Many bone tumours are benign and do not spread, although some still need treatment. Malignant ones can start in the bone or spread to it from a cancer elsewhere [1]. Examination, imaging and, where needed, a biopsy tell them apart, so persistent bone pain, especially at night or at rest, should be assessed [1].
What do benign and malignant mean?
Benign tumours are usually not life-threatening and in most cases do not spread to other parts of the body; depending on how they grow and where they are, they may still need treatment [1].
Malignant tumours can spread (metastasise). Those that start in the bone are called primary; those that reach the bone from cancer elsewhere, such as breast, lung, thyroid, kidney or prostate, are called secondary [1].
What symptoms occur?
The commonest symptom is pain at the site of the tumour, typically dull and aching. Pain at night or at rest should be assessed. Fever and night sweats can occur but also happen with bone infection. Many benign tumours cause no symptoms at all and are found by chance on imaging done for another reason [1].
How is it diagnosed?
X-rays show whether a tumour dissolves bone, makes holes in it or stimulates new bone formation. MRI and CT give detailed cross-sections, and PET scans look for spread [1].
When imaging is not conclusive a biopsy confirms the diagnosis: either a needle biopsy guided by a radiologist or an open biopsy under general anaesthetic. Blood and urine tests help exclude infection but do not on their own identify primary bone cancers [1].
How is treatment planned?
Benign tumours without symptoms can be watched with periodic imaging; those that grow aggressively or threaten function need surgery, and some respond to medication [1].
Malignant tumours are treated by a team working together: chemotherapy, radiotherapy (particularly effective in Ewing sarcoma) and surgery may be combined. Limb-sparing surgery is used wherever possible; amputation may be needed if nerves and vessels are involved [1]. The team includes an orthopaedic oncologist, medical oncologist, radiation oncologist, radiologist and pathologist [1].
When should you see a doctor?
Be assessed without delay if you have [1]:
- Bone pain that does not go away, especially at night or at rest
- Swelling or a palpable lump on or around a bone
- A fracture after only a minor injury
Frequently asked questions
- Is every lump in a bone cancer?
- No. Many bone tumours are benign and do not spread; examination and imaging are needed to tell them apart [1].
- Why does night pain matter?
- Pain at night or at rest is a sign that needs assessment; it is not always a tumour, but it should be looked at [1].
- Is a biopsy always needed?
- When imaging findings are not clear enough, a biopsy is done to confirm the diagnosis [1].
- Does surgery mean losing the limb?
- Limb-sparing surgery is used wherever possible; amputation is considered only if nerves and vessels are involved [1].
- Who plans the treatment?
- A team of an orthopaedic oncologist, medical oncologist, radiation oncologist, radiologist and pathologist [1].
We give general information only; no diagnosis can be drawn from this article or from a single test. We assess patients with a bone or soft-tissue lump together with their imaging.
Sources
- Bone Tumor. American Academy of Orthopaedic Surgeons (OrthoInfo), n.d.. orthoinfo.org
This article is general information and does not replace an examination or imaging. If you have symptoms, see a doctor.