Bone sarcoma

Bone sarcomas can develop at any age and in any bone, but they are most often found in the long bones of the arms and legs, such as the thigh bone (femur) and shin bone (tibia). Some types, particularly osteosarcoma and Ewing sarcoma, are most commonly diagnosed in children, teenagers and young adults, while others, such as chondrosarcoma, are more often seen in adults over 40.

The Main Types of Bone Sarcoma

Osteosarcoma – the most common primary bone cancer. It develops from the cells that build new bone and is most often diagnosed in children and young adults, usually around the knee or shoulder.

Ewing sarcoma – a rare cancer that can start in bone or in the soft tissue around it. It is most often diagnosed between the ages of 10 and 20 and commonly affects the pelvis, ribs or the long bones of the legs and arms.

Chondrosarcoma – develops in cartilage-producing cells. It is the second most common primary bone cancer and usually affects adults over 40, most often in the pelvis, ribs, shoulder or upper leg.

Chordoma – a very rare, slow-growing tumour that develops in the bones of the skull base and spine.

Giant cell tumour of bone – usually benign but locally aggressive, most often found near the knee. It can come back after treatment and needs long-term follow-up.

Symptoms to Look Out For

The most common first sign of a bone sarcoma is pain. Bone pain that should be checked by a doctor is typically:

• Persistent, rather than coming and going for a day or two
• Getting worse over weeks or months
• Not clearly linked to an injury or to activity
• Worse at night, or present when you are resting

Other symptoms can include swelling or a hard lump over a bone, difficulty putting weight on a limb, reduced movement in a nearby joint, or a bone that breaks after a minor knock. In children and teenagers, persistent pain that is put down to a sports injury or growing pains but does not settle should always be reviewed again.

How Bone Sarcoma is Diagnosed

Diagnosis usually begins with an X-ray, followed by an MRI scan to show the bone and the tissue around it in more detail. A CT scan of the chest and sometimes a bone scan or PET scan are used to check whether the cancer has spread. A biopsy — taking a small sample of the tumour for a pathologist to examine — confirms the diagnosis and identifies the exact type.

Where a bone sarcoma is suspected, the biopsy should be carried out by, or in consultation with, a specialist sarcoma team. Where and how the biopsy is taken can affect the surgery that follows, so this step matters.

How Bone Sarcoma is Treated

Treatment is planned by a specialist multidisciplinary team and depends on the type of sarcoma, its size and position, and your general health. Surgery to remove the tumour is central to treatment for most bone sarcomas. In the great majority of cases it is possible to remove the tumour and reconstruct the limb — known as limb-sparing surgery — although amputation is still necessary for some people.

Chemotherapy is used before and after surgery for osteosarcoma and Ewing sarcoma, and radiotherapy plays an important role in the treatment of Ewing sarcoma and in some other situations. Chondrosarcoma is usually treated with surgery alone, as it responds less well to chemotherapy and radiotherapy.

In Ireland, adults with a suspected bone sarcoma are referred to the National Sarcoma Service based at St Vincent’s University Hospital, with orthopaedic oncology care provided at Cappagh National Orthopaedic Hospital. Children and young people are referred to CHI at Crumlin.

Living with and After Bone Sarcoma

Treatment for bone sarcoma can be long, and recovery — particularly after major surgery, reconstruction or amputation — continues well after the hospital appointments stop. Physiotherapy, prosthetic services, rehabilitation and emotional support are all part of that recovery. Follow-up appointments and scans usually continue for several years.

Sarcoma Cancer Ireland is here throughout. Our support groups, one-to-one counselling, financial grants and Support Line are open to anyone in Ireland affected by a bone sarcoma diagnosis, at any stage.