Bone Cancer

Source: American Cancer Society

June, 2013

 

What is bone cancer?

Bone is the framework that supports the body. Most bones are hollow. Bone marrow is the soft tissue inside hollow bones. The main substance of bone is made up of a network of fibrous tissue onto which calcium salts are laid down. This makes the bone very hard and strong. At each end of the bone is a softer bone-like tissue called cartilage that acts as a cushion between bones. The outside of the bone is covered with a layer of fibrous tissue.

The bone itself contains 2 kinds of cells. Osteoblasts are cells that form the bone. Osteoclasts are cells that dissolve bone. Although we think that bone does not change, the truth is that it is very active. New bone is always forming and old bone dissolving.

The marrow of some bones is only fatty tissue. In other bones the marrow is a mixture of fat cells and the cells that make blood cells. These blood-forming cells make red blood cells, white blood cells, and platelets.

 

Types of bone tumors

Most of the time when someone is told they have cancer in their bones, the doctor is talking about a cancer that started somewhere else and then spread to the bone. This is called metastatic cancer (not bone cancer). This can happen to people with many different types of advanced cancer, such as breast cancer, prostate cancer, lung cancer, and many others. Under a microscope, theses cancer cells in the bone look like the cancer cells that they came from. If someone has lung cancer that has spread to the bone, the cells there will look and act like lung cancer cells and they will be treated the same way.

To learn more about cancer that has spread to bone, please see the American Cancer Society document Bone Metastasis, as well as the document on the place where the cancer started (Breast Cancer, Lung Cancer (Non-Small Cell), Prostate Cancer, etc.).

Other kinds of cancers that are sometimes called “bone cancers” start in the bone marrow – in the blood-forming cells – not the bone itself. These are not true bone cancers. The most common of these is multiple myeloma. Certain lymphomas (which more often start in lymph nodes) and all leukemias start in bone marrow. To learn more about these cancers, refer to the document for each.

A primary bone tumor starts in the bone itself. True (or primary) bone cancers are called sarcomas. A sarcoma is a cancer that starts in bone, muscle, tendons, ligaments, fat tissue, or some other tissues in the body.

Bone tumors

There are different types of bone tumors. Their names are based on the bone or tissue that is involved and the kind of cells that make up the tumor. Some are cancer (malignant). Others are not cancer (benign). Most bone cancers are called sarcomas.

Benign bone tumors do not spread to other tissues and organs. They can usually be cured by surgery. The information here does not cover benign bone tumors.

Bone tumors that are cancer (malignant)

Osteosarcoma: Osteosarcoma (also called osteogenic sarcoma) is the most common true bone cancer. It is most common in young people between the ages of 10 and 30. But about 10% of cases are people in their 60s and 70s. This cancer is rare during middle age. More males than females get this cancer. These tumors start most often in bones of the arms, legs, or pelvis. This type of bone cancer is not discussed in this document, but is covered in detail in our document, Osteosarcoma.

Chondrosarcoma: This is cancer of the cartilage cells. Cartilage is a softer form of bone-like tissue. Chondrosarcoma is the second most common true bone cancer. It is rare in people younger than 20. After age 20, the risk of this cancer keeps on rising until about age 75. Women get this cancer as often as men.

Chondrosarcomas can develop in any place where there is cartilage. It most often starts in cartilage of the pelvis, leg, or arm, but it can start in many other places, too.

Chondrosarcomas are given a grade, which measures how fast they grow. The lower the grade, the slower the cancer grows. When cancer grows slowly, the chance that it will spread is lower and the outlook is better. There are also some special types of chondrosarcoma that respond differently to treatment and have a different outlook for the patient. These special types look different when seen under a microscope.

Ewing tumor: This cancer is also called Ewing sarcoma. It is named after Dr. James Ewing, the doctor who first described it in 1921. It is the third most common bone cancer. Most Ewing tumors start in bones, but they can start in other tissues and organs. This cancer is most common in children and teenagers. It is rare in adults older than 30. This type of bone cancer is not discussed in this document, but is covered in detail in our document, Ewing Family of Tumors.

Malignant fibrous histiocytoma (MFH): This cancer more often starts in the soft tissues around bones (such as ligaments, tendons, fat, and muscle) rather than in the bone itself. If it starts in the bones, it most often affects the legs or arms. It usually occurs in older and middle-aged adults. MFH mostly tends to grow into nearby tissues, but it can spread to distant sites, like the lungs. (Another name for this cancer is pleomorphic undifferentiated sarcoma.)

Fibrosarcoma: This is another type of cancer that starts more often in “soft tissues” than it does in the bones. Fibrosarcoma usually occurs in older and middle-aged adults. Leg, arm, and jaw bones are most often affected.

Giant cell tumor of bone: This type of bone tumor has both benign (not cancer) and malignant forms. The benign form is most common. These don’t often spread to distant sites, but after surgery they tend to come back where they started. Each time they come back after surgery they are more likely to spread to other parts of the body. These tumors often affect the arm or leg bones of young and middle-aged adults.

Chordoma: This tumor usually occurs in the base of the skull and bones of the spine. It is found most often in adults older than 30. It is about twice as common in men than in women. Chordomas tend to grow slowly and usually do not spread to other parts of the body. But they often come back in the same place if they are not removed completely. When they do spread, they tend to go to the lymph nodes, lungs, and liver.

 

How many people get bone cancer?

The American Cancer Society’s estimates for cancer of the bones and joints in the United States for 2013 are:

  • About 3,010 new cases
  • About 1,440 deaths from these cancers

Cancers that start in the bones (primary bone cancers) make up a very small percentage of all cancers.

Chondrosarcoma and osteosarcoma are the 2 most common primary bone cancers in adults. These are followed by chordoma, Ewing tumor, and malignant fibrous histiocytoma/fibrosarcoma. Some rare types of cancers account for the rest of the cases.

In children and teens (younger than 20 years old), osteosarcoma and Ewing tumors are the most common types of bone cancer, and are more common than chondrosarcoma.

 

What are the risk factors for bone cancer?

A very small number of bone cancers appear to be caused by changes (mutations) in certain genes. But the exact cause of most bone cancers is not known. We do know that certain risk factors are linked to this disease. A risk factor is something that affects a person’s chance of getting a disease. Some risk factors, like smoking, can be controlled. Others, like a person’s age or race, can’t be changed. But having a risk factor, or even several, does not mean that you will get cancer.

Most people with bone cancer do not have any known risk factors. Some risk factors for bone cancer are having had certain other diseases or medical treatments.

Diseases and syndromes

The following conditions can increase the risk of some types of bone cancer. If you have any of these, you should ask your doctor for more information.

Genetic syndromes

These syndromes are linked to having an abnormal gene

  • Li-Fraumeni syndrome
  • Rothmund-Thomson syndrome
  • The inherited form of retinoblastoma (a rare eye cancer of children)
  • Multiple exostoses syndrome, also called multiple osteochondromas (an inherited condition that causes many bumps on a person’s bones)
  • Tuberous sclerosis

Other diseases

  • Paget disease
  • Multiple enchondromatosis (many benign cartilage tumors)

Other risk factors

Radiation

People who have been treated with ionizing radiation for an earlier cancer have a higher risk of getting bone cancer later. Being treated at a younger age or being treated with high doses of radiation increases the risk of bone cancer.

Non-ionizing radiation, such as microwaves, electromagnetic fields from power lines, cell phones, and household appliances, does not increase bone cancer risk.

Stem cell transplant

Osteosarcoma has been reported in a few people who have had bone marrow (stem cell) transplantation.

 

Can bone cancer be prevented?

Changes in lifestyle, like quitting smoking and staying at a healthy weight, can help prevent many types of cancer. But at this time, there are no known lifestyle changes that can prevent bone cancer.

 

How is bone cancer found?

For some types of cancer there are tests that can find the cancer early, before it causes any symptoms. But right now, there are no special tests to find bone cancer early. The best thing to do is report any symptoms to a doctor right away.

Signs and symptoms of bone cancer

Pain

Pain in a bone is the most common symptom of bone cancer. At first, the pain is not constant. It may be worse at night or when the bone is used (with activity). If it is in a leg, it may cause the person to limp. As the cancer grows, the pain will be there all the time.

Swelling

Swelling in the area of the pain may not happen until weeks later. Depending on the where the tumor is, you may be able to feel a lump.

Breaks (fractures)

The cancer may weaken the bone it grows in and can rarely cause the bone to break.

Other symptoms

Problems like weight loss and tiredness (fatigue) may mean that the cancer has spread. If it has spread to organs inside the body, there may be other symptoms, too. For instance, if the cancer spreads to the lung, the person may have a cough or trouble breathing.

Bone pain and swelling are more often caused by other problems, like an injury or arthritis. Most people with these symptoms do not have cancer. Still, if these problems go on for a long time without a known reason, you should see a doctor.

 

Tests to find bone cancer

There are many things doctors can do to look for bone cancer. Symptoms, a physical exam, imaging tests, and blood tests may all suggest bone cancer. Then a sample of the tumor is removed (a biopsy) and looked at under the microscope.

Imaging tests

X-rays: Most of the time, bone cancer will show up on x-rays of the bone. The radiologist (a doctor who is trained to read x-rays) can often tell whether or not a tumor is cancer by the way it looks on the x-ray. But a biopsy (see below) is the only way to know for sure. A chest x-ray may be done to see whether the bone cancer has spread to the lungs.

CT scans (computed tomography) scans: For a CT scan, many x-rays of the body are taken from different angles. These pictures are combined by a computer to make cross-sectional pictures of your insides. Before the x-rays are taken, a contrast dye may be given into a vein. The dye helps better outline details. Some people have a reaction to the dye (hives, flushing, trouble breathing). Be sure to tell the doctor if you have ever had problems with contrast dye or have shellfish allergies. CT scans can also be used to guide a biopsy needle into a tumor.

A CT scanner has been described as a large donut, with a narrow table in the “hole.” You will need to lie still on the table while the scan is being done. CT scans take longer than regular x-rays, and you might feel a bit confined by the ring while the pictures are being taken.

CT scans help tell if your bone cancer has spread into your lungs, liver, or other organs. These scans also show the lymph nodes and distant organs where there might be cancer.

MRI (magnetic resonance imaging) scans: MRI scans use radio waves and strong magnets instead of x-rays to make detailed pictures of parts of the body. Sometimes a contrast dye might be used, just as with CT scans.

MRI scans are often the best test for outlining a bone tumor. They are also useful for looking at the brain and spinal cord.

MRI scans take longer than CT scans, often up to an hour. And you have to be placed inside a tube, which can upset some people. The machine makes thumping and clicking noises, but many places will give you headphones with music to block this out.

Radionuclide bone scans: A bone scan helps show whether cancer has spread to other bones. It can also show how much the cancer has damaged the bone. In this test, a radioactive material is put into a vein in your arm. (The radioactivity is very low and causes no long-term effects.) The material is attracted to diseased bone cells throughout the body. A special camera then takes a picture. The picture shows the diseased bone as dense, gray to black areas, called “hot spots.” These areas may be cancer. But arthritis, infection, and other bone diseases can look much the same. The doctor may use other tests or biopsies to find out for sure what is causing the hot spots.

PET scan (positron emission tomography) scans: PET scans use a radioactive glucose (a type of sugar), which can be seen by a special camera. The radioactive material is put into a vein in your arm. Because cancer cells are very active, they take in large amounts of the sugar. A PET scan can be more helpful than many x-rays because it scans the whole body. It can sometimes help tell whether or not a tumor is cancer. Machines that combine a PET scan with a CT scans can be even more helpful in finding areas of cancer spread.

Biopsy

A biopsy is a sample of tissue taken from a tumor so that it can be looked at it under a microscope. This is the only way to know that the tumor is cancer and not some other bone disease. The biopsy can also help tell if the cancer started in the bone or started somewhere else and spread to the bone.

The surgeon doing the biopsy needs to have experience diagnosing and treating bone tumors. The wrong kind of biopsy can sometimes make it hard later for the surgeon to remove all of the cancer without having to also remove all or part of the arm or leg containing the tumor. It also might cause the cancer to spread.

There are 2 different types of biopsies: needle biopsy and surgical bone biopsy.

Needle biopsy: This can be done with a thin (fine) or a thick (core) needle. For both types, a drug is first used to numb the area for the biopsy. The fine needle biopsy removes a small amount of fluid and pieces of tissue. The doctor aims the needle by feeling the area. If the tumor is deep inside the body, the needle can be guided by a CT scan. A core needle biopsy uses a bigger needle. With a core biopsy, the doctor takes out a small cylinder of tissue.

Surgical bone biopsy: For this biopsy, the doctor cuts through the skin to get to the tumor and take out a small piece of it. This is often done using drugs to numb the skin and tissue around the tumor. It can be done under general anesthesia (when drugs are used to put the patient into a deep sleep). It can also be done using a nerve block, which makes a large area numb. If this type of biopsy is needed, it is important that the surgeon who will later remove the cancer also does the biopsy.

 

Staging for bone cancer

Staging is the process of finding out how far the cancer may have spread. This is very important because the type of treatment and the outlook for recovery (prognosis) depend on the stage of the cancer.

The most common system used to stage bone cancer is the TNM system of the American Joint Committee on Cancer (AJCC). It combines information about the tumor, spread to nearby lymph nodes, and spread to distant organs and tissues, and something called grade. The grade is based on how the cancer cells look under the microscope. A high grade means the cancer is more likely to grow fast and spread.

All of this information is then combined to get the stage. The stage is given as a Roman numeral from I through IV (1-4). The smaller the number, the less the cancer has spread. A higher number, such as stage IV, means a more advanced disease. Most stages are also further sub-divided into A and B.

Even though the AJCC staging system is widely used for most cancers, bone cancer experts tend to use a more simple grouping: localized and metastatic. Localized means that the cancer is still only in the same bone it started in, and includes stages I, II, and III. Metastatic means that the cancer has spread out of that bone, and is the same as stage IV.

Ask your doctor to explain the stage of your cancer in a way you can understand. This will help you better understand your treatment choices.

 

Survival rates for bone cancer

Some people with cancer may want to know the survival rates for their type of cancer. Others may not find the numbers helpful, or may even not want to know them. Whether or not you want to read about survival rates is up to you. If you decide you don’t want to read them, stop reading here and skip to the next section.

The outlook for people with primary bone cancer varies greatly, based on the exact type of cancer and how far it has spread.

5-year survival rates are the percentage of patients who live at least 5 years after their cancer is found. Of course, many patients may live longer than 5 years. Relative 5-year survival rates assume that some people will die of other causes. So they compare the number of people who are still alive 5 years after their cancer was found to the survival of others the same age who don’t have cancer. This is a better way to show the impact that cancer can have on survival.

For all cases of bone cancer combined (in both adults and children), the 5-year relative survival is about 70%. (Survival rates for Ewing tumors and osteosarcoma can be found in our documents about those cancers.)

Chondrosarcoma is found most often in adults and has a relative 5-year survival of about 80%.

While numbers provide an overall picture, keep in mind that every person is unique and that statistics can’t predict exactly what will happen in your case. Talk with your cancer care team if you have questions about your own chances of a cure or how long you might survive your cancer. They know your situation best.

 

How is bone cancer treated?

This information represents the views of the doctors and nurses serving on the American Cancer Society’s Cancer Information Database Editorial Board. These views are based on their interpretation of studies published in medical journals, as well as their own professional experience.

The treatment information in this document is not official policy of the Society and is not intended as medical advice to replace the expertise and judgment of your cancer care team. It is intended to help you and your family make informed decisions, together with your doctor.

Your doctor may have reasons for suggesting a treatment plan different from these general treatment options. Don’t hesitate to ask him or her questions about your treatment options.

About treatment

The main types of treatment for bone cancer are:

Often, more than one type of treatment is used.

Surgery for bone cancer

Surgery is the main treatment for most bone cancers. Surgery includes the biopsy done to find the cancer and the surgery done to remove it. It is very important that the biopsy and surgical treatment be planned together. If possible, the same surgeon should do both the biopsy and the main surgery.

The goal of surgery is to remove all of the cancer. To try to be sure that no cancer cells are left behind, the surgeon will often remove the tumor plus some of the normal-looking tissue around it. This is called a wide-excision. After surgery, an expert will look at the tissue that was removed under the microscope to see if the outer edges (margins) have cancer cells. If so, it could mean that some cancer was left behind. When no cancer is seen at the edges of the tissue, the margins are said to be negative, clean, or clear. A wide-excision with clean margins gives the lowest chance that the cancer will grow back where it started.

Tumors in the arms or legs

There are 2 types of surgery for tumors in the arms or legs:

  • Amputation removes the cancer and all or part of an arm or leg.
  • Limb-salvage (also called limb-sparing) surgery removes the cancer without amputation.

While both surgeries have the same overall survival rates, it is important to know that there are pros and cons that go along with either type of surgery. And no matter which type of surgery is done, rehabilitation will be needed afterwards to help you use the limb again. This can be the hardest part of treatment. If possible, the patient should meet with a rehab specialist before surgery in order to learn what will be involved.

Amputation: Amputation may be the only option for some patients. If there is a large tumor that extends into the nerves and/or the blood vessels, it may not be possible to save the limb (arm or leg). Surgery is planned so that muscles and skin will form a cuff around the end of the arm or leg. This cuff will fit into the end of an artificial limb (called a prosthesis). With proper physical therapy a person is often walking again 3 to 6 months after leg amputation.

If the bone tumor is located in the upper arm, the tumor may be removed and then the lower arm attached again. This leaves the patient with an arm that works but is much shorter.

Limb-salvage surgery: This is a very complex surgery. The goal is to remove all of the cancer and still leave the patient with a working leg or arm. The surgeons who do it must have special skills and experience. The bone that is removed is replaced with a bone graft from donors or with a rod made of metal or other materials. This rod is called an endoprosthesis (meaning internal prosthesis).

Nine out of 10 patients with bone cancer in a limb are able to have their limbs spared. Ask the surgeon to explain the best way to remove the cancer and keep as much use of the arm or leg as possible. Because the rods or grafts are often used in growing children, they are designed to grow with the child. They can be made longer without any extra surgery. Some have tiny devices in them that can lengthen the implant when needed to make room for growth.

Problems with this approach can include infection and grafts or rods that become loose or broken. Patients may also need more surgery during the next 5 years, and some may need an amputation after all. On average, it takes a year for patients to learn to walk again after such surgery on a leg. Rehabilitation is more intense than after amputation. If the patient does not take part in the rehab program, the salvaged arm or leg may become useless.

Tumors in other places

Bone cancer in the pelvis is treated with a wide-excision when possible. If needed, bone grafts can be used to rebuild the pelvic bones.

For a tumor in the lower jaw bone, the whole lower half of the jaw may be removed and later replaced with bones from other parts of the body.

For tumors in places like the spine or the skull, it may not be possible to safely do a wide-excision. Cancers in these bones may need a number of different treatments like cutterage, cryosurgery, and radiation.

Curettage: This treatment involves scooping out the tumor from the bone. This leaves a hole in the bone. In some cases, after most of the tumor has been removed, the surgeon will treat the nearby bone tissue to kill any remaining tumor cells. This can be done with cryosurgery or by using bone cement.

Cryosurgery: For this treatment, liquid nitrogen is poured into the hole that is left in the bone after the tumor was removed. This kills tumor cells by freezing them. After cryosurgery, the hole in the bone can be filled by bone grafts or by bone cement.

Bone cement: A bone cement called PMMA starts out as a liquid and hardens over time. It can be put into a hole in the bone in liquid form. As PMMA hardens, it gives off a lot of heat. The heat helps kill any remaining tumor cells. This allows PMMA to be used without cryosurgery for some types of bone tumors.

Surgery for cancer that has spread

In order to be able to cure a bone cancer, it must be completely removed with surgery, even in any places where it has spread. The lungs are the most common place for bone cancer to spread. Surgery to remove bone cancer that has spread to the lungs must be planned very carefully. Before the operation, the surgeon takes into account the number of tumors, where they are (one lung or both lungs), their size, and the general condition of the patient.

A chest CT scan may not show all the lung tumors. The surgeon must have a plan in case more tumors are found during the operation than can be seen in the chest CT scan.

Removing all the lung metastases likely gives the patient the only chance for cure. But some tumors are too big or are too close to important structures in the chest (such as large blood vessels) to be removed safely. And patients whose general health is not good may not be able to withstand the stress of surgery. Then other treatments are needed.

 

Radiation treatment for bone cancer

Radiation treatment uses high-energy radiation to kill cancer cells or shrink tumors. External beam radiation uses radiation given from outside the body. The beam is focused on the cancer. This is the type of radiation that has been used most often as a treatment for bone cancer. But bone cancers are not easily killed by radiation and high doses are needed. So radiation does not play a major part in the treatment of most types of bone tumors. It may be useful, though, in some cases where the tumor cannot be completely removed by surgery. It might also be helpful after surgery if cancer cells were present in the edges of the removed tissue. And it might be used for symptoms like pain and swelling if the cancer has come back.

Intensity-modulated radiation therapy (IMRT)

IMRT is an advanced form of external beam radiation therapy. With this technique, a computer matches the radiation beams to the shape of the tumor and can adjust the strength of the beams. This makes it possible to reduce radiation damage to normal tissues while giving a higher dose of radiation to the cancer.

Proton-beam radiation

 

Chemotherapy for bone cancer

Chemotherapy (chemo) is the use of drugs to kill cancer cells. The drugs are often given into a vein or by mouth. Once the drugs enter the bloodstream, they go throughout the body. This treatment is useful for cancer that has spread to other organs.

Chemo is often a part of treatment for Ewing sarcoma and osteosarcoma, but it doesn’t often work well for other types of bone cancers like chordomas and chondrosarcomas. (It can be useful for some special types of chondrosarcoma.) Chemo is sometimes used for bone cancer that has spread through the bloodstream to the lungs and/or other organs.

Before giving chemo, your doctor will check your lab test results to be sure your liver, kidneys, and bone marrow (which makes blood cells) are working well.

Chemo kills cancer cells, but it also damages some normal cells. This can cause side effects. These side effects depend on the type of drugs given, the amount taken, and how long treatment lasts.

Short-term side effects could include the following:

  • Nausea and vomiting
  • Loss of appetite
  • Hair loss (the hair grows back after treatment ends)
  • Mouth sores
  • Increased chance of infection (from a shortage of white blood cells)
  • Bleeding or bruising after small cuts or injuries (from a shortage of platelets)
  • Tiredness or shortness of breath (from low red blood cell counts)

Some side effects depend on which drugs are used. Before treatment begins, talk to your cancer care team about what side effects you can expect. Most of them go away once treatment stops. If you have any problems with side effects, be sure to tell your doctor or nurse because there are often ways to help. For instance, certain drugs can help with nausea and vomiting.

 

Targeted therapy for bone cancer

As doctors have learned more about the changes in cells that cause cancer, they have been able to develop newer drugs that target some of these changes. These targeted drugs work differently from standard chemo drugs and have different side effects. Targeted drugs are proving to be especially helpful in diseases like chordoma and other bone cancers, where chemo has not been very useful.

The drug imatinib (Gleevec®) is a targeted therapy drug that can block the signals from certain genes. This can cause some tumors to stop growing or even shrink a little. Imatinib is used to treat chordomas that have spread or have come back after treatment. Imatinib has been used to treat chordoma for several years, but it isn’t approved by the Food and Drug Administration to treat this type of cancer. It is approved to treat more common cancers.

 

Clinical trials for bone cancer

You may have had to make a lot of decisions since you’ve been told you have cancer. One of the most important decisions you will make is deciding which treatment is best for you. You may have heard about clinical trials being done for your type of cancer. Or maybe someone on your health care team has mentioned a clinical trial to you.

Clinical trials are carefully controlled research studies that are done with patients who volunteer for them. They are done to get a closer look at promising new treatments or procedures.

If you would like to take part in a clinical trial, you should start by asking your doctor if your clinic or hospital conducts clinical trials. You can also call our clinical trials matching service for a list of clinical trials that meet your medical needs. You can reach this service at 1-800-303-5691 or on our Web site at www.cancer.org/clinicaltrials. You can also get a list of current clinical trials by calling the National Cancer Institute’s Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) or by visiting the NCI clinical trials Web site at www.cancer.gov/clinicaltrials.

There are requirements you must meet to take part in any clinical trial. If you do qualify for a clinical trial, it is up to you whether or not to enter (enroll in) it.

Clinical trials are one way to get state-of-the art cancer treatment. They are the only way for doctors to learn better methods to treat cancer. Still, they are not right for everyone.

You can get a lot more information on clinical trials, in our document called Clinical Trials: What You Need to Know. You can read it on our Web site or call our toll-free number and have it sent to you.

 

Complementary and alternative therapies for bone cancer

When you have cancer you are likely to hear about ways to treat your cancer or relieve symptoms that your doctor hasn’t mentioned. Everyone from friends and family to Internet groups and Web sites offer ideas for what might help you. These methods can include vitamins, herbs, and special diets, or other methods such as acupuncture or massage, to name a few.

What are complementary and alternative therapies?

It can be confusing because not everyone uses these terms the same way, and they are used to refer to many different methods. We use complementary to refer to treatments that are used along with your regular medical care. Alternative treatments are used instead of a doctor’s medical treatment.

Complementary methods: Most complementary treatment methods are not offered as cures for cancer. Mainly, they are used to help you feel better. Some examples of methods that are used along with regular treatment are meditation to reduce stress, acupuncture to help relieve pain, or peppermint tea to relieve nausea. Some complementary methods are known to help, while others have not been tested. Some have been proven not to be helpful, and a few are even harmful.

Alternative treatments: Alternative treatments may be offered as cancer cures. These treatments have not been proven safe and effective in clinical trials. Some of these methods may be harmful, or have life-threatening side effects. But the biggest danger in most cases is that you may lose the chance to be helped by standard medical treatment. Delays or interruptions in your medical treatments may give the cancer more time to grow and make it less likely that treatment will help.

Finding out more

It is easy to see why people with cancer think about alternative methods. You want to do all you can to fight the cancer, and the idea of a treatment with few or no side effects sounds great. Sometimes medical treatments like chemotherapy can be hard to take, or they may no longer be working. But the truth is that most of these alternative methods have not been tested and proven to work in treating cancer.

As you think about your options, here are 3 important steps you can take:

  • Look for “red flags” that suggest fraud. Does the method promise to cure all or most cancers? Are you told not to have regular medical treatments? Is the treatment a “secret” that requires you to visit certain providers or travel to another country?
  • Talk to your doctor or nurse about any method you are thinking of using.
  • Contact us at 1-800-227-2345 to learn more about complementary and alternative methods in general and to find out about the specific methods you are looking at.

The choice is yours

Decisions about how to treat or manage your cancer are always yours to make. If you want to use a non-standard treatment, learn all you can about the method and talk to your doctor about it. With good information and the support of your health care team, you may be able to safely use the methods that can help you while avoiding those that could be harmful.

 

Treating specific bone cancers

For information on treating Ewing sarcoma and osteosarcoma please see our documents about those cancers.

Chondrosarcomas

After a biopsy, surgery is done to remove the tumor. Again, it is important that the biopsy be done by the same surgeon who will remove the tumor. For a low-grade chondrosarcoma in an arm or leg, curettage with cryotherapy is an option. (Details about curettage can be found in the “Surgery for bone cancer” section) If the tumor is high-grade, limb-sparing surgery will be done if possible. Sometimes amputation is needed to remove all of the cancer. If the chondrosarcoma has spread to the lung, the lung tumors may be removed if there are only a few.

If the tumor is in a place where it can’t be removed (for example, the skull) it might sometimes be treated with curettage and cryosurgery (a treatment that uses freezing to kill cancer cells) or with high-dose radiation therapy. Proton-beam radiation works well for these tumors.

Some of the special types of chondrosarcoma are treated with chemotherapy (chemo).

Malignant fibrous histiocytomas (MFH)

MFH is treated the same way as osteosarcoma (see our document Osteosarcoma for more details). The usual treatment plan starts with chemo. This shrinks the tumor and makes it easier to remove. Next, surgery may be done to take out the tumor and nearby bone. After that, the bone may be rebuilt with a bone graft or metal rod. Amputation is rarely needed. In some cases, chemo is given after surgery.

Fibrosarcomas

Surgery is the main treatment for this kind of bone cancer. If all of the tumor cannot be removed, radiation treatment may be used instead of or along with surgery. Radiation is also used if the cancer comes back after surgery.

Giant cell tumors of bone

These tumors are most often treated with surgery. The extent of surgery can vary, and depends on where the tumor is found and how big it is. One option is to remove the part of the bone affected by the tumor and replace it with a bone graft or prosthesis (such as a metal rod). Another option is curettage, sometimes followed by using extreme hot or cold temperatures to kill any remaining cancer cells. (More about curettage can be found in the “Surgery for bone cancer” section.) Radiation is not often used to treat giant cell tumors because if the tumor is not killed completely it may increase the chance that it comes back as a cancer (in the malignant form). Amputation is rarely needed to treat a giant cell tumor.

If there are only a few metastatic tumors in the lungs, it may be possible to remove them with surgery. Metastases can also be treated with radiation.

Chordomas

This tumor is most often found in the base of the skull and bones of the spine. Removing all of the cancer is best, but it might not be possible. If some of the tumor is left after surgery, radiation may be used, but it must be aimed carefully. Long-term follow-up is important because these tumors can come back, even 10 or more years after treatment.

The targeted therapy drug imatinib (Gleevec) may be used if a chordoma has spread widely.

 

What are some questions I can ask my doctor about bone cancer?

As you cope with cancer and cancer treatment, we encourage you to have honest, open talks with your doctor. Feel free to ask any question that’s on your mind, no matter how small it might seem. Here are some questions you might want to ask. Be sure to add your own questions as you think of them. Nurses, social workers, and other members of the treatment team may also be able to answer many of your questions.

  • Would you please write down the exact type of cancer I have?
  • Has the cancer spread beyond the bone where it started?
  • What is the stage of my cancer and what does that mean in my case?
  • What treatment choices do I have?
  • What do you suggest and why?
  • What is the goal of this treatment?
  • What are the risks or side effects that I should expect?
  • What are the chances of the cancer coming back after treatment?
  • What should I do to be ready for treatment?
  • Based on what you’ve learned about my cancer, how long do you think I’ll survive?
  • How long might it take me to recover?
  • What kind of rehabilitation should I expect?

 

Moving on after treatment for bone cancer

For some people with bone cancer, treatment may remove or destroy the cancer. Completing treatment can be both stressful and exciting. You may be relieved to finish treatment, but find it hard not to worry about cancer coming back. (When cancer comes back after treatment, it is called recurrence.) This is a very common concern in people who have had cancer.

It may take a while before your fears lessen. But it may help to know that many cancer survivors have learned to live with this uncertainty and are living full lives. Our document, Living With Uncertainty: The Fear of Cancer Recurrence gives more details about this.

For other people, the cancer may never go away completely. These people may get regular treatments with chemotherapy (chemo), radiation, or other treatments to try to help keep the cancer in check. Learning to live with cancer that does not go away can be very stressful. It has its own type of uncertainty. Our document, When Cancer Doesn’t Go Away, talks more about this.

Follow-up care

After your treatment is over, ongoing follow-up is very important. During these visits, your doctors will ask about any symptoms you might have and may use exams and lab tests or x-rays and scans to look for signs of cancer or treatment side effects.

Also keep in mind that after bone surgery, rehab and physical therapy will be important to help you regain as much of your mobility and independence as possible.

Almost any cancer treatment can have side effects. Some may last for a few weeks or months, but others can be permanent. Please tell your cancer care team about any symptoms or side effects that bother you so they can help you manage them. Use this time to ask your health care team questions and discuss any concerns you might have.

It is also important to keep health insurance. While you hope your cancer won’t come back, it could happen. If it does, you don’t want to have to worry about paying for treatment. Should your cancer come back, our document When Your Cancer Comes Back: Cancer Recurrence helps you manage and cope with this phase of your treatment.

Seeing a new doctor

At some point after your cancer is found and treated, you may find yourself in the office of a new doctor who doesn’t know about your cancer. It is important that you be able to give your new doctor the exact details of your diagnosis and treatment. Gathering these details soon after treatment may be easier than trying to get them at some point in the future. Make sure you have this information handy and always keep copies for yourself:

  • A copy of your pathology report from any biopsy or surgery
  • If you had surgery, a copy of your operative report
  • If you were in the hospital, a copy of the discharge summary that the doctor wrote when you were sent home from the hospital
  • If you had radiation treatment, a summary of the type and dose of radiation and when and where it was given
  • If you had chemo or targeted therapies, a list of your drugs, drug doses, and when you took them
  • A copy of your x-rays and other imaging studies (these can be put on a CD or DVD)

 

Lifestyle changes after treatment for bone cancer

You can’t change the fact that you have had cancer. What you can change is how you live the rest of your life – making choices to help you stay healthy and feel as well as you can. This can be a time to look at your life in new ways. Maybe you are thinking about how to improve your health over the long term. Some people even start during cancer treatment.

Make healthier choices

For many people, finding out they have cancer helps them focus on their health in ways they may not have thought much about in the past. Are there things you could do that might make you healthier? Maybe you could try to eat better or get more exercise. Maybe you could cut down on the alcohol, or give up tobacco. Even things like keeping your stress level under control may help. Now is a good time to think about making changes that can have positive effects for the rest of your life. You will feel better and you will also be healthier.

You can start by working on those things that worry you most. Get help with those that are harder for you. For instance, if you are thinking about quitting smoking and need help, call the American Cancer Society for information and support.

Eating better

Eating right can be hard for anyone, but it can get even tougher during and after cancer treatment. Treatment may change your sense of taste. Nausea can be a problem. You may not feel like eating and lose weight when you don’t want to. Or you may have gained weight that you can’t seem to lose. All of these things can be very frustrating.

If treatment caused weight changes or eating or taste problems, do the best you can and keep in mind that these problems usually get better over time. You may find it helps to eat small portions every 2 to 3 hours until you feel better. You may also want to ask your cancer team about seeing a dietitian, an expert in nutrition who can give you ideas on how to deal with these treatment side effects.

One of the best things you can do after cancer treatment is put healthy eating habits into place. You may be surprised at the long-term benefits of some simple changes, like eating more healthy foods. Getting to and staying at a healthy weight, eating a healthy diet, and limiting your alcohol intake may lower your risk for a number of types of cancer, as well as having many other health benefits.

Rest, fatigue and exercise

Feeling tired (fatigue) is a very common problem during and after cancer treatment. This is not a normal type of tiredness but a “bone-weary” exhaustion that doesn’t get better with rest. For some people, fatigue lasts a long time after treatment and can keep them from staying active. But exercise can actually help reduce fatigue and the sense of depression that sometimes comes with feeling so tired.

If you are very tired, though, you will need to balance activity with rest. It is OK to rest when you need to. To learn more about fatigue, please see our documents, Fatigue in People With Cancer and Anemia in People With Cancer.

If you were very ill or weren’t able to do much during treatment, it is normal that your fitness, staying power, and muscle strength declined. You need to find an exercise plan that fits your own needs. Talk with your health care team before starting. Get their input on your exercise plans. Then try to get an exercise buddy so that you’re not doing it alone.

Exercise can improve your physical and emotional health.

  • It improves your cardiovascular (heart and circulation) fitness.
  • It makes your muscles stronger.
  • It reduces fatigue.
  • It can help lower anxiety and depression.
  • It can help make you feel happier.
  • It helps you feel better about yourself.

Long term, we know that getting regular physical activity plays a role in helping to lower the risk of some cancers, as well as having other health benefits.

 

How does having bone cancer affect your emotional health?

Once your treatment ends, you may be surprised by the flood of emotions you go through. This happens to a lot of people. You may find that you think about the effect of your cancer on things like your family, friends, and career. Money may be a concern as the medical bills pile up. Or you may begin to think about the changes that cancer has brought to your relationship with your spouse or partner. Unexpected issues may also cause concern − for instance, as you get better and need fewer doctor visits, you will see your health care team less often. This can be hard for some people.

This is a good time to look for emotional and social support. You need people you can turn to. Support can come in many forms: family, friends, cancer support groups, church or spiritual groups, online support communities, or private counselors.

The cancer journey can feel very lonely. You don’t need to go it alone. Your friends and family may feel shut out if you decide not include them. Let them in − and let in anyone else who you feel may help. If you aren’t sure who can help, call your American Cancer Society at 1-800-227-2345 and we can put you in touch with a group or resource that may work for you.

You can’t change the fact that you have had cancer. What you can change is how you live the rest of your life − making healthy choices and helping your body and mind feel well.

 

If treatment for bone cancer stops working

When a person has had many different treatments and the cancer has not been cured, over time the cancer tends to resist all treatment. At this time you may have to weigh the possible benefits of a new treatment against the downsides, like treatment side effects and clinic visits.

This is likely to be the hardest time in your battle with cancer − when you have tried everything within reason and it’s just not working anymore. Your doctor may offer you new treatment, but you will need to talk about whether the treatment is likely to improve your health or change your outlook for survival.

No matter what you decide to do, it is important for you to feel as good as possible. Make sure you are asking for and getting treatment for pain, nausea, or any other problems you may have. This type of treatment is called palliative care. It helps relieve symptoms but is not meant to cure the cancer.

At some point you may want to think about hospice care. Most of the time, it is given at home. Your cancer may be causing symptoms or problems that need to be treated. The focus of hospice is on your comfort. You should know that having hospice care doesn’t mean you can’t have treatment for the problems caused by your cancer or other health issues. It just means that the purpose of your care is to help you live life as fully as you can and to feel as well as you can. You can learn more about this in our document Hospice Care.

Staying hopeful is important, too. Your hope for a cure may not be as bright, but there is still hope for good times with family and friends − times that are filled with happiness and meaning. Pausing at this time in your cancer treatment gives you a chance to focus on the most important things in your life. Now is the time to do some things you’ve always wanted to do and to stop doing the things you no longer want to do. Though the cancer may be beyond your control, there are still choices you can make.

 

What`s new in bone cancer research?

Research on bone cancer is now being done at many places across the nation. Several clinical trials are going on that focus on bone cancer.

Chemotherapy

Some clinical trials are looking into ways to combine surgery, radiation therapy, and chemotherapy (chemo). Others are testing new chemo drugs.

Targeted therapy

Targeted therapy drugs work differently from standard chemo. These drugs target certain genes and proteins in cancer cells. Doctors are looking at whether adding targeted therapy drugs to regular chemo will help it work better.

The drug denosumab is used to treat osteoporosis and cancer that has spread to bone. A recent study showed that it may work well in treating giant cell tumors of bone that have spread or that cannot be removed with surgery. Studies of other targeted drugs are going on right now.

Radiation

Some studies are looking at the best ways to give radiation to treat bone cancers. For instance, studies are being done to compare proton beam radiation with carbon ion radiation in treating chordomas and chondrosarcomas of the skull base.

Genetics

Along with clinical trials, researchers are making progress in learning about the causes of bone cancers. It is hoped that more information about the DNA changes that cause bone cancer will lead to treatments aimed at these changes.

 

More information about bone cancer

From your American Cancer Society

The following information may also be helpful to you. These materials may be ordered from our toll-free number, 1-800-227-2345.

Bone Cancer Detailed Guide (also in Spanish)

After Diagnosis: A Guide for Patients and Families (also in Spanish)

Caring for the Patient With Cancer at Home (also in Spanish)

Ewing Family of Tumors

Osteosarcoma

Pain Control: A Guide for People With Cancer and Their Families (also in Spanish)

Understanding Chemotherapy: A Guide for Patients and Families (also in Spanish)

Understanding Radiation Therapy (also in Spanish)

When Cancer Doesn’t Go Away

When Your Cancer Comes Back: Cancer Recurrence

Your American Cancer Society also has books that you might find helpful. Call us at 1-800-227-2345 or visit our bookstore online at cancer.org/bookstore to find out about costs or to place an order.

National organizations and Web sites*

Along with the American Cancer Society, other sources of information and support include:

National Cancer Institute
Toll-free number: 1-800-4-CANCER (1-800-422-6237)
Web site: www.cancer.gov

*Inclusion on this list does not imply endorsement by the American Cancer Society.

No matter who you are, we can help. Contact us anytime, day or night, for information and support. Call us at 1-800-227-2345 or visit www.cancer.org.