World Cancer Day: Have you been experiencing pain or swelling in bones for weeks? Time to visit the doctor

By Dr Suman S Karanth

Bone cancers refer to a tumour or abnormal tissue that begins in the bone. There are mainly two broad types of bone cancer.

Primary malignant bone tumours refers to those which begin in the bone or surrounding soft tissue such as cartilages. These are rare tumours, accounting for less than 1 per cent of all cancers. They however represent the sixth-most common cancer in children, and the third-most common in adolescents and young adults leading to significant morbidity and mortality. The common subtypes in this group include Osteosarcoma, Ewing’s sarcoma and Chondrosarcoma. Osteosarcomas comprises of 56 per cent, Ewing sarcoma accounts for 34-36 per cent, and chondrosarcomas for less than 10 per cent of all bone cancers in individuals under the age of 20.


Secondary metastatic bone cancers include those tumours which have spread to the bone from other parts. These represent the most common cause of bone tumours, particularly in older adults. Cancers of the breast, prostate, thyroid, lung, kidney, and pancreas are the usual culprits for more than 80 per cent of this subgroup.

Some of the risk factors for bone cancer include patients who have a family history of predisposition to bone cancer, those who have received prior radiation or chemotherapy or those suffering from Paget’s disease which is a condition that causes the bones to break down and then grow back abnormally. Aberration in the normal process of bone growth and remodelling at a time of growth spurt has been speculated as a risk for tumours in adolescents.


Patients usually seek medical attention when they suffer from persisting localised pain or swelling in the bone of few weeks or months duration. Trauma, which is most often minor, may be the trigger that brings attention to this. The pain is usually mild at first, being aggravated by exercise, and is often worse at night.

If bone cancer is suspected, a patient must go to a facility with expertise for such treatments. When there is a suspicion of a primary bone cancer, patient must undergo imaging tests in the form of X-rays and magnetic resonance imaging of the involved limb or part. If there is a suspicion that the disease has spread to other parts or this is a secondary bone cancer, a whole-body PET CT scan should be performed.

As the treatment differs according to the subtype of bone cancer, it is very essential to undergo a diagnostic biopsy from the suspected bone. The biopsy must be carried out by an onco-surgeon, interventional radiologist or an orthopaedic surgeon who has enough expertise in their management. Proper planning of the biopsy is very important for future definitive surgery.

When the disease is localised, treatment includes a multi-disciplinary approach with combination of chemotherapy, definitive surgery and radiation depending on the subtype of bone cancer. Before the mid-1970s, amputation of the affected limb was the routine treatment for osteosarcoma.

With the advent of more intensive combination chemotherapy regimens, we have been able to achieve dramatic improvements in survival from five-year survivals between 20-40 per cent to more than 65-70 per cent. The rate of limb salvage has also improved significantly. The outcomes for patients with metastatic primary bone diseases however remains disappointing with an approximate five-year survival of 25 per cent.

Treatment mainly includes combination chemotherapy, and in some feasible cases, surgery. For secondary metastatic bone disease, the treatment and outcomes vary according to the primary type of cancer. Progress is ongoing to find newer therapies in areas of immune therapy and targeted chemotherapy which may help improve survivals in the future.

(The author is Consultant, Department of Medical Oncology, Fortis Memorial Research Institute, Gurugram)