Bone sarcoma is a cancer that starts in the bone. Sometimes a bone sarcoma is called a primary bone cancer. It is uncommon, with an average of about 670 diagnoses in the UK each year.
Bone sarcoma can affect any bone in the body but the most common area it affects is the legs.
The four most common types of bone sarcoma are:
Chondrosarcoma develops in the cartilage cells. It mostly affects adults above the age of 40 and the most common sites are the upper arm, pelvis and thigh bone.
Osteosarcoma is mostly diagnosed in teenagers and young people; however, it can also affect older adults. It mostly affects the knee, thigh bone, shin bone or upper arm. They make up about 30% of all bone sarcoma diagnoses.
It most commonly affects teenagers and young adults with the pelvis, thigh bone and shin bone being the most commonly-affected areas. In rare cases, Ewing’s sarcoma can develop in the soft tissue around the bone, this is called soft tissue sarcoma. It is sometimes called extraosseous sarcoma – extra means outside, osseous means bone. Ewing’s sarcoma can also start in subcutaneous tissue, this means beneath the skin.
Chordoma makes up only 6% of all bone sarcoma diagnoses and most commonly affects adults in their 40’s and 50’s. The majority of chordomas (50%) arise in the sacrum (the bottom of the spine); however, 30% arise at the base of the skull and the remaining 20% arise in other locations in the spine.
Signs and symptoms
Symptoms of bone sarcoma can vary depending on the size and location of your tumour.
- Bone pain, particularly occuring at night
- A mass or swelling
- Restricted movement in a joint
Symptoms can sometimes be confused with more common problems such as a sports injury or in children and young people, growing pains.
Types of diagnostic scans
Uses x-radiation to take images of dense tissuses inside the body such as bones or tumours.
The Computer Tomography (CT) scan takes a number of x-rays to make a 3D image of an affected area.
The Positron Emission Tomography (PET) scan shows up changes in tissues that use glucose as their main source of energy – for example, the brain or heart muscle. It involves an injection of a very small amount of a radioactive drug into the body. The drug travels to places where glucose is used for energy and shows up cancers because they use glucose in a different way from normal tissue.
Magnetic Resonance Imaging (MRI) uses magnets to create an image of the tissues of the body.
Uses radioactive chemicals called radionuclides which are injected, swallowed or breathed into the body, to take images of bones.
Examination of a tissue sample by a pathologist under a microscope to identify disease.
Laboratory analysis of a blood sample.
Understanding the diagnosis
A diagnosis of bone sarcoma usually starts with a visit to your GP who will refer you for an x-ray. If a bone sarcoma is suspected following the results of the x-ray your GP will refer you to a specialist bone sarcoma centre.
A specialist doctor will diagnose sarcoma through a series of tests. These may include:
- Physical examination
- A scan – taking pictures of the inside of the body using ultrasound, x-ray, CT, EUS, PET or MRI
- A biopsy – taking and testing a tissue sample
A diagnosis of bone sarcoma should be confirmed by a specialist sarcoma pathologist who will identify the type of sarcoma and the stage and grade of the tumour. Identifying the stage and grade of a cancer means your doctor can advise on the best course of treatment for you. It also describes the cancer in a common language which is useful when your doctor is discussing your case with other doctors or health professionals. The stage of a cancer is measured by how much it has grown or spread which can be seen on the results of your tests and scans. The results from a biopsy can tell the grade of the cancer.
Low-grade means that the cancer cells are slow-growing and look quite similar to normal cells. They are less aggressive and less likely to spread.
High-grade means the cancer cells are fast growing and look very abnormal. They are more aggressive and more likely to spread.
The cancer is low-grade and has not grown outside the bone. Stage 1 is further divided into:
- 1a The cancer is low-grade and is still completely within the bone it started in.
- 1b The cancer is low-grade and has grown through the bone wall.
The cancer is high-grade and has spread beyond the bone. Stage 2 is further divided into:
- 2a The cancer is high-grade and is still completely in the bone it started in.
- 2b The cancer is high-grade and has grown outside the bone wall.
The cancer may be any grade and has spread to another part of the body, such as the lungs.
The National Institute for Health and Care Excellence (NICE) recommends that anyone with sarcoma should be referred to a specialist sarcoma team for diagnosis and treatment. There are five national bone sarcoma centres in England and Wales where all bone sarcoma patients should be treated. These are located in Newcastle, Manchester & Oswestry, Birmingham, Oxford and London.
People in Northern Ireland will be treated in Belfast. People in Scotland will be treated in Glasgow, Edinburgh, Aberdeen, Dundee and Inverness. This may mean you will have to travel some distance for your treatment. Some treatments like radiotherapy or chemotherapy may be given in your local hospital under the supervision of the specialist sarcoma centre.
Your case will be managed by a team of experts from a wide range of health care professions called a multidisciplinary team (MDT). Your MDT will include your key worker or sarcoma clinical nurse specialist, surgeon and other healthcare professionals involved in your care.
Types of treatment
The treatment you will receive depends on the type of bone sarcoma you have and which part of the body is affected. Your MDT will discuss your case and your doctor or nurse will talk you through your options so you are included in deciding what treatment is best for you.
Click through for the treatment options for each of the following kinds of bone sarcoma.
After treatment for sarcoma you may benefit from rehabilitation services. They can offer specialist advice and treatment that aids your recovery and helps you to deal with the effects of cancer and its treatment.
Rehabilitation services include:
Occupational therapists assess your ability to carry out daily living activities such as washing, dressing and meal preparation. They can also help you return to normal daily activities such as work, parenting, and leisure activities.
Physiotherapists help you return to as active a lifestyle as possible. They will help you strengthen your muscles and ensure your joints regain as much mobility as they can.
This may involve designing a special exercise programme, providing advice about managing tiredness or teaching you to use equipment to help you walk or to support your joints.
Dieticians assess whether you need any special diet and can advise on the most appropriate nutritional support to help you before, during and after treatment.
Orthotics and prosthetics
After surgery for bone sarcoma you may need aids to help you. For example, an orthotist can help by providing you with supports or splints. If you have had an amputation, a prosthetist can assess and fit an artificial limb.
Rehabilitation usually starts after treatment. However, with bone sarcoma you may find that it helps to start rehabilitation earlier. Ask your sarcoma clinical nurse specialist or doctor to refer you to the rehabilitation team. You may find that you are not automatically offered a referral to rehabilitation services by your medical team, so it is important to ask at the earliest opportunity for a referral.
A recurrence of cancer may appear in other parts of the body. This is called a metastasis or secondary cancer. In people with bone sarcoma, these secondary cancers may appear in the lungs. A chest x-ray is taken at follow-up appointments to look for secondary cancers in the lung.
Treatment for secondary cancers may involve surgery, radiotherapy or chemotherapy as appropriate; your treatment will be assessed on an individual basis.