Bone cancer refers to malignant tumors that start in bone tissue (primary bone cancers) or cancers from other parts of the body that have spread to the bones (secondary bone cancers). People with bone cancer most often notice persistent bone pain, swelling, or a lump; sometimes a weakened bone breaks (a pathologic fracture). Less specific symptoms can include fatigue, fever, or weight loss, which may also be caused by other conditions. This article provides clear, reliable information about what bone cancer is, the main types, typical symptoms, how doctors diagnose it, and common treatment options—so you know when to seek care and what to expect. If you have persistent or worsening bone pain, see your doctor or go to the tests and diagnosis section below for next steps.

What Is Bone Cancer?

Bone cancer describes malignant tumors that develop in bone tissue (primary bone cancers) or cancers that reach the bones after starting elsewhere in the body (secondary bone cancers, also called bone metastases). Primary bone cancers are relatively rare; most cancers found in bone are metastases from other parts of the body, most commonly the breast, prostate, and lungs. When cancer cells form a mass in bone, they can destroy normal bone tissue and weaken the bone, which may cause pain or fractures.

Key facts:

  • Primary bone cancer (for example, osteosarcoma, Ewing sarcoma, chondrosarcoma) starts in the bone itself and is uncommon compared with metastatic bone disease.
  • Secondary bone cancers (bone metastases) occur when cancer spread from another organ to the bones; breast, prostate, and lung cancers are frequent sources.
  • Symptoms, stage at diagnosis, and prognosis depend on the type of bone cancer, how far it has spread, and the person’s age and overall health.

For readers looking for concise information: primary bone cancers account for a small fraction of all cancers, while bone metastases are far more common. Because treatment and outcomes differ between primary and secondary bone cancers, doctors will order specific tests to confirm the diagnosis and stage the disease before recommending treatment. See the diagnosis and treatment sections below to learn what tests doctors use and which treatments are typically recommended.

What Causes Bone Cancer?

The exact cause of most primary bone cancers is not fully understood. However, several known risk factors can increase the likelihood that abnormal cells in bone will form a tumor. Some factors are strongly linked to bone cancer development, while others are associated more weakly or only in specific situations.

  • Radiation exposure — High-dose radiation (for example, radiation therapy used to treat another cancer) can increase the long-term risk of developing a sarcoma in bone or soft tissue. This is a recognized risk, though secondary radiation-induced bone cancers are uncommon.
  • Inherited genetic conditions — Certain hereditary syndromes raise risk. Examples include Li‑Fraumeni syndrome and hereditary retinoblastoma, which are linked to higher rates of osteosarcoma. Genetic counseling is recommended for people with a strong family history of cancer.
  • Paget’s disease of bone — Long-standing Paget’s disease (a disorder of abnormal bone remodeling) modestly increases the risk of developing osteosarcoma in older adults, but most people with Paget’s disease do not get cancer.
  • Presence of other cancers — Many cancers (for example, breast, prostate, and lung) commonly spread to bone. These are secondary bone cancers (metastases) rather than cancers that begin in bone tissue.
  • Growth and development factors — Osteosarcoma has a peak incidence in adolescents and young adults, often at sites of rapid bone growth (near the knee). Rapid bone growth during puberty is thought to be one of several contributing factors, though it is not a proven direct cause.

What is NOT a cause: Everyday activities such as routine exercise, sports, or minor bumps do not cause bone cancer. Most people with these risk factors will never develop bone cancer.

If you have a personal or family history that raises concern (for example, known genetic syndromes or prior high‑dose radiation), talk with your doctor about genetic counseling and appropriate monitoring. For general concerns about persistent bone pain or unusual symptoms, see the diagnosis section below to learn what tests doctors use to investigate possible bone cancers.

What Are the Symptoms of Bone Cancer?

Bone cancer can develop in any bone but most often appears in long bones such as the thigh (femur), shin (tibia), and upper arm (humerus). People with bone cancer commonly notice persistent, worsening pain at the site of the tumor — sometimes described as aching, throbbing, or sharp — and they may feel a lump or swelling. Because early symptoms can be vague, bone cancer is sometimes mistaken for an injury or growing pains, especially in children and adolescents.

Local symptoms (at the affected bone):

  • Persistent bone pain that gets worse over weeks to months or is worse at night
  • Swelling or a palpable lump over the bone
  • Tenderness and reduced movement in the nearby joint or limb (for example, reduced use of an arm or leg)
  • Pathologic fracture — a bone that breaks with minimal trauma because it has been weakened by a tumor

Systemic symptoms (may affect the whole body):

  • Unexplained fatigue
  • Unintended weight loss
  • Fever or night sweats (less common but possible)
  • Signs of anemia (pale skin, shortness of breath) if blood counts are affected

When to see a doctor: See your doctor if you have persistent bone pain lasting more than 2–4 weeks, pain that wakes you at night, a growing lump on or near a bone, sudden bone weakness, or a fracture after minor injury. For children and young adults, persistent limb pain or new limping should prompt evaluation because osteosarcoma and Ewing sarcoma are more common in these age groups.

Symptoms by type (brief): Osteosarcoma often causes localized pain and swelling near the knee (distal femur or proximal tibia); Ewing sarcoma commonly affects the pelvis, femur, shoulder, and ribs and may present with pain and systemic symptoms such as fever; chondrosarcoma tends to occur in adults and may cause a slow-growing mass and pain. Exact symptoms vary with tumor type, location, and stage.

If you experience severe pain, signs of a broken bone, or sudden loss of function, seek emergency care. Otherwise, make an appointment with your primary care doctor or an orthopedic specialist to begin the diagnostic process (see the diagnosis/tests section for details on imaging and biopsy).

Types of Bone Cancer

Primary bone cancers are a group of rare cancers that begin in bone tissue. Different types arise from different bone cells or supporting tissues (for example, bone-forming cells or cartilage). Below are the main types of primary bone cancer, with fast facts about who is most likely to get them, where they usually occur, and how they typically present.

  • Osteosarcoma: Fast facts — most common in adolescents and young adults but can affect any age; often found near the knee (distal femur, proximal tibia) or in the proximal humerus (upper arm). Osteosarcoma arises from bone-forming cells and typically causes localized pain and swelling; it often occurs at the ends of long bones where growth is most active. Osteosarcoma is one of the primary bone cancers most frequently treated with a combination of chemotherapy and surgery.
  • Chondrosarcoma: Fast facts — most commonly diagnosed in adults aged about 30–60; originates from cartilage-forming cells and frequently affects the pelvis, hip, shoulder, and long bones. Chondrosarcoma tends to grow more slowly than osteosarcoma and may present as a gradually enlarging mass with pain. Many low-grade chondrosarcomas are treated primarily with surgery because they are less responsive to chemotherapy and radiation.
  • Ewing Sarcoma: Fast facts — most often seen in children, adolescents, and young adults (peak in teens and young adults); commonly affects the pelvis, femur (thigh bone), ribs, and shoulder girdle. Ewing sarcoma arises from the bone or nearby soft tissues and commonly causes pain, swelling, and sometimes systemic symptoms such as fever. Ewing sarcoma is usually treated with combination chemotherapy, surgery, and/or radiation.
  • Spindle cell and other rare sarcomas: Fast facts — this category includes several uncommon tumor types (for example, spindle cell sarcomas or undifferentiated pleomorphic sarcoma when it involves bone). These are more often seen in adults and can appear in leg bones or other sites. Terminology and classification have evolved, so some tumors previously labeled “spindle cell sarcoma” may now be classified differently; pathology review at a specialized center is important for precise diagnosis and treatment planning.

How these types compare (quick reference)

  • Age: Osteosarcoma and Ewing sarcoma lean younger (children, teens, young adults); chondrosarcoma and many spindle cell tumors are more common in adults.
  • Common sites: Osteosarcoma — near the knee and upper arm; Ewing — pelvis, femur, ribs; Chondrosarcoma — pelvis, hip, shoulder; spindle/other — variable.
  • Treatment sensitivity: Osteosarcoma and Ewing are generally more responsive to chemotherapy; chondrosarcoma is often less chemosensitive and relies more on surgery.

Practical notes: Accurate pathology (tissue diagnosis) and staging are essential because treatment and prognosis vary widely by type and grade. If you or someone you know is diagnosed with a bone tumor, ask whether the case has been reviewed by or referred to a sarcoma center or a multidisciplinary team with experience in primary bone cancers — this improves access to specialized care, surgery options (including limb-sparing techniques), and clinical trials.

For more detail on each tumor type (typical imaging findings, staging, and standard treatments), see the diagnosis and treatment sections below or consult authoritative sources such as the National Cancer Institute and the American Cancer Society.

What is Bone Marrow Cancer?

“Bone marrow cancer” is a lay term for cancers that originate in the marrow — the soft, spongy tissue inside bones that makes blood cells. These cancers include multiple myeloma and certain leukemias. Because they affect blood-cell production and often involve the bone marrow environment, they are commonly grouped under the broader label of blood cancers rather than primary bone cancers, which start in the bone tissue itself.

Two common marrow cancers

Multiple myeloma: A cancer of plasma cells (a type of white blood cell) that most often affects adults, typically older than 50–60 years. Myeloma frequently causes bone pain (often in the back or ribs), anemia, increased risk of fractures, and high calcium levels. Diagnosis commonly involves blood tests (including serum protein electrophoresis), urine tests, imaging (X-ray, MRI, or PET/CT), and a bone marrow biopsy.

Leukemia: A group of cancers affecting blood-forming cells in the bone marrow. Symptoms vary by leukemia type but can include fatigue, easy bruising or bleeding, frequent infections, and sometimes bone pain. Diagnosis is typically made with blood tests and a bone marrow biopsy; treatment often involves systemic therapies such as chemotherapy, targeted agents, or sometimes stem cell transplant.

Important distinction: marrow cancers are more common than primary bone cancers and are treated differently because they arise from blood cells rather than from bone-forming or cartilage cells. If marrow involvement is suspected, doctors will order specific tests such as blood counts, serum protein studies (for myeloma), imaging, and bone marrow biopsy to confirm the diagnosis and guide treatment.

If you have unexplained bone pain, persistent fatigue, recurrent infections, or abnormal blood tests, discuss these symptoms with your doctor — early evaluation and the right tests (for example, bone marrow biopsy or specific blood studies) are important for diagnosis and timely treatment.

How is Bone Cancer Treated?

Treatment for bone cancer depends on the type of primary bone cancer, the tumor’s size and location, whether the cancer has spread (stage), and the person’s age and overall health. Care is usually coordinated by a multidisciplinary team at a sarcoma or cancer center and often combines surgery with systemic and local therapies to remove or control cancer and preserve function.

Surgery

When used: For many primary bone cancers, surgery is the mainstay of treatment to remove the tumor and achieve clear margins. Limb-sparing (limb-salvage) procedures are now possible in most cases; amputation is reserved for tumors that cannot be removed safely while preserving function.

What it involves: Tumor resection with reconstruction using metal implants, bone grafts, or endoprostheses; sometimes complex joint reconstruction or rotationplasty. Surgery may follow preoperative therapy to shrink the tumor or be performed after systemic treatment to remove residual disease.

Common issues and recovery: Risks include infection, implant problems, and need for further surgeries; coordinated rehabilitation and prosthetic care are vital for return to function.

Chemotherapy (Systemic Drug Therapy)

When used: Chemotherapy is commonly used for osteosarcoma and Ewing sarcoma to treat micrometastatic disease, shrink tumors before surgery, and reduce recurrence risk. Chondrosarcoma is generally less responsive to chemotherapy.

What it involves: Multi‑drug regimens (for example, osteosarcoma regimens often include agents such as high‑dose methotrexate, doxorubicin, and cisplatin—commonly referenced as MAP) are given in cycles. Treatment is delivered by medical oncologists with supportive care to manage side effects.

Side effects: Nausea, fatigue, low blood counts, hair loss, and increased infection risk; antiemetics and growth‑factor support can reduce some risks.

Radiation Therapy

When used: Radiation can be used when surgery would be too damaging, to control local disease, or as part of combined therapy (for example, for Ewing sarcoma or palliation of bone metastases). Preoperative radiation may shrink tumors to aid surgery.

Common effects: Local skin irritation, fatigue, and long‑term effects depending on dose and site (for example, effects on growth in children); modern techniques reduce exposure to healthy tissue.

Targeted Therapy and Immunotherapy

When used: Targeted therapies attack specific molecular features of cancer cells and are used when tumors have actionable mutations. Immunotherapy (checkpoint inhibitors and other approaches) is an area of active research and may be appropriate for certain patients or within clinical trials.

Side effects: Fatigue, nausea, changes in liver tests, skin reactions, and immune-related effects for immunotherapy (autoimmune inflammation of organs); management requires close monitoring.

Local and Other Drug Approaches

Some therapies are delivered locally (for example, intra‑arterial infusion, embolization, or intralesional injections) to control bleeding, reduce tumor bulk, or relieve pain for metastatic lesions. Bisphosphonates or denosumab may be used to strengthen bone and reduce fracture risk in metastatic disease.

Rehabilitation, Survivorship, and Palliative Care

Comprehensive treatment includes rehabilitation (physical and occupational therapy), pain management, prosthetic services if needed, psychosocial support, and survivorship planning. For advanced or metastatic disease, palliative care focuses on symptom control and quality of life and can be provided alongside curative‑intent treatments.

Clinical Trials and Specialized Care

Because primary bone cancers are rare, clinical trials can provide access to new targeted drugs, immunotherapies, and combination treatments. Ask your care team about clinical trials (for example, through clinicaltrials.gov) and consider evaluation at a high‑volume sarcoma center where multidisciplinary expertise can improve treatment planning and outcomes.

Summary (standard of care by type): Osteosarcoma and Ewing sarcoma — combination chemotherapy plus surgery (often limb-sparing) ± radiation; chondrosarcoma — primarily surgical management with limited chemotherapy benefit for most cases; metastatic bone disease — systemic therapy for the primary cancer, local control for painful lesions, bone‑strengthening agents, and palliative measures.

If you or a loved one is facing a bone cancer diagnosis, seek care from a multidisciplinary team experienced in sarcomas, ask about clinical trials, and discuss rehabilitation and long‑term follow‑up as part of the treatment plan. For specific tests used to stage disease and guide treatment decisions, see the diagnosis section.

Conclusion

Bone cancer includes rare primary bone cancers (like osteosarcoma, Ewing sarcoma, and chondrosarcoma) that start in bone tissue and much more common secondary cancers that spread to bone from other organs. Symptoms often include persistent or worsening bone pain, swelling, or a lump, but signs vary by type and age — adolescents and young adults are more likely to develop osteosarcoma or Ewing sarcoma, while chondrosarcoma tends to occur in adults.

  • Key takeaways: Accurate diagnosis (imaging and biopsy) and classification are essential because treatment and prognosis differ by type and stage.
  • Treatment commonly combines surgery with chemotherapy and/or radiation depending on the tumor; specialized multidisciplinary care improves outcomes.
  • Clinical trials may offer access to newer targeted or immunotherapy options and are worth discussing with your care team.

If you have symptoms: see your doctor if you have persistent bone pain (especially pain that gets worse at night or after a few weeks), a growing lump, or a fracture after minor injury. Ask for timely tests and, if diagnosed, consider evaluation at a sarcoma center for expert care and to learn about treatment and clinical trials.

For reliable information and help finding specialized care, consult resources such as the National Cancer Institute and the American Cancer Society, and talk with your healthcare team about next steps for diagnosis, treatment, and long‑term follow‑up.