Bone cancer is a rare but serious condition that can affect people of all ages, though it is most common in children and teenagers. Primary bone cancer — cancer that starts directly in the bone — is quite different from cancer that spreads to the bone from somewhere else in the body. In this article, we explain the types, symptoms, causes, and treatment options for bone cancer, so you can better understand what to watch for and when to speak with your family doctor.
What Is Bone Cancer?
Primary bone cancer starts in the cells of the bone itself. It is relatively rare, with only a small number of new cases diagnosed in Canada each year. This is different from secondary bone cancer, where cancer begins in another organ and then spreads, or metastasises, to the bones.
It is also important to note that bone cancer is not the same as cancers of the bone marrow. Conditions like multiple myeloma and leukaemia begin in the soft tissue inside bones, but they are not classified as bone cancer. According to Health Canada, understanding the difference between cancer types helps guide proper diagnosis and treatment.
The Most Common Types of Primary Bone Cancer
There are three main types of primary bone cancer. Each type behaves differently and affects different age groups.
Osteosarcoma: This type starts in growing bone tissue. It is most common in children, teenagers, and young adults — particularly those between 10 and 20 years old.
Ewing’s sarcoma: This type originates in the immature tissue of the bone marrow. Like osteosarcoma, it most often affects young people under the age of 20.
Chondrosarcoma: This type forms in cartilage. It is more common in adults over the age of 50.
Treatment for bone cancer depends on the type, location, size, and stage of the tumour. Therefore, getting an accurate diagnosis early makes a real difference in outcomes.
Bone Cancer Symptoms to Watch For
The most common symptom of bone cancer is pain. The pain may start gradually and worsen over time, especially at night or during physical activity. However, bone pain alone does not confirm cancer — it is most often caused by injury or arthritis.
Bone cancer most frequently develops in the long bones of the arms and legs. In addition to pain, other possible symptoms include:
Swelling or tenderness around a joint or along a bone
Weakened bones that may lead to fractures with little or no trauma
Unexplained fatigue or a general feeling of being unwell
Fever without an obvious cause
Unintentional weight loss
Anaemia, or low red blood cell counts
Many of these symptoms can also be caused by far less serious conditions. For example, growing pains in teenagers can mimic early bone cancer symptoms. However, if symptoms are persistent or unexplained, it is always worth getting checked out.
What Causes Bone Cancer?
In most cases, the exact cause of primary bone cancer is not known. However, researchers have identified certain conditions and risk factors that may increase the chance of developing it.
Medical Conditions Linked to Higher Risk
Some people with certain medical conditions face a higher risk of developing bone cancer. These include:
Paget’s disease of the bone: This condition causes abnormal bone cell development in adults. It is associated with a higher risk of osteosarcoma.
Li-Fraumeni syndrome: This hereditary condition raises the risk for several cancers, including osteosarcoma, breast cancer, and brain cancer.
Rothmund-Thomson syndrome: This rare genetic disorder is linked to short stature, skeletal problems, skin rashes, and an increased risk of bone cancer.
Hereditary retinoblastoma: Children with this rare form of eye cancer have a higher chance of later developing osteosarcoma.
Multiple hereditary exostoses: This inherited condition causes cartilage-capped growths on bones and raises the risk of chondrosarcoma.
The Role of Radiation Exposure
Radiation is another known risk factor. Everyday diagnostic X-rays at low doses do not cause bone cancer. However, high-dose radiation — such as radiation therapy used to treat other cancers — can increase the risk, especially in younger patients.
Fortunately, modern radiation therapy has become much more precise. Doctors can now target tumours more accurately and control dosage more carefully, which helps reduce this risk significantly. As a result, radiation-related bone cancer is becoming less common over time. You can read more about cancer risks and radiation on the Mayo Clinic’s bone cancer overview.
How Is Bone Cancer Diagnosed?
If your doctor suspects bone cancer, they will begin with a thorough medical history and a physical exam. From there, several tests help confirm the diagnosis. In Canada, your family doctor will typically refer you to a specialist, who will coordinate further testing.
Imaging Tests
Imaging is usually the first step. These tests allow doctors to see the size and location of a suspected tumour without surgery.
X-ray: Often the first imaging tool used. It can reveal abnormal changes in bone structure.
CT scan (computed tomography): Provides detailed cross-sectional images of the body.
MRI (magnetic resonance imaging): Gives detailed images of soft tissue and bone. It is especially useful for planning surgery.
Ultrasound: Helps assess soft tissue changes near the bone.
Bone scan: A small amount of radioactive material is injected into the body. A special camera then detects this material and creates images of the skeleton. This helps identify areas of abnormal bone activity.
Biopsy: Confirming the Diagnosis
The only sure way to know if a tumour is cancerous is through a biopsy — a procedure where a small sample of tissue is removed and examined under a microscope. There are two main types:
Needle biopsy: A doctor uses a fine needle to remove a small amount of tissue. A core needle biopsy uses a slightly larger needle to collect a small, solid piece of tissue.
Surgical biopsy: A surgeon makes an incision in the skin to remove part or all of the tumour. Larger or deeper tumours may require general anaesthetic for this procedure.
It is important that an experienced sarcoma specialist performs the biopsy. The way the biopsy is done can affect future treatment options, so this step should not be rushed.
Bone Cancer Treatment Options
Treating bone cancer requires a team of specialists working together. This team typically includes an oncologist, an orthopaedic surgeon, a radiation oncologist, and a physiotherapist. The best treatment plan depends on the type, location, and stage of the bone cancer.
Common treatment approaches include:
Surgery: The main treatment for most bone cancers. Surgeons aim to remove the entire tumour while preserving as much of the limb as possible. In some cases, amputation may still be necessary.
Chemotherapy: Uses drugs to kill cancer cells. It is often used before surgery to shrink a tumour or after surgery to destroy any remaining cancer cells.
Radiation therapy: Uses high-energy beams to target and destroy cancer cells. It is commonly used for Ewing’s sarcoma and in cases where surgery is not possible.
For more detailed information about bone cancer treatment, the Healthline guide to bone cancer offers a helpful overview of what patients can expect at each stage of care.
When to See a Doctor
You should speak with your family doctor if you have unexplained bone pain that does not go away, or if you notice swelling around a bone or joint that has no clear cause. Do not wait to see if symptoms pass on their own.
If you do not have a family doctor, visit a walk-in clinic. Most provincial health plans in Canada cover initial assessments for unexplained pain and referrals to specialists when needed. Early detection gives you the best chance at effective treatment.
Remember: bone pain is most often caused by injury or arthritis, and most bone tumours are benign (non-cancerous). However, only a medical professional can determine that through proper testing. Always consult your doctor if you are concerned about any new or changing symptoms.
Frequently Asked Questions About Bone Cancer
What are the early warning signs of bone cancer?
The earliest sign of bone cancer is often a dull, aching pain in a bone or joint that gradually gets worse. You may also notice swelling or a lump near the affected area. These symptoms can have many causes, so it is important to see your doctor if they do not improve within a few weeks.
Is bone cancer curable?
Many cases of bone cancer, especially when caught early, can be treated successfully with surgery, chemotherapy, or radiation therapy. The outlook depends on the type and stage of bone cancer at the time of diagnosis. Your oncology team will discuss realistic goals and treatment options with you.
Who is most at risk of developing bone cancer?
Bone cancer is most common in children and teenagers, particularly osteosarcoma and Ewing’s sarcoma, which peak between the ages of 10 and 20. Chondrosarcoma is more common in adults over 50. Certain inherited conditions and previous high-dose radiation therapy also increase risk.
How is bone cancer different from cancer that spreads to the bones?
Primary bone cancer starts directly in the bone cells. Secondary, or metastatic, bone cancer starts in another organ — such as the prostate, breast, or lung — and then spreads to the bones. Even if cancer reaches the bones, it is still named after the organ where it began, and it is treated differently than primary bone cancer.
Does a bone scan always detect bone cancer?
A bone scan can identify areas of abnormal bone activity, but it cannot confirm bone cancer on its own. Abnormal results on a bone scan may be caused by infection, fractures, or arthritis. A biopsy is the only definitive way to diagnose bone cancer.
Can bone cancer be covered under provincial health plans in Canada?
Yes. Diagnosis and treatment for bone cancer — including specialist visits, imaging, surgery, chemotherapy, and radiation therapy — are generally covered under provincial and territorial health insurance plans across Canada. Contact your provincial health authority or speak with your family doctor to understand your specific coverage.
Key Takeaways
Bone cancer that starts in the bone itself is rare and is most common in children and young adults.
The three main types are osteosarcoma, Ewing’s sarcoma, and chondrosarcoma, each affecting different age groups.
Persistent or unexplained bone pain, swelling, and fatigue are the key symptoms to watch for.
A biopsy is the only definitive way to diagnose bone cancer — imaging alone is not enough.
Treatment usually involves a team of specialists and may include surgery, chemotherapy, and radiation therapy.
Most provincial health plans in Canada cover bone cancer diagnosis and treatment.
If you are concerned about any symptoms, speak with your family doctor or visit a walk-in clinic as soon as possible.
