Bone Cancer Symptoms

This article describes the symptoms that might indicate the presence of bone cancer.  There are many different types of bone tumors, some of them being cancer and some benign.  Of those that are cancer they can be divided up into those that grow from the bone directly or those that have spread to the bone from a cancer elsewhere.  The division of these is very complex and beyond the scope of this article.  Fortunately the symptoms that a bone cancer might cause can be very similar between the different types of tumors despite the different origin of the tumor.  Recognition of key “red flag” symptoms” is the purpose of this article.  Early recognition of a potential bone disease will facilitate early investigation and prompt treatment if need be.  The worst scenario would be to ignore a potential cancer until it becomes very troublesome at which point the window for a true cure may have been missed.

A partial list of tumors or cancers of bone includes:

  • Osteosarcoma
  • Chondrosarcoma
  • Ewing sarcoma
  • Angiosarcoma
  • Malignant fibrous histiocytoma
  • Chordoma
  • Liposarcoma
  • Leiomyosarcoma
  • Rabdomyosarcoma
  • Hemangioma
  • Lipoma
  • Metastatic lesion (from multiple possible sites)
  • Many others possible

Bone tumors that arise from the bone itself are rare cancers but are a leading cause of cancer among children and young adults.  While still rare, they account for a significant amount of childhood cancer.

The two most common symptoms that should raise suspicion for bone disease include bone pain and bone tumor or mass.  If the tumor is without symptoms, it may be found during a doctor’s examination.  Another possible symptom might be deformity causing an unusual appearance or difficulty with movement of the limb.  For example, a bone tumor near the knee might cause pain with running due to pressure on thigh muscles or constant friction of them on the tumor.

The pain from a bone tumor might be dull and aching or sharp possibly being associated with a fracture.  If a lump or abnormal contour of a bone is felt it should be investigated for the possibility of cancer.  Many bone tumors have certain characteristic features that can be identified on x-ray and make diagnosis of cancer or non-cancer possible.

The age at which the symptoms occur may give clues to the type of tumor as some tumors are common with younger age and vice versa.

Other symptoms might include those that affect the entire body such as weight loss, fever, chills, fatigue and lack of appetite.  These with a bone tumor can signify a number of possible conditions.  This scenario could indicate a bone infection with bacteria being seeded into the blood causing intermittent chills and fever.  This scenario could also indicate a cancer that occurs in several areas including bone.  Many cancers secrete a type of hormone or chemical messenger known as a cytokine that causes fever and lack of appetite.  These messengers also can cause weight loss that typically occurs with many types of cancer.

Complaints of pain in nearby armpit or groin may be from cancer spreading to adjacent lymph nodes.  For example, a bone cancer of the thigh bone (also known as femur) may spread to the “upstream” lymph nodes in the groin.  Lymph node enlargement will usually feel like firm or rubbery small grapes under the skin in a bunch.  These do not necessarily indicate the cancer has spread however and might just be reactive or swollen due to inflammation or infection nearby.

Abnormal skin spots, rashes or discoloration can sometimes be found with bone tumors.  For example, light tan spots that’s are referred to as coffee with milk spots (also called café au-lait) might indicate the presence of tumors with neurofibromatosis.

The most common type of bone cancer are those that arise from other cancers and spread to the bone.  These typically occur in older adults.  A list of cancers that commonly spread to the bone(s) includes:

When cancer spreads to the bone it often causes severe weakness of the bone known as lytics lesions or even pathologic fractures.  These can cause severe pain and discomfort particularly when they occur in the spine.  An older adult with an unexplained fracture should have an evaluation for a possible underlying cancer cause such as an undiagnosed breast cancer in a woman or prostate cancer in an elderly man.  When these occur they are very troubling and indicate that the cancer is not curable.  The cancer may still be treatable however and specific things can be done to ease the symptoms of the bone.  Sometimes these are treated with repair or resection, radiation therapy and more commonly pain medicine.  The specific tumor that has spread may even have a special sensitivity or target for treatment such as the HER2 receptor in breast cancer that can be targeted with the medication called trastuzamab.

Once a symptom of bone cancer has been discovered it should be brought to the attention of your doctor for further investigation.  This will usually begin with examination and plain x-rays.  Sometimes this is all that is needed if the imaging is straightforward and explains the bulge or growth as benign.  Often, when more information is needed an MRI (magnetic resonance imaging) is obtained.  An MRI gives excellent detail of bone and surrounding soft-tissue.  A high quality MRI can often provide a diagnosis.  If the diagnosis is unclear or tumor type needs to be further classified, a bone biopsy or sample of the cells might be obtained.

REFERENCES:

  1. www.cancer.gov/cancertopics/factsheet/Sites-Types/bone
  2. www.nlm.nih.gov/medlineplus/bonecancer.html
  3. Ferguson WS, Goorin AM. Current treatment of osteosarcoma. Cancer Invest 2001; 19:292
  4. Blanco Sequeiros R, Klemola R, Ojala R, et al. MRI-guided trephine biopsy and fine-needle aspiration in the diagnosis of bone lesions in low-field (0.23 T) MRI system using optical instrument tracking. EurRadiol 2002; 12:830.
  5. This article was originally published on September 3, 2012 and last revision and update was 9/4/2015.