Bone Cancer

January 22, 2026

This page was reviewed under our medical and editorial policy by Lee Cranmer, M.D., Ph.D., professor, Department of Medical Oncology & Therapeutics Research, City of Hope^® Cancer Center Duarte.

Cancer in the bone and bone cancer are different. Cancer may be in bones, either because it spread there from another site (secondary bone cancer), or because it arose in the bone in the first place (primary bone cancer).

Cancer that has spread to the bone is much more common. For example, patients with breast cancer and lung cancer may develop metastatic tumors (new tumors that have spread from the original site) in the bone. These cancers in the bone are still breast or lung cancer, but they have now metastasized to the bone. They may be treated with specific treatments that are used when cancer is present in the bone, but they are also treated with treatments used for the original cancer.

In contrast, true bone cancer, originating in the bone, is a relatively uncommon condition. There are a variety of types of cancer that can arise in the bone and which might be referred to using the term “bone cancer.” In the United States this year, approximately 4,100 people will be diagnosed with bone cancer arising in the bone itself. Approximately 2,000 people will die of these conditions.

What Is Bone Cancer?

Bone cancer is a disease that occurs when cells in the bones begin to multiply out of control and then form into tumors. A tumor is generally viewed as a collection of cells that may be seen in some manner, such as by examination or X-rays. To be cancerous, a bone tumor needs to have the ability to spread to other parts of the body, which may occur through the blood. In other organs, such as the lungs, the cancerous cells may take up residence and begin to multiply, forming tumors in those distant organs. At some point, the tumors may become large and numerous enough to interfere with the function of that distant organ. At some point, that may endanger the function of a vital organ, and thereby endanger someone’s life.

Only a small number of bone tumors are cancerous. Bone tumors may be identified because people experience weakness or pain in the joints or bones. They may also be identified “incidentally.” This means that someone is having a medical test, often an X-ray, for another purpose and a bone tumor is seen on that X-ray. This may happen even if someone is having no symptoms from the tumor at all. Again, most of these tumors are benign, meaning that they are not cancerous. It sometimes requires an evaluation by an experienced specialist in orthopedics to determine whether a tumor is worrisome for being cancerous or not.

People may be diagnosed with either primary or secondary bone cancer, as described above.

Bone Cancer Symptoms

People with bone cancers may experience different symptoms depending on which type of the disease they have and which bones or other organs are involved. However, some common symptoms and signs of bone cancer include:

• Pain in the joints or bones that may get worse and does not get better by itself
• A lump or mass on a bone that may be felt through the skin
• Bone weakness or fractures (breaks). A fracture of a bone that is unexpected may be the first sign of bone cancer.
• Red or swollen areas around a bone or joint

To be cancerous, the cells in the bone tumor must be able to spread to other parts of the body. In some people, the first symptom they experience occurs because the disease has already spread. The lungs are a common place where this may occur. In that circumstance, there may be no pain or other symptoms in the site where the cancer arose. Instead, patients may have symptoms such as shortness of breath or coughing up blood due to tumors in the lungs. People may have other symptoms, depending on where the cancer may have spread.

What Does Bone Cancer Feel Like?

Most people first experience bone cancer pain as a tenderness around a particular bone that then develops into an ongoing ache or soreness. That being said, this type of discomfort may also occur with many other conditions, a vast majority of which are not cancer.

Cancer pain does not get better by itself. It is persistent (meaning that it does not go away when resting or sleeping) and generally gets worse over time. If pain does not get better, that would be a reason to seek medical attention to determine the cause. In most cases, it will not be due to cancer.

Bone Cancer Causes

Researchers do not know what causes most primary bone cancers. Scientists are studying the different types of bone cancer to find out more about how they develop and why. Some factors may increase a person’s risk of developing primary bone cancer.

Risk Factors

Most of the known risk factors for developing bone cancer account for only a small number of cases – and different types of primary bone cancer may have different risk factors. But some risk factors that may be common to all types of bone cancer are:

• Age: Bone cancers may occur in children and young adults, as well as in older persons. They are less common among adults in the 30- to 50-year-old age range.
• Previous exposure to radiation therapy, usually during treatment for cancer earlier in life
• Having certain genetic conditions, in particular those that cause benign bone tumors (called multiple exostoses and multiple enchodromatosis)
• Suffering from Paget’s disease of the bone, a condition that tends to affect people over 50 and causes the bones to become more brittle

Is Bone Cancer Hereditary?

In a small number of cases, bone cancer may be caused by genetic mutations someone inherits from a parent. However, most research suggests that the majority of bone cancers are not inherited. Scientists are continuing to study the causes of bone cancer.

Types of Bone Cancer

There are many different types of bone cancer. Some are quite rare. Among the more common groups are:

Chondrosarcoma: This type of cancer starts in the cartilage, which is the tissue between bones and around the joints. It usually affects adults over 40.

Chordoma: This very rare cancer develops adjacent to the spine. Commonly, these develop either at the bottom of the skull or in the pelvis. Chordomas are more common in older adults.

Ewing sarcoma: This type of cancer most frequently develops in the legs, pelvis or ribs and predominantly affects children aged 10 to 20. However, there are cases which develop outside of bones (called “extra-skeletal”). The disease may also occur in people outside of this age range.

Osteosarcoma: This type of cancer begins in the cells that make up bones. It is most often found near the shoulder or knee and is most common in children and young adults. A second age range affected are people in their 50s to 70s.

Diagnosis and Testing

Doctors use a variety of tests to diagnose bone cancer. These tests may tell whether a growth is cancerous or not. They may also help determine whether someone has primary bone cancer or secondary bone cancer, meaning cancer that has spread from another part of the body.

Some of the most common tests include:

• A physical exam that includes reviewing a patient’s medical history
• Imaging tests, such as magnetic resonance imaging (MRI), X-ray, positron emission tomography (PET) or computed tomography (CT) scans, or a bone scan A biopsy, which takes a small sample of tumor to look for cancer cells.
• A biopsy is ultimately the way in which cancer is diagnosed with certainty. Other tests may suggest a cancer diagnosis, but it is confirmed by biopsy.

Bone Cancer Stages

When cancer is diagnosed, doctors use the TNM staging system to stage the cancer based on how widespread it is. The TNM system assesses the size of a tumor (T), how many lymph nodes (N) the cancer has affected and whether the cancer has spread, or metastasized (M), to other parts of the body. They may also examine sample cells taken from a tumor and characterize the cancer as low grade or high grade, depending on what the cells look like and whether they grow slowly or quickly.

High-grade tumors tend to have a higher chance of spreading to other parts of the body and may therefore endanger a patient’s life sooner. The grade of a cancer may be suggested by its appearance on imaging and its clinical behavior. However, the determination of grade is ultimately made by a pathologist looking at the tumor microscopically after a biopsy.

Bone cancer may be classified as stage 1, 2, 3 or 4, depending on how much of the body it affects, whether it has spread beyond the original site of the tumor and whether it is low or high grade. Staging criteria may also be different for different types of bone cancer.

Stage 1 Bone Cancer

At stage 1, bone cancer is contained to the bone where it started. There may be one or several smaller tumors. It is low grade.

Stage 2 Bone Cancer

Stage 2 bone cancer is also contained to a single bone, but tumors may be larger and it is classified as high grade.

Stage 3 Bone Cancer

At stage 3, there are multiple bone cancer tumors in the same bone and the cancer is high grade. However, it has not spread to other parts of the body.

Stage 4 (Metastatic) Bone Cancer

In stage 4 (or metastatic) bone cancer, the cancer has spread to other parts of the body, such as the brain, lungs or lymph nodes. It may be low or high grade.

Bone Cancer Treatment

Many treatment options are available for patients with bone cancer. Which treatment plan is most effective depends on a number of factors, such as which type of bone cancer a patient is diagnosed with, whether the cancer has spread, and the patient’s overall health and goals.

An effective bone cancer treatment plan may include one or a combination of the following:

• Surgery to remove cancer tumors
• High-dose radiation therapy or chemotherapy to destroy tumors and cancer cells
• Targeted therapies, which seek to interfere with the abnormal growth processes of the cancer cells
• Immunotherapy, which harnesses the patient’s own immune system to attack the cancer.

Bone Cancer Survival Rate

The five-year relative survival rate for all bone cancer patients is around 68%. This means that approximately 68% of people with bone cancer will likely still be alive five years or more after their diagnosis when compared to people who do not have that cancer type.

Keep in mind that survival rates vary considerably depending on the subtype of bone cancer, its extent of spread when diagnosed, and the patient’s underlying health. These rates have slowly been improving over the past several decades.