The exact cause of primary bone cancer is not fully understood but the researchers believe that it is caused by over-activity of the bone cells. Studies have shown that there is a much higher risk of bone cancer in those persons, who had taken radiotherapy or chemotherapy with alkylating anticancer drugs during their childhood. Pain and swelling are the most common symptoms of bone cancer. For more information: www.cancertame.com

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Bone Cancer

2. There are various types of primary bone cancers depending on the type of cells of their
origin.
● The most common primary bone cancer is osteosarcoma (osteogenic sarcoma) that
arises from the osteoid tissue and usually affects long bones of the arms & the legs
● The second most common primary bone cancer is chondrosarcoma that arises from
the cartilage
● The third most common primary bone cancer is Ewing’s sarcoma that arises from
the immature nerve tissue in the bones
● Other primary cancers of the bone include fibrosarcoma that arises from connective
tissue within the bone marrow cavity, malignant giant cell tumour that arises from the
connective tissue of the bone marrow and chordoma that arises from cellular
remnants of the foetal spinal cord

3. Image: https://www.cancerresearchuk.org/about-cancer/bone-cancer/about
The exact cause of primary bone cancer is
not fully understood but the researchers
believe that it is caused by over-activity of
the bone cells. Studies have shown that
there is a much higher risk of bone cancer
in those persons, who had taken
radiotherapy or chemotherapy with
alkylating anticancer drugs during their
childhood. Pain and swelling are the most
common symptoms of bone cancer.
The tumours located in or near a joint may
lead to stiffness and tenderness of the
affected joint, whereas the tumours in the
pelvic bones and lower part of the spine
may affect the normal functioning of the
bladder and the bowel.

4. Bone cancer usually leads to pathological fractures of the affected bones. Procedures
used in diagnosis and evaluation of the bone cancer include a blood test, X-rays, bone
scan, CT scan, fluoroscopy and biopsy.
1. Osteosarcoma
Osteosarcoma (osteogenic sarcoma) is the most common and highly malignant primary
bone tumour. It is more common in men as compared to women and usually occurs
during the second and third decades of life. Osteosarcoma usually affects long bones
such as the humerus, distal part of the femur and proximal part of the tibia & the fibula.
The exact cause of osteosarcoma is not fully understood but radiation is considered as
one of the major risk factors. Histopathologically, the tumour is composed of pleomorphic
cells that invade and destroy the bone. Osteosarcoma is divided into three types, i.e.
● Parosteal osteosarcoma
● Multifocal osteosarcoma
● Soft tissue sarcoma

5. Osteosarcoma presents as a painful bony swelling usually
around the shoulder or the knee. If untreated, tumour may
fungate to form an ulcer. The malignant cells of osteosarcoma
often produce an abnormal irregular bony structure. The
expanding tumour forming a new bone in soft tissue may
appear as Codman’s triangle and Sun-ray spicules in X-ray
films. Osteosarcoma may cause pathological fracture. The
tumour usually metastasises to lungs.
Staging of the osteosarcoma is done as follows:
● In local stage of the osteosarcoma, the tumour is localised
in the affected bone
● In metastatic stage, the osteosarcoma spreads to other
parts of the body
Procedures used in diagnosis of the osteosarcoma include X-
rays, CT scan, fluoroscopy, bone scan and biopsy.
Image: https://commons.wikimedia.org/

6. 2. Chondrosarcoma
Chondrosarcoma is the second most common cancer of the bones.
It may arise from the cartilage and the bone-forming tissue.
Chondrosarcoma usually occurs during 40 to 60 years of age. It
may affect the ribs, ilium, scapula and proximal ends of the femur &
the humerus. Any pre-existing cartilaginous tumour may also get
transformed into the chondrosarcoma. Chondrosarcoma is of two
types, i.e.
● Low-grade chondrosarcoma (the slow growing tumour)
● High-grade chondrosarcoma (the fast growing tumour)
The lesions of chondrosarcoma usually have ill-defined margins and
these may lead to destruction of the bone. The most common
symptom of chondrosarcoma is a painful lump, usually found in the
pelvic area. Chondrosarcoma often invades the adjacent soft
tissues. The tumour may attain a considerable size in the flat bones.
A central chondrosarcoma has a
predominantly lytic appearance
in the medullary portion of the
bone. Medially there is
extraosseous extension. The
cortical defect on the left is the
biopsy site. The gross specimen
is seen in this figure.
Image:
http://www.pathologyoutlines.com/image
s/bones/111.jpg

7. In the spine, the chondrosarcoma usually presents as a small tumour that may lead to the
vertebral collapse and compression of the spinal cord. It usually metastasises to the lungs.
Procedures used in diagnosis of the chondrosarcoma include X-rays, CT scan and biopsy.
3. Fibrosarcoma
Fibrosarcoma may arise from the soft tissue and the bone. Fibrosarcoma of the soft tissue
is more common in men as compared to women and occurs during 40 to 50 years of age
usually arising from fibrous tissue of the arms, legs and the trunk. Fibrosarcoma of the
bone often occurs during 30 to 40 years of age and affects bones of the hip, pelvis, legs
and the arms. Fibrosarcoma of the bone is further divided into two types, i.e.
● Endosteal fibrosarcoma
● Periosteal fibrosarcoma
Endosteal fibrosarcoma causes bone destruction leading to pathological fracture and
usually metastasises to the regional lymph nodes & the lungs.

8. Periosteal fibrosarcoma invades the bone but does not metastasise to distant parts of the
body. The diagnosis of fibrosarcoma is usually done by biopsy.
4. Synovial sarcoma
Synovial sarcoma is a highly malignant tumour that may arise from the muscle, connective
tissue and the subcutaneous tissue. It usually occurs during 20 to 40 years of age. Synovial
sarcoma often presents as a soft tissue mass in a major joint such as the knee, ankle and
the wrist. It usually metastasises to the regional lymph nodes.
5. Malignant giant cell tumour
Malignant giant cell tumour usually originates in the epiphyseal region of long bones such
as distal part of the femur and proximal part of the tibia & fibula. It is more common in
women as compared to men and usually occurs during 30 to 50 years of age. Malignant
giant cell tumour often presents as a swelling in bone and adjacent joint along with pain.

9. There may be destruction of the bone that gives typical soap bubble appearance in the X-
ray film. The growing tumour expands the bone resulting into thinning of the bone.
Pathological fracture is a common symptom of the malignant giant cell tumour. Invasion of
the tumour into the adjacent tissues occurs after the fracture. Malignant giant cell tumour
usually metastasises to the lungs. Recurrence of the tumour is also common.
6. Secondary tumours of the bone
Secondary tumours of the bone are quite common. About two third secondary tumours of
the bone metastasise from primary cancers of the breast, lung and the prostate; about one-
sixth metastasise from primary cancers of the bronchus, kidney and the thyroid; and in the
remaining one-sixth secondary tumours of the bone, the primary site is unknown.
Secondary tumour of the bone usually presents with debilitating pain, impaired walking and
severe neurological impairment. The destructive lesions in the bone may lead to the
pathological fracture. Procedures used to diagnose secondary tumours of the bone include
X-rays, bone scan, CT scan and MRI.

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