Everyone can have bone cancer, but children and adolescents are more prone to this critical illness. According to the Hong Kong Cancer Registry statistics, bone cancer is one of the five most common cancers among those aged 0-19.
Sometimes, people may be confused or unaware of the early symptoms of bone cancer since the symptoms are pretty similar to osteoarthritis, growing pains, common back pains and soreness. In the 70s, amputation was the primary way to treat bone cancers in the arms or legs. Nowadays, bone cancer treatment incorporates tumour removal surgery and chemotherapy to raise patients’ survival rates and save more of their limbs.
What Is Bone Cancer?
Bone cancer is the most common type of cancer which starts in the cells that make up the bone. The tumour cancers cells are similar to the newly developed bone tissues, but the latter has an organised structure.
Locations of Bone Cancer Tumours
Bone cancer tumours usually start in areas where bones grow rapidly, such as the ends of long bones in the arms and legs.
- Most cases of bone cancer start in areas around the knee, referring to the distal femur and proximal tibia.
- The second most common location is the shoulders, the proximal humerus.
However, malignant tumours can be developed in other bones as well. For the elderly, bone cancer commonly starts in the pelvis bones (hip bones) and lower jaw.
Types of Bone Cancer
Bone cancer can be categorised as primary and secondary. Primary bone cancer is relatively rare in occurrence.
- Primary bone cancer forms directly in the bones or surrounding tissue
- Secondary bone cancer starts from another part of your body and is the result of bone metastasis.
Primary bone cancer can be further divided into the following types：
- Osteosarcoma: It is the most common type of bone cancer prevalent among children and adolescents. The incidence rate of males is slightly higher than that of females.
- Chondrosarcoma: It is the second most common type of bone cancer. Most patients are aged 40 to 60. It starts in the soft tissues at the joints.
- Ewing Sarcoma: It is more common in children and teenagers. The incidence rate of males is slightly higher than that of females.
Causes of Bone Cancer
It is not clear what causes bone cancer, but doctors have found certain factors are associated with an increased risk, including:
- Inherited conditions: Individuals with a family history of bone cancer and other cancers have a higher risk.
- Benign bone tumour: The risk of bone cancer increases if you currently or previously have had multiple tumours in the cartilage, which is the connective tissue in the bone.
- Radiation therapy: Those received radiotherapy exposed to high doses of radiation during radiotherapy may cause cancerous changes in your bone cells at a later stage
- Rare genetic conditions: Individuals with retinoblastoma (rare eye cancer in children that can be hereditary), Paget disease and Li-Fraumeni syndrome are more prone to bone cancer
Symptoms of Bone Cancer
Symptoms of bone cancer are easily overlooked since the symptoms are akin to osteoarthritis, common back pains and soreness. If you experience prolonged pain and observe unreasoned swelling in a particular bone, you should visit your doctor at the earliest advance.
- Pain: Persistent pain and tenderness at knee, pelvis, thigh, calf, upper arm, sternum and shoulder bone that continues at night and when resting.
- Swelling: A lump develops at the affected bone along with the growth of a tumour, which may hinder one’s movement if it is found near a joint.
- Easily broken bone: A symptom of the later stage as the bone tissues become fragile.
- Other symptoms: Fatigue, fever, unintended weight loss (less common symptom)
Bone Cancer Among Children And Adolescents
It can be confusing between growing pains and aches caused by bone cancer since both discomforts are commonly found among children and teenagers. To avoid delayed treatments, you could understand more about the differences between these two types of pain according to foreign research
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Growing Pain in Children |
Pain Caused by Osteosarcoma |
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Persistent pain that continues at night |
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3-5 years old, 8-11 years old |
10-20 years old |
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No swelling |
Swelling and lumps |
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Irregular pain spots |
Pain at a fixed position |
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Muscle and bone aches |
Merely bone ache |
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The pain lessened during exercise |
The pain worsens during exercise |
Stages of Bone Cancer
Stages of bone cancer are determined by the size and spread of a bone tumour.
- Stage IA: The tumour is 8 cm or less without spreading to the nearby lymph nodes.
- Stage IB: The tumour is over 8 cm without spreading to the nearby lymph nodes. It is in more than one place on the same bone.
- Stage IIA: The tumour is 8 cm or less. It has not spread outside the bone (like stage I) but is high grade.
- Stage IIB: The tumour is larger than 8 cm. It has not spread outside the bone (like stage I) but is high grade.
- Stage III: It has not spread outside the bone but is in more than one place on the same bone.
- Stage IVA: It can be any size and spreads outside of the bone it started in. The tumour has spread to the lung but not the nearby lymph nodes.
- Stage IVB: It can be any size and spreads outside of the bone it started in. The tumour has spread to nearby lymph nodes or distant sites other than the lung (or both)
How Is Bone Cancer Diagnosed?
Your doctors may conduct clinical checks at first. He/she may ask about your symptoms and examine the affected area before deciding whether you need to have any further tests, as shown below.
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Tests for Bone Cancer |
Principles |
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Blood Tests |
Test the concentration of alkaline phosphatase (ALK-P) in the blood. Bone cancer patients have a higher concentration of ALK-P in their blood. |
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X-Ray |
Detects the location and size of a tumour. A biopsy is required to determine if the tumour is benign or malignant. |
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Bone Scan |
Detect if tumour metastasis to other bones |
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CT Scan |
Analyse the size and area of a tumour. Compare the affected area with the non-affected area to understand the difference. Chest CT scan is also conducted, as lungs have the highest risk of metastasis. |
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MRI |
Precisely locate the affected areas, including fats, muscles, other organs, blood vessels and nerves. |
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PET Scan |
Locate the tumour to understand if it spreads |
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Biopsy |
A small piece of the tumour is obtained during a biopsy for an examination by a neuropathologist. |
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Treatments of Bone Cancer and the Costs
Your doctor may suggest the following bone cancer treatments according to the sizes and stages of bone tumours.
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Treatments of Bone Cancer |
Principles |
Reference Fees for Treating Bone Cancer (HKD)* |
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Resection Surgery |
It depends on the spread of cancer. For early stages, your doctor may employ local tumour resection. If cancer spreads to adjacent areas, large-scaled resection or even amputation is needed. |
Please consult your doctor for more details. |
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Chemotherapy |
Chemotherapy drugs can be taken orally or injected into a vein to enter the bloodstream and travel throughout the body to destroy cancer cells. |
Application and preparation costs: $2,400 per day; chemotherapy drugs are charged separately at cost. |
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Radiotherapy |
Use high-energy radiation emitted by a treatment machine to kill malignant tumours at specific locations. |
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Currently, targeted therapy drugs are used to prevent the bone metastasis complications of cancer patients. Targeted therapy drugs for bone cancer: zoledronate and denosumab. |
Please consult your doctor for more details. |
*Charges as of 3 May 2021; With reference to the charges of local private hospitals and the Hospital Authority
Bone Cancer Survival Rate
Along with medical advancement, the survival rate of bone cancer has risen in recent years. If diagnosed early with suitable treatments, the five-year survival rate of bone cancer can be as high as over 70%.
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Stages |
Five-Year Survival Rate of Bone Cancer |
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Localised: There is no sign that cancer has spread outside of the bone where it started. |
74% |
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Regional: Cancer has spread outside the bone and into nearby structures, or it has reached nearby lymph nodes. |
66% |
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Distant: Cancer has spread to remote parts of the body, such as to the lungs or bones in other parts of the body. |
27% |
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Overall Survival Rate |
60% |
How to Prevent Bone Cancer?
Since the causes and risk factors are unclear for scientists, there are no concrete ways to prevent bone cancer. Generally, you could stay healthy and lower your risk of cancer by having a balanced diet, exercising regularly, quitting smoking and avoiding excessive alcohol intake.
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