Bone cancer begins when abnormal cells in the bone grow and divide in an uncontrolled way. Because every patient’s situation is unique, our team at Illinois CancerCare focuses on early detection, accurate diagnosis, and personalized treatment plans designed to give you the best possible outcome. Primary bone cancers start in the bone itself, while secondary bone cancers (bone metastases) begin in another organ and spread to the bones. This page focuses on primary bone cancers.  

Understanding the Bones

Your skeleton is made up of different types of bone and cartilage cells that build, maintain, and remodel bone throughout life. Primary bone cancers (also called bone sarcomas) can arise from these different cell types and behave differently depending on their origin, grade, and location.  

Types of Bone Cancer

Osteosarcoma

The most common primary bone cancer in teens and young adults; usually starts in long bones such as the thigh (femur) or shin (tibia).

Ewing sarcoma

Often occurs in children and young adults; can start in bone or nearby soft tissue. 

Chondrosarcoma

More common in adults; begins in cartilage cells and often involves the pelvis, hip, or shoulder.

Chordoma

A rare, slowgrowing tumor that typically forms at the base of the skull or along the spine.

Other rare tumors

Such as undifferentiated pleomorphic sarcoma of bone and (noncancerous but locally aggressive) giant cell tumor of bone.

These cancers differ in how they present and how they are treated.  

Signs & Symptoms

  • Persistent or worsening bone pain (often worse at night or with activity)
  • Swelling or a lump over a bone or joint 
  • Unexplained fractures or bone weakening 
  • Stiffness, limited range of motion, or limping 

Symptoms can vary by tumor location and type, and many noncancer conditions can cause similar symptoms. If you’re concerned, talk with your doctor. 

Risk Factors

  • Genetic conditions (for example, LiFraumeni syndrome/TP53, hereditary retinoblastoma/RB1) 
  • Previous radiation therapy to a bone or highdose exposure 
  • Certain bone diseases or abnormalities (e.g., Paget disease of bone in older adults) 
  • Rapid bone growth during adolescence (primarily linked with osteosarcoma) 
    Having one or more risk factors does not mean you will develop bone cancer.  

Screening

There is no standard screening test for people at average risk of primary bone cancer. Evaluation is typically prompted by symptoms or abnormal imaging done for another reason.  

Diagnosis

Your care team will use a combination of exams and tests to confirm a diagnosis and guide treatment planning: 

  • Xray: Often the first test to look for bone changes 
  • MRI: Defines the tumor’s extent in bone and nearby soft tissues 
  • CT scan: Helpful for assessing bone detail and checking the lungs 
  • Bone scan or PET/CT: Looks for active tumor sites and spread 

  • Core needle biopsy (often imageguided) or surgical biopsy to obtain tissue for pathology 
  • Biopsies should be planned by the treating orthopedic oncology team to avoid complicating later surgery 

  • Blood work (e.g., alkaline phosphatase, LDH) may support diagnosis and monitoring

Diagnostic steps are tailored to the suspected tumor type and your clinical situation. 

Staging

Staging describes how advanced the cancer is and helps guide treatment. Primary bone cancers are staged using a tumornodemetastasis (TNM) system and grade (how the cells look under a microscope). In general terms: 

Stage I

Localized, lowgrade tumor confined to the bone

Stage II

Localized, highgrade tumor confined to the bone

Stage III

Highgrade tumor with more than one site within the same bone

Stage IV

Cancer has spread to the lungs, lymph nodes, or other distant sites

Some bone sarcomas (like Ewing sarcoma) are grouped more simply as localized or metastatic at diagnosis. Your team will explain which system applies to you.  

Treatment Options

Treatment is individualized based on the type of bone cancer, stage, location, grade, your overall health, and your goals. Care is typically coordinated by a multidisciplinary team experienced in sarcomas. 

Surgery  

  • Limbsparing surgery is possible for many patients to remove the tumor while preserving function 
  • Reconstruction with bone grafts or implants may be used 
  • Amputation is sometimes the safest option when tumors involve critical nerves/vessels or infection/recurrence makes limbsparing unsafe 

Chemotherapy  

  • A mainstay for osteosarcoma and Ewing sarcoma, commonly given before and after surgery to shrink tumors and treat microscopic disease 

Radiation Therapy  

  • Used when surgery is not feasible, to treat margins after surgery, or as part of combined therapy (especially for Ewing sarcoma); advanced techniques (including proton therapy at select centers) may be considered 

Targeted Therapy & Immunotherapy  

  • Options depend on tumor type and biomarkers; some patients may be eligible for newer medicines or combinations through clinical trials 

Rehabilitation & Supportive Care  

  • Physical therapy, pain management, nutrition, and psychosocial support are integral parts of care 

Your Illinois CancerCare team will discuss the benefits and risks of each option and whether a clinical trial is right for you.  

Prognosis

Many people with localized bone cancers can be treated successfully. Outlook depends on tumor type, stage, grade, location, tumor response to therapy, and overall health. Your doctor will review what these factors mean in your specific case.  

Follow Up Care

Regular follow up typically includes physical exams, imaging of the original tumor site, and chest imaging to check for recurrence or spread, along with rehabilitation and management of any longterm or late effects of treatment. Your schedule will be personalized to your diagnosis and treatment.  

Living With Bone Cancer

Illinois CancerCare offers comprehensive support, including counseling, nutrition guidance, rehabilitation services, survivorship programs, clinical trials access, and caregiver support to help you and your loved ones navigate treatment and recovery.  

Why Choose Illinois CancerCare

  • A dedicated team of medical oncologists, radiation oncologists, and orthopedic oncology partners experienced in sarcomas 
  • Advanced diagnostic imaging (including PET/CT) and coordinated biopsy planning 
  • Compassionate, patient‑centered care close to home
  • Access to innovative treatments and clinical trials close to home 
  • Compassionate, patientcentered care focused on preserving function and quality of life 

Sources & Patient Friendly References

All information was taken from the NCI (National Cancer Institute) JNCCN (Official Journal of the National Comprehensive Cancer Network), and ACS (American Cancer Society).