Our bones are made up of two basic types of cells: osteoblasts, which create and maintain new bone, and osteoclasts, which dissolve old bone. Normally, bone cells know when to grow and when to stop growing. But sometimes, abnormal bone cells develop and grow at an uncontrolled rate, forming a tumor. 

Most bone tumors are benign (not cancerous), but a few are cancerous. Known as primary bone cancers, these are quite rare, accounting for less than 0.2 percent of all cancers. The majority of cases of cancer involving bone are metastatic, meaning the disease has spread to the bones from another place in the body.

Treatment for bone cancer depends on the type of tumor, whether it is primary or metastatic, and the extent of the tumor, and often includes some combination of surgery, radiation therapy, chemotherapy and immunotherapy.

“Our ability to accurately diagnosis and successfully treat bone tumors has tremendously improved,” says Gary Elliott Friedlaender, MD, a Yale Medicine orthopedic oncologist, who is part of the Sarcoma Program at Smilow Cancer Hospital, “based on innovative research and clinical trials, along with the skill and experience of our team.”

Primary bone cancers are also called sarcomas. Osteosarcoma—the most common type of primary bone cancer—generally develops in children and young adults, forming in one of the long bones of the arm or leg. About 10 percent of cases occur in older patients, including some who have a condition called Paget’s disease.

There are other types of bone tumors. Ewing sarcoma develops in children and young adults, whereas chondrosarcoma (cancer arising from cartilage cells) tends to occur in people older than 40. These cancers can start in the pelvis, shoulder, arm, leg or another bone site in the body. Although multiple myeloma is not considered to be a primary bone cancer (it arises in the marrow space inside bones), it can still damage the bones and cause bone pain, fractures and loss of function.

Patients with most cancerous bone tumors, like osteosarcoma, often have bone pain, along with swelling and a palpable tumor. If the bone becomes very weak, a fracture can occur.

The symptoms of metastatic bone cancers range widely, from pain that makes it hard for patients to move around, to no symptoms at all. Some tumors are diagnosed when a patient suffers a fracture, and some are found incidentally, while the doctor is performing an evaluation for another reason.

When doctors suspect a patient may have bone cancer, they usually start with an X-ray of the painful area. If this is abnormal or suspicion for a bone tumor is high, then other types of imaging are available to help find the problem. 

One type of imaging is called a bone scan, which shows pictures of the skeleton based on the body’s chemistry (like metabolism) rather than on physical shapes and forms (like with other imaging tests). During the procedure, the patient receives an injection of a small amount of a radioactive material that collects in the bones, helping to highlight a tumor during scanning.

Other imaging studies (MRI, CT scan or PET scan) and lab tests may also be performed to check for signs of cancer throughout the body and help make the diagnosis as to what type of tumor is present.

The doctor may decide to take sample of the bone tumor to analyze it for cancer cells, being extremely careful not to cause any additional damage to the bone. This can usually be done using novocaine and a special needle.

For primary bone cancer, the goal of treatment is to quickly destroy or remove the tumor. Treatment typically involves a combination of surgery, radiation therapy, chemotherapy and immunotherapy. If possible, limb-sparing surgical procedures are performed, to remove the diseased area while allowing the patient to keep as much of the normal bone as possible. If amputation is required, bone and soft tissues (like muscles) may be reconstructed or patients may be fitted with a prosthesis.

For patients with metastatic cancer, the goal is to minimize pain and discomfort while the original cancer is treated. The bone may be supported structurally using metal plates or rods or bone cement to avoid fracture.

“Caring for cancer is a team effort,” says Dr. Friedlaender. “Here at Yale Medicine, we have outstanding and experienced clinicians, scientists and care providers who make these teams highly effective and customized for each individual person.”

“We have clinicians skilled in diagnoses, including world-class radiologists and pathologists,” he says. “Our team reflects a wide spectrum of treatment talents provided by orthopedic and surgical oncologists, pediatric and adult medical oncologists, and radiation oncologists.” The Yale Medicine oncology team also includes pain management and rehabilitation specialists and has the benefit of modern and uplifting inpatient and outpatient facilities. 

Part of the team’s effort is to bring discoveries quickly from the doctors’ research activities to patients to provide the best available clinical care available.

“It is a privilege to take care of patients, and we are constantly improving ways to make patients healthier and earn their trust,” says Dr. Friedlaender.