About 5% of childhood cancers are bone cancer. It can cause pain, swelling, fractures, and interference with everyday activities.

The above information comes from a 2022 paper.

Diagnosis involves a physical exam, imaging tests, and blood tests. However, a biopsy is necessary to confirm bone cancer.

Depending on the type of bone cancer, treatment options may include surgery, chemotherapy, and radiation therapy. The outlook is generally positive, as about 60% of people with bone cancer remain cancer free.

Read on to learn more about bone cancer in children, including the types, symptoms, diagnosis, treatment, and outlook.

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The two most common types of bone cancer in children are osteosarcoma and Ewing sarcoma.


Osteosarcoma is a type of bone cancer that mainly affects adolescents and young adults.

Typically, it occurs in the growing ends of the long bones, such as the femur (thigh bone) and tibia (shin bone). Although it most frequently appears in the leg bones that form the knee joint, it also occurs near the shoulder’s end of the humerus (upper arm bone).

It can manifest in the skull, shoulder, and pelvis.

Learn more about osteosarcoma here.

Ewing sarcoma

A characteristic of Ewing sarcoma is the appearance of small, round blue cells in the tumor. This type of bone cancer most frequently affects adolescents.

Although it may manifest in any bone in the body, the most common sites are the following:

  • lower leg
  • thigh
  • pelvis
  • rib
  • upper arm

Learn more about Ewing sarcoma here.

Primary bone cancer accounts for 5% of all childhood cancers. In children and adolescents with bone cancer, 56% have osteosarcoma, and 34% have Ewing sarcoma.

A primary cancer originates within the bone tissue. However, some bone cancers are secondary, meaning they stem from cancer that started in another body part.

Learn more about the stages of cancer here.

The most common symptom is bone pain. Other symptoms may include:

  • stiffness, tenderness, or swelling around a bone or joint
  • weak bones, leading to fractures
  • interference with everyday movements
  • tiredness, weight loss, fever, and anemia

Bone cancer frequently escapes notice until a child has an injury when playing, and the pain lingers well after the bone should have healed. Typically, a doctor diagnoses bone cancer after parents or caregivers take the child to a doctor for a suspected fracture or another injury, and X-rays reveal a bone tumor.

Learn about the early signs of bone cancer here.

The diagnosis of osteosarcoma and Ewing sarcoma involve a physical exam, imaging tests, blood tests, and biopsies:

Medical history and physical exam

This includes noting past illnesses and checking for lumps or anything unusual.

Learn what to expect during a physical exam here.

Imaging tests

If a doctor suspects cancer, they may order one or more of the following imaging tests:

  • MRI:This uses radio waves, a magnet, and a computer to visualize the tumor area.
  • CT scan: The computer attached to an X-ray machine makes detailed images of the tumor area from different angles.
  • PET scan: A healthcare professional will inject radioactive sugar into the blood to reveal tumors. A special camera shows radioactive spots that indicate when bone cancer has spread.
  • PET-CT scan: This uses a single machine to simultaneously do a PET and CT scan. It combines the pictures to make an image that provides more details than either image would offer singly.
  • Bone scan: This involves the injection of radioactive material into a vein, which travels to the bones with cancer. A scanner detects suspicious areas.
  • X-ray: This provides detailed images of the bones using radiation

Learn more about an MRI scan for Ewing sarcoma here.

Blood tests

They may also order the following blood tests:

  • Blood chemistry tests: These measure specific substances in the blood. Results that are higher or lower than expected may indicate disease.
  • Complete blood count tests: These measure quantities of different blood cells and other blood components.

Learn more about complete blood count tests here.


A biopsy involves testing a small tissue sample for cancer cells. There are various types of biopsy, including:

  • Bone marrow biopsy and aspiration: This involves the removal of fluid from the bone marrow and a small piece of bone and tissue for microscopic examination.
  • Needle biopsy: This entails the removal of a tissue sample through a needle.
  • Open biopsy: A surgeon will make an incision and directly cut out a piece of tissue.

Learn more about bone marrow biopsy and aspiration here.

The treatment of the two main types of bone cancer differs.

Osteosarcoma treatment

Whenever possible, the treatment includes surgical removal of the tumor. Doctors may also advise chemotherapy. Radiation does not play a prominent role in treatment because it cannot easily kill osteosarcoma cells.

Learn more about treatment for osteosarcoma.

Ewing sarcoma treatment

Treatment for Ewing sarcoma also includes surgical removal when possible. However, unlike osteosarcoma, it also includes radiation therapy. Healthcare professionals may also recommend multi-agent chemotherapy.

Learn more about treatment for Ewing sarcoma.

A person’s outlook depends on how early they receive a diagnosis. The more cancer has spread, the less favorable the likelihood of successful treatment.

Approximately 60% of people with either osteosarcoma or Ewing sarcoma have long-term disease-free survival.

Learn more about the survival rates for osteosarcoma and Ewing sarcoma.

Bone cancer in children can cause pain, swelling, and fractures. However, individuals with it often do not receive a diagnosis until an injury occurs and the pain lasts longer than the expected healing time.

A physical exam, imaging, and blood tests may indicate the presence of bone cancer, but only a biopsy can confirm it. Approximately 60% of people with bone cancer have disease-free long-term survival.

Learn more about cancer in our dedicated hub here.