Bone Tumors

At UT Southwestern Medical Center, our cancer and orthopedic specialists combine the latest research and expertise to provide multidisciplinary care for people with bone tumors and bone cancer.

Multidisciplinary Care for Bone Tumors

Bone tumors form when cells within any part of any bone begin to grow uncontrollably. Most bone tumors are benign (not cancerous) and not life-threatening. Malignant (cancerous) bone tumors, while much less common, are much more dangerous and can spread to other parts of the body. 

Even benign tumors can destroy bone tissue and weaken bones, increasing the risk of fractures. Treatment for a bone tumor depends on its type:

• Benign tumors are frequently found incidentally with another injury or medical complaint. Usually, we monitor benign bone tumors over time. If the tumor changes or becomes symptomatic, then surgical removal can be performed.
• Malignant tumors, or bone cancer, can require chemotherapy, radiation therapy, surgery, or a combination of treatments.

Specialists at UT Southwestern take a team approach, with doctors in the Simmons Cancer Center collaborating with orthopedic surgeons. Our focus on research means that we can provide our patients with the latest advancements in treatment in order to provide the best possible outcomes and quality of life.

Types of Bone Tumors

Benign Bone Tumors

The most common types of benign bone tumors include enchondromas, osteochondromas, nonossifying fibromas, giant cell tumors, chondroblastomas, and osteoid osteomas.

Most benign bone tumors develop in adolescents and young adults. Some benign bone tumors are locally aggressive and can cause bone destruction or fracture. We usually recommend medical and/or surgical treatment for these conditions.

Malignant Bone Tumors (Bone Cancer)

• Primary bone cancer is cancer that begins growing in a bone or cartilage. Types of primary bone cancer are:
• Osteosarcoma: The most common primary bone cancer in children; this tends to occur in the knee or shoulder.
• Multiple myeloma: The most common primary bone cancer in adults; multiple myeloma develops in bone marrow, the tissue inside bones that makes blood cells.
• Chrondrosarcoma: More common in adults, this is cancer originating from cartilage-producing cells typically found in the hips, pelvis, shoulders, or knees.
• Ewing’s sarcoma: This bone cancer typically affects children, adolescents, and young adults, usually in the legs, pelvis, upper arms, or ribs.

Secondary bone cancer, or metastatic bone cancer, is cancer that begins growing elsewhere in the body and spreads to bones. Certain cancers are more likely to metastasize (spread) to bones, such as:

• Breast cancer
• Kidney cancer
• Lung cancer
• Lymphoma
• Myeloma
• Prostate cancer
• Thyroid cancer

Causes and Risk Factors for Bone Tumors

The causes of most bone tumors are unknown, but certain factors can increase a person’s risk of developing them. These factors include:

• Hereditary conditions such as hereditary multiple exostoses, Maffucci syndrome, Ollier disease, Paget’s disease, Li-Fraumeni syndrome, retinoblastoma, or Rothmund-Thomson syndrome
• Previous treatment for cancer, especially high-dose radiation therapy 

Symptoms of Bone Tumors

Benign bone tumors might not produce any symptoms. Certain symptoms, such as bone pain, can occur in other conditions. Some symptoms of benign or cancerous bone tumors include:

• Dull ache in the affected bone, which might be worse at night or with activity
• Painless tissue growth or swelling near the tumor site
• Fever
• Night sweats
• Fractures that can occur even with minor injury

Diagnosis of Bone Tumors

Symptoms of bone tumors can resemble those of other conditions, so our doctors will perform a complete evaluation to confirm a bone tumor and determine which type it is.

Doctors begin with the patient’s medical history, including reviewing any family history of cancer or other tumors and discussing symptoms, and then will conduct a physical exam to check for signs of a bone tumor and rule out other conditions.

Additional tests that can help diagnose bone tumors include:

Imaging studies: We might recommend one or more types of imaging to find bone tumors, such as:

• X-ray is the main imaging test for bone tumors.
• Bone scan is a nuclear imaging test in which patients receive a small amount of radioactive material before having X-rays to highlight any abnormal bone tissue.
• Computed tomography (CT) scan uses specialized X-rays to produce cross-sectional images of bones to look for bone abnormalities.
• Magnetic resonance imaging (MRI) scan uses radio waves and a powerful magnet to produce detailed images of bones to check for problems.

Blood or urine tests: These tests check for certain substances released into the bloodstream or urine when bones are damaged or have abnormal tissue growth. Doctors often use blood tests to monitor benign bone tumors. 

Biopsy: We might take a biopsy (small tissue sample) to confirm bone cancer if we cannot diagnose it using the other tests above. If a biopsy is needed, the doctor uses CT scans to guide a needle into a suspicious area in the bone to remove a sample. The sample is examined under a microscope for signs of cancer.

Treatment for Benign Bone Tumors

For benign bone tumors, patients might need only observation (monitoring) if the tumor is not causing symptoms. Some tumors, especially those that affect children, can shrink or even go away over time. At UT Southwestern, our doctors monitor bone tumors using imaging tests to determine growth or blood tests to check for certain substances that can indicate changes in bone tumors.

Patients might need surgery to remove a benign bone tumor if the tumor:

• Begins to cause symptoms or interfere with functionality 
• Is a type that can become cancerous
• Increases the risk of bone fractures

Treatment for Cancerous Bone Tumors

Primary Bone Cancer

For primary bone cancer, doctors usually begin treatment with staging, or identifying how advanced the cancer is. Generally, for osteosarcoma or Ewing’s sarcoma, a patient will start with chemotherapy. Next, surgery is performed to remove all of the tumor. The surgeon then reconstructs the missing bone using a variety of techniques. Depending on the type of bone cancer, patients might need additional chemotherapy and/or radiation therapy to destroy any cancer cells that remain after surgery. 

Depending on how advanced the bone cancer is, patients might need different types of surgery:

• Limb-salvage surgery: Surgeons remove the entire tumor along with all muscle and bone involved with the tumor. The goal is to remove every tumor cell, including a margin of normal tissue. Surgeons then reconstruct the limb with large joint replacements (metal endoprostheses) or cadaver bone. Sometimes surgeons augment these surgeries with bone grafts from the patient.
• Amputation: Surgeons might need to remove all or part of a limb if the bone tumor is large or has spread to nearby nerves or blood vessels. Patients can choose to have a prosthetic limb after amputation surgery.
• Curettage: Surgeons can remove some bone tumors without removing any bone, leaving a hole in the bone. Surgeons rebuild the hole with bone cement or bone grafts.
• Cryosurgery: Treatment using extreme cold can destroy any remaining cancer cells after curettage. Surgeons also use bone cement or grafts after cryosurgery to rebuild bone.
• Bone cement: Surgeons can use bone cement to rebuild bones after curettage or cryosurgery. Bone cement is a liquid that produces intense heat as it hardens, destroying any remaining cancer cells.

Radiation therapy uses high-energy radiation to destroy cancer cells. Radiation is most effective for secondary bone cancer (bone metastasis), multiple myeloma, or Ewing’s sarcoma. We also use radiation for soft-tissue sarcomas. Generally, radiation is not effective for chondrosarcoma or osteosarcoma. 

Chemotherapy is anticancer medications given by mouth or injection to destroy cancer cells or slow their growth. Doctors often use chemotherapy to treat osteosarcoma, multiple myeloma, Ewing’s sarcoma, and metastatic bone cancer. Chemotherapy is usually not effective for treating chondrosarcoma.

Secondary (Metastatic) Bone Cancer

Secondary, or metastatic, bone cancer is treated with the same methods as the original cancer. For example, lung cancer that has spread to bones is treated with the same methods as primary lung cancer. 

Metastatic cancer is very difficult to cure, and the goal of treatment is to prolong life and minimize symptoms by slowing the cancer’s growth. 

Clinical Trials

As a medical research institution, UT Southwestern conducts frequent clinical trials, giving our patients access to the newest treatments for bone tumors. Patients should speak with their doctors about the availability of clinical trials.