones and the soft tissue surrounding them. It occurs mostly in children and young adults and most often begins in the leg bones and pelvis. Treatment generally includes chemotherapy and surgery.
Not every bone tumour requires aggressive treatment, however.
“Many benign tumors don’t require treatment and can simply be monitored if they’re not causing pain, limiting function or weakening the bone. Other benign bone tumors may require surgery,” Allen-Rhoades says.
“Malignant bone tumors, however, require treatment. Depending on the type of cancer, treatment may include surgery, chemotherapy, radiation therapy or a combination.”
Advances in treatment
Technology is also playing an increasing role in the treatment of bone tumours.
Three-dimensional printed models of a patient’s tumour and the physical structures surrounding it can help surgeons determine the best approach to removing the tumour. The models can provide a clearer understanding of the tumour’s location and its relationship with nearby structures.
Another option, in some cases, is proton beam therapy. This form of radiation treatment may allow higher doses of radiation to be delivered to bone tumours while reducing damage to healthy tissue nearby.
Despite advances in diagnosis and treatment, the cause of most bone cancers remains unknown, and there is no known way to prevent them.
Some factors can increase the risk. These include certain rare genetic syndromes that can run in families, such as Li-Fraumeni syndrome and hereditary retinoblastoma. Other risk factors include bone conditions such as Paget’s disease of bone and fibrous dysplasia, as well as radiation therapy and some types of chemotherapy used to treat other cancers.
Getting the right diagnosis
Because bone tumours are rare, being assessed by a healthcare team with experience in diagnosing and treating these conditions is important.
A number of specialists may be involved, including radiologists, pathologists, orthopaedic surgeons and medical oncologists. Working together, they can establish an accurate diagnosis and recommend the most appropriate treatment plan.
For patients and families, the message is not to panic when a bone lesion or tumour is discovered.
“If you’ve been told you have a bone tumor or bone lesion, try not to assume the worst. Many bone tumors are benign, and even malignant bone cancers can often be treated successfully,” Allen-Rhoades says.
“If you have persistent pain, an abnormal imaging finding or symptoms that concern you, don’t ignore them. Talk with your healthcare team. An accurate diagnosis is the first step toward getting the care that’s right for you.”
