Bone cancer

Bone cancer has many forms, all of them rare and difficult to diagnose. Some types are specific to children, adolescents and young adults while other forms occur predominantly in the adult population. Because of the rarity and difficulty in diagnosis, once suspected, all bone cancers should be referred to a specialist centre for immediate investigation. 

The Royal National Orthopaedic Hospital

SCT’s head office is located at the Royal National Orthopaedic Hospital Trust in Stanmore, emphasising our close relationship with this bone cancer specialist unit.

The Royal National Orthopaedic Hospital links with the University College London Hospitals to form the ‘London Bone and Soft Tissue Sarcoma Service’. The Service is recognised on a national and international level as a centre of excellence for the diagnosis and management of primary bone and soft tissue cancers.

Surgeons

Our surgeons work with a dedicated team of oncologists and other specialists to provide a special package of care for each patient which may include: investigation and staging, chemotherapy, surgical removal of the tumour and radiotherapy. Certain tumours may require amputation of a whole or part of a limb. The Royal National Orthopaedic Hospital is a pioneering centre for the continuing development of limb sparing surgery (an alternative to amputation). Such surgery may use custom made metal implants (prostheses) to replace the bone and/or joint. These metal implants can now be lengthened without surgery to match normal growth in young people.

What are sarcomas?

Sarcomas are malignant tumours that arise from cells that make up connective tissue (bone, cartilage, blood vessels, muscle, fatty tissue, nerves), and can develop at any site in the body. 

There are many different types of sarcoma, but it is helpful to think of them as either soft tissue sarcomas or bone sarcomas. Sarcomas are rare cancers and are only the 21st most common cancer. A GP can expect to see only one or two sarcomas in an entire career. There are approximately 2000 soft tissue sarcomas and 400 bone sarcomas diagnosed each year in the UK.

What are Bone Sarcomas?

Bone Sarcomas are very rare, accounting for 0.2% of all malignant tumours. They are commonest in children, teenagers and young adults, accounting for 4% of all malignancy in children up to 14 years, although much less commonly they can occur in older age groups. 

The cause of bone sarcomas is not known, although they may be associated with underlying bone diseases, previous radiotherapy, and very rarely may be hereditary. The commonest types of bone sarcoma are osteosarcoma, Ewing’s sarcoma and spindle cell sarcoma. They can arise in any bone of the body, although are most common in the limbs and pelvis. Initial symptoms usually include pain, tenderness and swelling of the affected bone, or an unexpected fracture.

What is Osteosarcoma?

Also called Osteogenic sarcoma this is the most common type of primary bone cancer.

In the UK, nearly a third of all primary bone cancers are osteosarcomas – approximately 150 people are diagnosed each year. Although it can occur at any age, osteosarcoma is most common in males. Any bone in the body can be affected but the most common sites are the upper arm (humerus) or the legs, particularly the lower thigh (femur) and the upper shin bone (tibia). Kelly was a 15 year-old, sporty teenager when she was diagnosed with Osteosarcoma in her shinbone.

What is Chondrosarcoma?

This is a cancer that starts in cartilage cells although it can grow within a bone or on its surface.

It is most commonly found in middle-aged adults. Chondrosarcoma is usually a slow-growing tumour. The most common sites are the pelvis, shoulder blade (scapula), ribs and the upper part of the arms (humerus) and legs (femur).

What is Chordoma?

This is an extremely rare cancer which starts in the bones of the spine, either in the sacrum (the bottom of the spine) or the neck.

Chordomas are more common in men, and can occur at any age, although they are more common in people in their 40’s and 50’s. They tend to be slow-growing tumours.

What are soft-tissue sarcomas?

Soft Tissue Sarcomas account for about 1% of all malignant tumours. The cause of these tumours is not known although they may be associated with previous radiotherapy, some toxins and very rarely may be hereditary. 

They can affect any age group, although are more common in the middle-aged and elderly, and less common in younger age groups. Nearly 60% of soft tissue sarcomas arise in the arms or legs, 20% in the trunk, 5% in the head and neck, and 15-20% in the abdomen or internal organs. The signs and symptoms of sarcomas vary according to where they develop, but often the first sign is a lump in an arm or a leg.

How are sarcomas treated?

Bone Sarcomas are particularly aggressive tumours that are usually treated with a combination of surgery and long courses of chemotherapy.

Modern surgery aims to remove the primary tumour, while at the same time preserving the limb function (or other body part) wherever possible. This is usually done by replacing the bone with a metal prosthesis. Radiotherapy is sometimes used after surgery, or instead of surgery if an operation is not possible.

What is Ewing's sarcoma?

Ewing’s sarcoma is named after the surgeon who first described it.

Again, this type of bone cancer is more common in young people than adults. Any bone can be affected, but the pelvis, thigh bone (femur) and the shin bone (tibia) are the most common places for it to occur. Like ostosarcoma, Ewing’s sarcoma is slightly more common in males than females. It is also possible to get a Ewing’s sarcoma in the soft tissues of the body. This is known as extraosseous Ewing’s sarcoma.

What is Spindle Cell Sarcoma?

There are four types of spindle cell sarcoma:

Malignant fibrous histiocytoma
A very rare bone cancer that occurs in middle-aged adults. Usually found in the arms or legs, especially around the knee joint.

Fibrosarcoma
Another very rare bone cancer, most often found in middle aged adults. Most commonly in the thigh bone (femur).

Leiomyosarcoma
Leiomyosarcoma of the bone is very rare. It can occur in people of any age, but is extremely rare in people under 20 years of age. It occurs slightly more often in men than women, and is more common in the long bones of the body, such as the thigh bone (femur), shin bones (tibia) and bone of the upper arm (humerus).

Undifferentiated sarcoma of the bone
These tumours are made up of primitive cells and it isn't possible to tell what type of normal bone cell they develop from.

What is Angiosarcoma?

This is a rare type of primary bone cancer that occurs more commonly in men.

It can occur in people of any age, but is very rare in people under 20 years of age. Angiosarcomas can affect any bone in the skeleton. They can affect more than one bone at the same time, or develop in more than one place in a singe bone.