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Orthopedics is often viewed as a branch of medicine that puts healthy, active people back on their feet—working, playing, living life fully again--after a broken bone or bad back. But serious, life-threatening illnesses are also part of orthopedics, and this includes bone cancer.

Most tumors of the bone are benign (noncancerous). They do not spread and are not life-threatening. Very rarely, however, bone tumors are malignant. Approximately 2,500 new cases are diagnosed annually in the United States. This is not the same type of cancer that develops as a result of metastasis from another organ (most commonly breasts, lungs, and prostate), but originates in the bone.

The most common type of primary bone cancer is osteosarcoma, which develops in new tissue in growing bones. Another kind, Ewing’s sarcoma, begins in immature nerve tissue in the bone marrow. These two types are most common in young people ages 10 to 25. Osteosarcoma represents 2.4 percent of all childhood cancers, and Ewing’s sarcoma accounts for 1.7 percent. In adults, chondrosarcoma is most common, primarily occurring in the pelvis, upper legs, and shoulders.

Although scientists are not certain what causes bone cancer, a number of factors may put a person at increased risk. One risk factor is chemotherapy treatment for another cancer. Paget’s disease, a noncancerous condition characterized by abnormal development of new bone cells, also puts you at increased risk for osteosarcoma. A small number of bone cancers are due to heredity.

Pain is the most common symptom of bone cancer, but pain may also be absent, especially in osteosarcoma. Tumors that occur in or near joints may cause swelling or tenderness in the affected area, which may be the first sign of the disease. Bone cancer can also interfere with normal movements and can weaken the bones, occasionally leading to a fracture. Other symptoms may include fatigue, fever, weight loss, and anemia. All these signs, however, can also indicate less serious conditions.

The diagnosis of bone cancer is made by blood tests and imaging tests, such as X-rays, bone scans, and MRIs. A biopsy of the tumor is needed in order to make a definite diagnosis.

Treatment options depend on the type, size, location, and stage of the cancer, as well as the person’s age and general health. Surgery is often the primary treatment. Preoperative or postoperative chemotherapy has made limb-sparing surgery possible in many cases. When appropriate, surgeons avoid amputation by removing only the cancerous section of bone and replacing it with an artificial device called a prosthesis. Chemotherapy and radiation therapy may also be used.

If you or your child has an unusual mass or swelling, or persistent, localized pain or limping, it would be wise to consult an orthopedist.

SOURCE: National Cancer Institute; American Cancer Society Cancer Facts and Figures 2001.