II. Epidemiology

  1. Primary Bone Cancers represent <1% of cancer diagnoses in the U.S.

III. Causes: Primary Bone Cancers

IV. Causes: Metastatic Bone Lesions

  1. See Metastatic Cancer involving Long Bones
  2. Cancers most prone to metastasize to long bones
    1. Breast Cancer (more common)
    2. Prostate Cancer (more common)
    3. Lung Cancer
    4. Renal Cancer
    5. Thyroid Cancer

V. Causes: Bone Marrow Involving Cancers

VI. Causes: Benign Bone Tumors

  1. Osteochondroma (35%)
  2. Giant cell tumour (20%)
  3. Osteoblastoma (14%)
  4. Osteoma (12%)
  5. Osteoid Osteoma (11-13%)
  6. Aneurysmal bone cyst (9%)
  7. Fibrous dysplasia (5-7%)
  8. Enchondroma (2-3%)
  9. (Hakim) J Bone Oncol. 2015 Jun; 4(2): 37–41 +PMID:26579486 [PubMed]

VII. Symptoms

  1. Focal symptoms
    1. Regional or localized pain
    2. Extremity tenderness
    3. Joint decreased range of motion
    4. Soft tissue swelling
  2. Systemic symptoms
    1. Fever
      1. Relapsing Fever in Ewing Sarcoma
  3. Other presentations (less common, but more suggestive of malignancy when present)
    1. Night pain
      1. Occurs in<37% of Osteosarcomas and 19% of Osteosarcoma
    2. Pathologic Fracture
      1. Occurs in 7-8% of Osteosarcoma patients

VIII. Imaging

  1. XRay
    1. Bone lesion may be found on xray obtained to evaluate for Fracture
  2. MRI (preferred over CT)
    1. Indicated to better define bony lesions
  3. Metastasis evaluation
    1. Chest CT (PET Scan in some cases)
    2. Bone Scan

IX. Labs: Indicated for finding suggestive of Bone Cancer

X. Diagnosis

  1. Bone biopsy (open or needle biopsy)
    1. Should be performed by experienced cancer surgeon
    2. Needle or biopsy track should be resected with cancer to pervent local recurrence

XI. Management

  1. Avoid diagnostic delay
  2. Referral to cancer center

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Ontology: Bone neoplasms (C0005967)

Definition (NCI) A benign or malignant (primary or metastatic) tumor involving the bone. Common malignant tumor types involving the bones are metastatic carcinomas and sarcomas. -- 2003
Definition (CSP) new abnormal bone tissue that grows by excessive cellular division and proliferation more rapidly than normal and continues to grow after the stimuli that initiated the new growth cease; includes tumors or cancer located in bone tissue or specific bones.
Definition (MSH) Tumors or cancer located in bone tissue or specific BONES.
Concepts Neoplastic Process (T191)
MSH D001859
SnomedCT 240201007, 115239009, 126537000
English Bone Neoplasms, Neoplasm, Bone, Neoplasms, Bone, NEOPL BONE, BONE NEOPL, neoplasm of bone (diagnosis), bone neoplasm, neoplasm of bone, Bone neoplasm NOS, Neoplasm bone, Bone Neoplasms [Disease/Finding], bone tumour, bone neoplasms, bone tumors, bone tumours, bone tumor, Bones--Tumors, Bone neoplasm, Bone tumor, Bone tumour, Bone tumor (morphologic abnormality), Neoplasm of bone (disorder), Neoplasm of bone, Bone neoplasms, Bone Neoplasm, Neoplasm of Bone, Neoplasm of the Bone, Osseous Neoplasm, Osseous Tumor, Tumor of Bone, Tumor of the Bone, Bone Tumors, Bone Tumor
Italian Tumore dell'osso, Tumore dell'osso NAS, Tumore delle ossa, Neoplasie delle ossa
Dutch botneoplasma NAO, neoplasma bot, botneoplasma, Botkanker, Bottumor, Bottumoren, Tumor van het bot, Tumor, bot-, Tumoren, bot-
French Tumeur d'un os, Tumeur des os SAI, Tumeurs des os, Tumeurs osseuses, Tumeur osseuse
German Neubildung des Knochens NNB, Neubildung des Knochens, Knochentumoren, Tumoren, Knochen-
Portuguese Neoplasia óssea, Neoplasia óssea NE, Tumor ósseo, Neoplasias Ósseas
Spanish Neoplasia de hueso NEOM, neoplasia ósea (trastorno), neoplasia ósea, tumor de hueso (anomalía morfológica), tumor de hueso, tumor óseo, Neoplasia de hueso, Neoplasias Óseas
Japanese 骨新生物NOS, コツシンセイブツNOS, コツシンセイブツ, 骨腫瘍, 骨新生物
Swedish Skelettumörer
Finnish Luuston kasvaimet
Russian KOSTEI NOVOOBRAZOVANIIA, КОСТЕЙ НОВООБРАЗОВАНИЯ
Czech Kostní novotvar NOS, Novotvar kosti, kostní nádory, nádory kostí, kosti - nádory
Croatian KOŠTANI TUMORI
Polish Nowotwory kości
Hungarian Csont neoplasia, Csontdaganat, Csont neoplasia k.m.n.
Norwegian Neoplasmer i ben, Neoplasmer i skjelettet, Neoplasmer i bein, Skjelettsvulster, Skjeletttumor

Ontology: Malignant Bone Neoplasm (C0279530)

Definition (MEDLINEPLUS)

Cancer that starts in a bone is uncommon. Cancer that has spread to the bone from another part of the body is more common.

There are three types of bone cancer:

  • Osteosarcoma - occurs most often between ages 10 and 19. It is more common in the knee and upper arm.
  • Chondrosarcoma - starts in cartilage, usually after age 40
  • Ewing's sarcoma - occurs most often in children and teens under 19. It is more common in boys than girls.

The most common symptom of bone cancer is pain. Other symptoms vary, depending on the location and size of the cancer. Surgery is often the main treatment for bone cancer. Other treatments may include amputation, chemotherapy, and radiation therapy. Because bone cancer can come back after treatment, regular follow-up visits are important.

NIH: National Cancer Institute

Definition (NCI) A primary or metastatic malignant neoplasm affecting the bones. Representative examples of primary malignant bone neoplasms include osteosarcoma, chondrosarcoma, and Ewing sarcoma. Primary malignant bone neoplasms most often affect children and adolescents. Representative examples of metastatic malignant neoplasms to the bones include carcinomas arising from other anatomic sites and lymphomas.
Definition (NCI_NCI-GLOSS) Primary bone cancer is cancer that forms in cells of the bone. Some types of primary bone cancer are osteosarcoma, Ewing sarcoma, malignant fibrous histiocytoma, and chondrosarcoma. Secondary bone cancer is cancer that spreads to the bone from another part of the body (such as the prostate, breast, or lung).
Concepts Neoplastic Process (T191)
MSH D001859
SnomedCT 428281000, 93725000, 269466003, 363371002
LNC LA10549-6
English Malignant bone tumor, Malignant bone tumour, CA - Bone cancer, Malignant neoplasm of bone (disorder), Malignant neoplasm of bone, bone cancer (diagnosis), bone cancer, malignant neoplasm of bone, malignant neoplasm of bone (diagnosis), malignant tumor of bone, bone malignant neoplasm, bone malignant tumors, cancer of the bone, cancer of bone, bone cancers, Bone cancer, Bone neoplasm malignant, Bone cancer NOS, Malignant bone tumour (disorder), Bones--Cancer, Bone cancer, NOS, -- Bone Cancer, Malignant neoplasm of bone, NOS, Malignant Bone Neoplasm, Malignant Bone Tumor, Malignant Neoplasm of Bone, Malignant Neoplasm of the Bone, Malignant Osseous Neoplasm, Malignant Osseous Tumor, Malignant Tumor of Bone, Malignant Tumor of the Bone, Osseous Cancer, Bone Cancer, Cancer of Bone, Cancer of the Bone, Neoplasm malig;bone(s), malignant neosplasm of the bone(s)
Spanish neoplasia maligna del hueso (trastorno), Cáncer de Hueso, neoplasia maligna de hueso (trastorno), neoplasia maligna de hueso, neoplasia maligna ósea, neoplasia maligna del hueso, Cáncer de hueso NEOM, Cáncer de hueso, Neoplasia ósea maligna, cáncer óseo, tumor óseo maligno, Cáncer Óseo
Portuguese Câncer Ósseo, Cancro ósseo NE, Cancro ósseo, Neoplasia óssea maligna, Câncer de Osso
French Cancer des os, Tumeur maligne de l'os, Cancer des os SAI, Cancer de l'os, Cancer osseux
German Knochenkrebs, Knochenkrebs NNB, Boesartiger Knochentumor, Krebs des Knochens, Krebs der Knochen
Italian Cancro dell'osso, Cancro delle ossa, Tumore maligno dell'osso, Cancro delle ossa NAS
Czech kost - rakovina, rakovina kosti, kosti - rakovina, rakovina kostí, Maligní nádorové onemocnění kosti, Novotvar kosti maligní, Maligní nádorové onemocnění kosti NOS
Norwegian Beinkreft, Skjelettkreft, Benkreft
Dutch botneoplasma maligne, botkanker NAO, botkanker
Hungarian Csontrák, Csont rosszindulatú neoplasia, Csontrák k.m.n.
Japanese 骨癌, コツノアクセイシンセイブツ, コツガンNOS, コツガン, 骨の悪性新生物, ホネノアクセイシンセイブツ, 骨癌NOS