Bone cancer is either primary, meaning it starts in the bone itself, or secondary, meaning a cancer from somewhere else (often breast, prostate or lung) has spread to the bone. Primary bone cancer is rare and is treated mainly with surgery, often combined with chemotherapy or radiotherapy, and many people, especially when it’s found before it spreads, are cured.
Here’s how the main types differ, which symptoms need checking, how doctors confirm it, and what treatment usually involves.
Primary or secondary: why the difference matters
The US National Cancer Institute says primary bone cancer makes up much less than 1% of all new cancers. Most tumours that start in bone are actually benign (not cancer).
In adults, secondary bone cancer is much more common than primary bone cancer. It’s still named after where it began. So breast cancer that has spread to the spine is treated as breast cancer, not as bone cancer. According to Cancer Research UK, the cancers that most often spread to bone are prostate, breast, lung, kidney and thyroid cancer, plus myeloma.
This matters for you because the treatment, the specialist and the outlook are completely different. If someone tells you “the cancer is in the bones”, ask: did it start there, or did it spread there?
Main types of primary bone cancer
| Type | Starts in | Who usually gets it | Common sites |
|---|---|---|---|
| Osteosarcoma | Bone-forming cells | Children, teenagers and young adults; risk peaks at 10 to 19 | Leg near the knee, arm near the shoulder |
| Ewing sarcoma | Usually bone (sometimes soft tissue) | Mostly under 19; more common in boys | Pelvis, legs, ribs |
| Chondrosarcoma | Cartilage | Mainly adults over 40 | Pelvis, upper leg, shoulder |
| Chordoma | Spinal bones | Usually older adults; about twice as common in men | Base of the spine (sacrum), base of the skull |
Source: NCI bone cancer fact sheet. Osteosarcoma and Ewing sarcoma tend to grow quickly and can spread to the lungs. Chondrosarcoma usually grows slowly.
Myeloma, a blood cancer that grows in the bone marrow, can also damage bones, but it isn’t classed as a primary bone cancer and is treated differently.
Symptoms of bone cancer
The NHS lists these main symptoms:
- bone pain or tenderness that may be constant or come and go, and is often worse at night
- a lump or swelling, which isn’t always easy to see or feel
- difficulty moving, especially if the tumour is near a joint, sometimes with a limp
Less common symptoms include tiredness that doesn’t go away after a good night’s sleep, fever with sweating, weight loss you didn’t intend, and, rarely, a bone that breaks after a minor knock.
Because osteosarcoma often appears around the knee in active teenagers, the pain is easy to blame on sport or a fall. A useful rule: an injury should steadily get better. Pain that keeps coming back, wakes your child at night, or comes with a swelling that wasn’t there before needs an X-ray, not more balm and rest.
Most bone pain isn’t cancer. Strains, injuries and arthritis are much more common causes, and low vitamin D can cause aches too. If you’re wondering about deficiency, read about signs of low vitamin D and calcium deficiency. But don’t use a supplement to “test” an unexplained pain for weeks; get it examined.
Who is at higher risk?
Doctors don’t know what causes most primary bone cancers. The NHS lists these risk factors:
- age (osteosarcoma often affects 10 to 19-year-olds; chondrosarcoma mainly affects adults aged 30 to 60)
- previous radiotherapy or chemotherapy, particularly in childhood
- some inherited conditions: hereditary retinoblastoma, Li-Fraumeni syndrome and Werner syndrome
- Paget’s disease of bone, or a benign bone tumour
Having one of these doesn’t mean you’ll get bone cancer. It just means new bone pain deserves a lower threshold for checking.
How bone cancer is diagnosed
Diagnosis usually moves in steps:
- Examination and X-ray. An X-ray of the painful area is often the first test.
- Blood tests. Alkaline phosphatase and lactate dehydrogenase may be raised. The NCI notes alkaline phosphatase is less reliable in growing children, whose levels are naturally higher.
- MRI and CT scans show the size of the tumour and nearby tissues. A chest CT checks the lungs, and a bone scan or PET scan looks for spread elsewhere.
- Biopsy. A sample of the tumour is taken with a needle or through a small cut and examined under a microscope. This is the only way to confirm the diagnosis and the exact type.
The NCI recommends that the biopsy be done by an orthopaedic oncologist (a bone tumour surgeon), ideally the surgeon who will do the operation. In India, this usually means going to a regional cancer centre or a large hospital with a dedicated bone and soft tissue tumour team before anyone does a biopsy.
How primary bone cancer is treated
Treatment depends on the type, size, location and whether it has spread. The NCI fact sheet describes these options:
- Surgery is the main treatment. The aim is to remove the whole tumour with a margin of healthy tissue. Limb-sparing surgery, usually followed by reconstructive surgery, often avoids amputation.
- Chemotherapy is used for newly diagnosed osteosarcoma and Ewing sarcoma. It’s not typically used for chondrosarcoma or chordoma.
- Radiotherapy is often used for Ewing sarcoma, and alongside other treatment for the other types, especially when surgery can’t remove everything.
- Cryosurgery (freezing tumour cells with liquid nitrogen) is sometimes used instead of standard surgery.
- Targeted therapy such as denosumab is approved for giant cell tumour of bone that can’t be removed surgically.
Osteosarcoma and Ewing sarcoma can spread to the lungs, so your team will plan follow-up checks after treatment ends. Ask them how often you’ll need scans and what symptoms to report between visits.
What is the outlook?
For osteosarcoma, the American Cancer Society says survival ranges from about 60% to 75% when the cancer hasn’t spread, and 5% to 30% when it has. Overall, about 60% to 70% of people are cured. These are averages; your specialist can tell you what applies to your situation.
What about secondary bone cancer?
When cancer spreads to bone, Cancer Research UK says the aim is usually to control the cancer and relieve symptoms. Depending on the original cancer, treatment may include hormone therapy, chemotherapy, radiotherapy and bone-strengthening drugs called bisphosphonates.
Two complications need fast action. High calcium in the blood (hypercalcaemia) can cause dehydration, confusion, nausea, vomiting, stomach pain and constipation. Spinal cord compression can cause back pain, leg weakness, numbness and loss of bladder or bowel control, and is an emergency.
If you’ve had breast cancer, knowing the symptoms and precautions helps, and any new, persistent bone or back pain should be reported to your cancer team.
When to see a doctor
Book an appointment soon if you or your child has:
- bone pain that lasts more than a couple of weeks, keeps returning, or is worse at night
- a new lump or swelling over a bone
- a limp or stiff joint without a clear injury, or an injury that isn’t improving
- bone pain with fever, night sweats or unexplained weight loss
Go to hospital immediately or call 112 if you have:
- new leg weakness, numbness, or loss of control of your bladder or bowels, especially with back pain
- confusion or repeated vomiting in someone with known cancer
- a bone that breaks after little or no force
Frequently asked questions
Is bone cancer curable?
Often, yes, when primary bone cancer is found before it spreads. Surgery combined with chemotherapy or radiotherapy cures many people. Secondary bone cancer is usually controlled rather than cured.
Does bone cancer show up on an X-ray?
Usually, yes. An X-ray is often the first sign. But a biopsy is needed to confirm cancer and find the type.
Is bone cancer the same as bone marrow cancer?
No. Leukaemia and myeloma start in the bone marrow and are blood cancers. They are treated differently from primary bone cancer.
Will my child need an amputation?
Not necessarily. Limb-sparing surgery is often possible. Your surgeon will explain which option gives the best chance of removing the whole tumour.
Can herbal or home treatment shrink bone cancer?
No. There’s no evidence that any herbal or home remedy treats bone cancer. Delaying surgery and chemotherapy can let a curable cancer spread.
This article is for general information and is not a substitute for advice from a doctor. If you have symptoms or a health condition, please consult a qualified healthcare professional.
