Bone Cancer: Symptoms, Causes, and Treatment
Updated: 3 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Quick Answer
Bone cancer is a growth of abnormal cells that starts in a bone, most often the thighbone (femur). Symptoms include bone pain, swelling, tenderness, weakened bones that break easily, tiredness and unexplained weight loss. The most common types are osteosarcoma, chondrosarcoma and Ewing sarcoma. Treatment may include surgery, chemotherapy and radiation therapy.
What the research says
Bone cancer is rare, osteosarcoma is the most common type, and outcomes depend heavily on whether the disease has spread. A systematic review of 9 studies found that osteosarcoma is the most prevalent malignant primary bone tumor, particularly in adolescents and young adults, with survival of roughly 50 to 60% for osteosarcoma and about 70% for Ewing sarcoma, rates that fall when the cancer has metastasized. Identified risk factors included genetic predispositions such as Li-Fraumeni syndrome and TP53 mutations, radiation exposure, and growth patterns related to height (Hosseini et al., BMC Cancer, 2025) [3].
In a large osteosarcoma cohort, spread at diagnosis and response to chemotherapy were the strongest prognostic signals. Among 2,260 patients aged 40 or younger registered in the EURAMOS-1 study and treated with methotrexate, doxorubicin, and cisplatin, 3-year and 5-year event-free survival were 59% (95% CI 57 to 61%) and 54% (95% CI 52 to 56%), and overall survival was 79% and 71%. Pulmonary metastases at diagnosis (hazard ratio 2.34; 95% CI 1.95 to 2.81), non-pulmonary metastases (HR 1.94), and an axial skeleton tumor (HR 1.53) were linked to worse outcomes, as was a poor histological response to chemotherapy after surgery (HR 2.13) (Smeland et al., Eur J Cancer, 2019) [4].
What is bone cancer?
Bone cancer is a growth of abnormal cells that starts in a bone. It is also called primary bone cancer. It can start in any bone, but it most often affects the thighbone, called the femur.
It helps to understand what bone cancer is not. It is different from cancer that starts elsewhere in the body — such as breast, prostate, or lung cancer — and then spreads to the bones, which is called bone metastasis. It is also different from cancers that start in the bone marrow, such as multiple myeloma.
Although all three conditions involve bones, they develop from different cells or tissues and may need different treatments. Cancer that starts in the bones themselves is rare, and there are several types — some happen mainly in children, others mostly in adults.
What are the three most common types of bone cancer?
Bones contain many types of cells, and bone cancers are grouped into separate types, often based on the type of cell where the cancer began.
The most common types of primary bone cancer include:
Osteosarcoma begins in the cells that form bones and is the most common type of primary bone cancer. It happens most often in teenagers and young adults, though younger children and older adults can get it too. It is most common in the long bones of the legs and can also occur in the long bones of the arms. A rare, related tumor called extraskeletal osteosarcoma can develop in soft tissue outside the bone.
Chondrosarcoma usually begins in the cartilage cells but can sometimes occur in soft tissue, which includes muscle, fat, blood vessels, nerves, tendons, and the linings of the joints. It happens most often in the pelvis, upper leg, and shoulder, and is most common in middle-aged and older adults.
Ewing sarcoma begins either in the bones or in the soft tissue around the bones. It mostly affects children and young adults, although it can happen at any age. It most often begins in the leg bones and in the pelvis, but it can happen in any bone.
Type | Where it starts | Most common location | Who it affects most |
Osteosarcoma | Cells that form bones | Long bones of the legs; also arms | Teenagers and young adults |
Chondrosarcoma | Cartilage cells (sometimes soft tissue) | Pelvis, upper leg, shoulder | Middle-aged and older adults |
Ewing sarcoma | Bone or soft tissue around bone | Leg bones, pelvis; can be any bone | Children and young adults |
It is also worth knowing that bone tumors can be benign, meaning they are not cancer. Benign bone tumors usually do not spread to other parts of the body, although some may grow and damage nearby bone. Imaging tests can help a healthcare team assess whether a bone tumor is benign or malignant — meaning it could spread — and a biopsy may be needed to confirm the diagnosis.
What are the symptoms of bone cancer?
Signs and symptoms of bone cancer may include bone pain, swelling and tenderness near the affected area, a weakened bone that can lead to a broken bone, feeling very tired, and losing weight without trying.
Symptoms can vary depending on which bone is affected. When bone cancer develops in the long bones of the legs or arms, pain around the knee, thigh, shoulder, or upper arm is common. Bone cancer in the pelvis may cause hip or groin pain. Tumors in the spine can cause back pain, and if they press on nerves, numbness or weakness. Bone cancers involving the skull or jaw may cause swelling, pain, or difficulty swallowing.
These symptoms are more often caused by conditions other than bone cancer. But ongoing pain or swelling should be evaluated by a healthcare professional.
Symptom clue | What it points to |
Bone pain | The most common sign of bone cancer |
Swelling and tenderness near a bone | Possible tumor in the area |
A bone that breaks easily | The tumor weakens the bone |
Pain around knee, thigh, shoulder, or upper arm | Cancer in the long bones of the legs or arms |
Hip or groin pain | Cancer in the pelvis |
Back pain, numbness, or weakness | Cancer in the spine pressing on nerves |
Swelling, pain, or trouble swallowing | Cancer involving the skull or jaw |
Unusual tiredness, unexplained weight loss | General signs that accompany bone cancer |
When should you see a doctor about bone cancer symptoms?
Make an appointment with a doctor or other healthcare professional if you have any symptoms that worry you, such as bone pain or swelling.
Because the same symptoms are more often caused by conditions other than bone cancer, a professional evaluation is what separates reassurance from delay. Ongoing pain or swelling — especially pain that doesn't improve or comes back — is the moment to get it checked.
What causes bone cancer and who is at risk?
The cause of most bone cancers is not known. Bone cancer starts when cells in bone or bone-forming tissue develop changes in their DNA.
A cell's DNA holds the instructions that tell the cell what to do. In healthy cells, DNA gives instructions that help control when cells grow, multiply, and die. In cancer cells, the DNA changes give different instructions — telling the cells to grow and divide when they shouldn't, or to keep living when healthy cells would die. This causes too many irregular cells to accumulate.
The cancer cells might form a mass called a tumor. The tumor can grow to invade and destroy healthy tissue. Over time, cancer cells can break away and spread to other parts of the body — called metastatic cancer, named for the original tumor site.
Most bone cancers are not inherited. A small number are linked to rare inherited genetic conditions, such as Li-Fraumeni syndrome and hereditary retinoblastoma. Having one of these conditions raises the risk of developing some types of bone cancer, but most people diagnosed with bone cancer do not have an inherited syndrome.
Risk factor | How it raises the risk |
Inherited genetic syndromes | Li-Fraumeni syndrome and hereditary retinoblastoma raise the risk of some types of bone cancer |
Other bone conditions | Paget's disease of bone and fibrous dysplasia may increase the risk |
Previous cancer treatment | Radiation therapy and some chemotherapy medicines may raise the risk of bone cancer |
Healthcare professionals have not found any ways to prevent bone cancer. That is an honest limitation, and the best response is awareness: noticing persistent pain or swelling and having it evaluated rather than waiting it out.
How is bone cancer diagnosed?
Your care team may start with a physical exam and a review of your medical history. You may have blood tests to learn more about your overall health or to rule out other conditions. Blood tests alone cannot diagnose bone cancer — imaging tests and a biopsy are usually needed to confirm the diagnosis.
Imaging tests make pictures of the body and can show the location and size of a bone cancer. Tests might include an X-ray, magnetic resonance imaging (MRI), a computerized tomography (CT) scan, a positron emission tomography (PET) scan, or a bone scan.
A biopsy is a procedure that removes a sample of tissue for testing in a lab. For bone cancer, the tissue sample might be collected by inserting a needle through the skin (a needle biopsy) and guiding it into the cancer to collect small samples, or by making an incision in the skin during surgery (a surgical biopsy) and removing a piece of the cancer for testing.
Determining which biopsy to do and how to do it requires careful planning by the medical team. Healthcare professionals need to perform the biopsy in a way that will not interfere with future surgery to remove the bone cancer. Whenever possible, the biopsy should be performed by the team that will treat the bone cancer.
Diagnostic step | What happens | What it shows |
Physical exam and history | The care team examines the painful area and reviews your history | First clues about location and severity |
Blood tests | Checks overall health and helps rule out other conditions | Cannot diagnose bone cancer on its own |
Imaging (X-ray, MRI, CT, PET, bone scan) | Pictures of the body are taken | The location and size of the bone cancer |
Biopsy (needle or surgical) | A tissue sample is removed for lab testing | Confirms the diagnosis and the cancer type |
How is bone cancer treated?
Bone cancer treatments may include surgery, chemotherapy, and radiation therapy. Which treatments are best depends on several factors: the type of bone cancer, its location, and its stage. The healthcare team also considers your overall health and your preferences.
Treatment | How it is used for bone cancer |
Surgery | The goal is to remove all of the cancer. The surgeon removes the bone cancer plus some healthy tissue around it, then repairs the bone with bone from another part of your body or with metal or plastic material |
Chemotherapy | Strong medicines, usually given through a vein, sometimes as pills. Often used after surgery to kill remaining cancer cells, or before surgery to shrink the tumor. Works best for osteosarcoma and Ewing sarcoma; not often used for chondrosarcoma |
Radiation therapy | Powerful energy beams from X-rays, protons, or other sources aimed at precise points. May follow surgery, or control cancer when surgery isn't possible. May be an option for Ewing sarcoma |
Surgery and bone repair
The goal of surgery for bone cancer is to remove all of the cancer. The surgeon may remove the bone cancer and some healthy tissue around it, then repair the bone — possibly using a piece of bone from another part of your body, or repairing the bone with metal or plastic material.
Sometimes this means amputation — removing an arm or leg — to get all of the cancer. This is not common, but it might be needed if the cancer grows very large, if it is in a place that makes surgery difficult, or if important nerves, blood vessels, or other structures are involved. After an arm or leg is removed, you may choose to use an artificial limb, and with training and time, you can learn to do many everyday tasks.
Chemotherapy
Chemotherapy treats cancer with strong medicines. Many chemotherapy medicines exist; most are given through a vein, and some come in pill form.
Chemotherapy is often used after surgery for some types of bone cancer. It can kill any cancer cells that remain and lower the risk that the cancer will come back. Sometimes chemotherapy is given before surgery to shrink a bone cancer and make it easier to remove.
Not all types of bone cancer respond to chemotherapy. It is often used to treat osteosarcoma and Ewing sarcoma. It is not often used for chondrosarcoma, but may be used for certain uncommon subtypes.
Radiation therapy
Radiation therapy treats cancer with powerful energy beams. The energy can come from X-rays, protons, or other sources. During treatment, you lie on a table while a machine moves around you, directing radiation to precise points on your body.
Radiation therapy might be used after surgery to kill any bone cancer cells that might remain. It also might help control bone cancer when surgery is not an option.
Some types of bone cancer are more likely to be helped by radiation than others. Radiation therapy may be an option for treating Ewing sarcoma. It is not often used to treat chondrosarcoma or osteosarcoma, but may be used when surgery cannot remove the tumor completely.
How can people cope with bone cancer and find support?
A cancer diagnosis can feel overwhelming. With time, most people find ways to cope with the distress and uncertainty of cancer. Until then, a few approaches help.
Learn enough about bone cancer to make decisions about your care. Ask your healthcare team about your bone cancer, including your treatment options and, if you like, your prognosis. As you learn more, you may feel more confident in making treatment decisions.
Keep friends and family close. Strong relationships help you deal with bone cancer — friends and family provide practical support, such as help at home when you are in the hospital, and emotional support when you feel overwhelmed.
Find someone to talk with. A good listener — a friend, family member, counselor, medical social worker, clergy member, or a cancer support group — can make a real difference. Ask your healthcare team about support groups in your area.
How do you prepare for your appointment?
If you have any symptoms that worry you, start by making an appointment with a doctor or other healthcare professional. If bone cancer is suspected, you may be referred to a specialist. Bone cancer is often treated by a team that may include orthopedic surgeons (who operate on bones and joints), orthopedic oncologists (who specialize in cancers affecting the bones), medical oncologists (cancer medicine), hematologists (blood and bone marrow conditions), radiation oncologists (radiation treatment), pathologists (tissue analysis), and rehabilitation specialists (recovery after surgery).
What you can do. Because appointments can be brief, prepare ahead of time. Ask whether there are restrictions to be aware of before the appointment, such as diet limits. Write down all your symptoms, including any that may seem unrelated. Write down key personal information, such as major stresses or recent life changes. Make a list of all medicines, vitamins, or supplements you are taking, with doses. Consider bringing a family member or friend — someone with you may remember things you miss. Bring previous scans or X-rays, reports, and other medical records related to this situation.
Questions worth asking include: What type of bone cancer do I have? What is the stage of my bone cancer? How quickly is it growing? Will I need additional tests? Should my biopsy or treatment be done at a center that specializes in bone cancer? What are the treatment options? What are the chances that treatment will cure my bone cancer? What are the side effects and risks of each option? Will treatment make it impossible for me to have children? How will treatments affect my other health conditions? Is there one treatment you think is best for me? What would you recommend to a friend or family member in my situation? Should I see a specialist, what will it cost, and will insurance cover it? If I would like a second opinion, can you recommend a specialist? Are there printed materials or websites you recommend?
What to expect from your doctor. Be prepared to answer questions such as: When did you first begin experiencing symptoms? Have they been ongoing, or do they come and go? How severe are they? What, if anything, seems to improve them?
What is the bottom line on bone cancer?
The word "bone cancer" covers several different conditions, and the distinctions matter. Primary bone cancer starts in the bone itself — most often the femur — and is a separate disease from cancer that spreads to bone or from multiple myeloma. Its three main types each follow their own pattern: osteosarcoma in the long bones of younger people, chondrosarcoma in the pelvis and shoulders of older adults, and Ewing sarcoma in children and young adults.
The warning signs are worth taking seriously, even though they are usually caused by something else. Ongoing bone pain, swelling, a bone that breaks too easily, unexplained tiredness, or unexplained weight loss all deserve a professional evaluation — and the diagnosis path is clear: exam, imaging, and biopsy, planned so that the biopsy never interferes with the surgery that may follow.
Treatment combines surgery, chemotherapy, and radiation in ways that depend heavily on the type of cancer — which is exactly why knowing the specific type and stage drives every decision. Bone cancer is rare and serious, and a center experienced in treating it is one of the most important factors you can control. If you have persistent bone pain or swelling, do not wait it out: make the appointment.
Next steps: See a healthcare professional if you have ongoing bone pain, swelling, or a bone that breaks more easily than it should.
FAQ
Is bone cancer the same as cancer that spreads to the bone?
No. Bone cancer (primary bone cancer) starts in the bone itself. Cancer that starts elsewhere — such as breast, prostate, or lung cancer — and spreads to the bones is called bone metastasis. They develop from different cells and may need different treatments. Multiple myeloma, which starts in the bone marrow, is different again.
What does bone cancer pain feel like?
Bone cancer may cause bone pain along with swelling and tenderness near the affected area, a weakened bone that can break easily, unusual tiredness, and unexplained weight loss. Where the pain occurs depends on the bone involved: the knee, thigh, shoulder, or upper arm for the long bones; hip or groin for the pelvis; back pain or numbness for the spine.
Who gets bone cancer?
Bone cancer is rare, and different types strike different ages. Osteosarcoma is most common in teenagers and young adults, chondrosarcoma is most common in middle-aged and older adults, and Ewing sarcoma mostly affects children and young adults. Risk is also raised by rare inherited syndromes such as Li-Fraumeni syndrome, certain bone conditions such as Paget's disease of bone, and previous radiation therapy or some chemotherapy.
How is bone cancer confirmed?
Blood tests alone cannot diagnose bone cancer. The diagnosis usually requires imaging tests — X-ray, MRI, CT, PET scan, or bone scan — plus a biopsy that removes tissue for lab testing. The biopsy must be carefully planned so it does not interfere with future surgery, and it should ideally be performed by the team that will treat the cancer.
Can bone cancer be prevented?
Healthcare professionals have not found any ways to prevent bone cancer, since the cause of most bone cancers is not known. The best practical response is attention: persistent bone pain or swelling should be evaluated rather than ignored.
Disclaimer: This article is for general informational purposes only and does not constitute medical advice. Always consult a qualified health care provider for individual questions.
Related Reading
Foot X-Ray: What It Shows, Why It's Done, What to Expect and Results explains the imaging test commonly used to diagnose this condition in the foot and ankle.
Bone Scan: What It Shows, How It's Done, Results and Risks explains the nuclear medicine scan that finds cancer spread, fractures and infection in bone.
References
Mayo Clinic Staff. Bone cancer - Symptoms and causes. Mayo Clinic. August 13, 2026. https://www.mayoclinic.org/diseases-conditions/bone-cancer/symptoms-causes/syc-20350217
Mayo Clinic Staff. Bone cancer - Diagnosis and treatment. Mayo Clinic. August 13, 2026. https://www.mayoclinic.org/diseases-conditions/bone-cancer/diagnosis-treatment/drc-20350221
Hosseini H, et al. Bone tumors: a systematic review of prevalence, risk determinants, and survival patterns. BMC Cancer. 2025;25(1):321. PMID 39984867. https://doi.org/10.1186/s12885-025-13720-0
Smeland S, et al. Survival and prognosis with osteosarcoma: outcomes in more than 2000 patients in the EURAMOS-1 (European and American Osteosarcoma Study) cohort. Eur J Cancer. 2019;109:36-50. PMID 30685685. https://doi.org/10.1016/j.ejca.2018.11.027
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