Bone cancer: symptoms, types, tests, treatment and survival

The NHS says the symptoms of primary bone cancer depend on the type and size of the cancer and where it is. Cancer Research UK says it is much more likely that some other problem is causing your symptoms, but it is important to get them checked by a GP.

Cancer Research UK adds that you might have pain or tenderness most of the time, even when you are resting, that the pain is often worse in bed at night, and that pain can be felt in a different part of the body from where the tumour is (referred pain).

• Bone pain or tenderness: it may be constant or come and go, and may be worse at night.

• A lump or swelling, although it may not always be easy to see or feel.

• Problems moving around: if the cancer is close to a joint it may be difficult to move the joint and you may walk with a limp.

• Less commonly: feeling very tired even after a good night's sleep.

• Less commonly: a high temperature (fever), perhaps with a lot of sweating.

• Less commonly: losing weight without trying to.

• Very rarely: breaking a bone, called a pathological fracture, because the bone is weakened.

The NHS says to see a GP if you have pain or tenderness in a bone, particularly if it is worse at night, if you notice a change that is not normal for you such as a lump or swelling or unexpected weight loss, or if pain in your bones or joints is making it difficult to move around.

The GP will look at the painful part of your body and may feel your lymph nodes. Tell the GP if you or a family member have had cancer. If they think you need tests you may be referred to a specialist, which may be urgent but does not definitely mean you have cancer.

The NHS says primary bone cancer can often be treated. The treatment depends on the type of bone cancer, where it is, your general health and your treatment preferences. Surgery and chemotherapy are the main treatments, and radiotherapy or targeted medicines are used for some types. A specialist team will create a treatment plan with you and discuss the chances of the cancer coming back.

Surgery depends on the size and position of the cancer, whether it has spread and how well chemotherapy has worked. You will need physiotherapy to help you regain mobility and regular follow-up appointments.

Cancer Research UK says primary bone cancer starts in the cells of the bones, and doctors sometimes call it bone sarcoma. Sarcomas are cancers that start in connective tissue, which includes bones but also muscles, tendons, blood vessels and fatty tissues. Primary bone cancer is different from secondary or metastatic bone cancer, which spreads to the bones from elsewhere in the body, and from myeloma, which develops from plasma cells in the bone marrow and is treated differently.

Bone cancer cells can break away and travel to other organs, usually the lungs or other bones.

Cancer Research UK says that, unusually for cancer, bone sarcoma is more common in older children and teenagers and then becomes more common again in older people. The NHS says osteosarcoma often affects children and teenagers aged 10 to 19 and Ewing sarcoma is more common in children and teenagers, though it can also affect adults.

Bone pain in a growing child is much more often due to other causes. The NHS advice to see a GP applies: see a GP if there is bone pain or tenderness, particularly if it is worse at night, a lump or swelling, or problems moving around.

The NHS says it is not known what causes most primary bone cancers. You are more likely to get bone cancer if you have had radiotherapy or chemotherapy for cancer in the past, particularly during childhood, if you have an inherited condition such as hereditary retinoblastoma, Li-Fraumeni syndrome or Werner syndrome, or if you have another bone condition such as Paget's disease of bone or a non-cancerous bone tumour.

If a GP thinks you could have bone cancer, the NHS says they will refer you to a bone specialist (an orthopaedic doctor) for tests. These may include an X-ray, a scan such as a CT scan or MRI scan, a bone biopsy in which a surgeon removes a small sample of bone to be checked for cancer, blood tests, and sometimes a bone marrow biopsy.

The NHS says it should take about 2 weeks for the biopsy results to come back, but sometimes it might be longer. If cancer is found, the tests show how big it is and how far it has spread (the stage) and how abnormal the cells look under a microscope (the grade), which help the specialist decide what treatment you need.

Cancer Research UK says there are no UK-wide statistics for bone sarcoma survival by stage. For people diagnosed in England between 2014 and 2016, across all types and stages, around 85 in 100 survive their cancer for 1 year or more and more than 65 in 100 survive for 5 years or more. These figures cover everybody diagnosed and do not take into account the stage, grade, age or how well treatment works.

The NHS says you will have a team of specialists, including a clinical nurse specialist who is your main point of contact during and after treatment, and regular check-ups during and after treatment. If you have any symptoms or side effects you are worried about you do not need to wait for your next check-up. Sarcoma UK runs a support line for people affected by sarcoma, as listed on the NHS page.

Because primary bone cancer is rare, care is usually coordinated by a specialist bone sarcoma team within the NHS, with your local hospital involved in follow-up. Private consultations and scans are available for assessment of a worrying lump or bone pain, but a suspected bone cancer should still be referred into a specialist NHS team for diagnosis and treatment planning, and biopsy is best planned by the team that will treat you.