Primary types of bone cancer include osteosarcoma, Ewing sarcoma, and chordoma. Secondary bone cancer develops as a result of cancer that has spread from another area of the body.

Doctors broadly divide bone cancer into primary and secondary bone cancers. Secondary cancers are also referred to as bone metastasis.

This article overviews the types of bone cancer and their symptoms and treatments. It also looks at the staging of bone cancer, diagnosis, outlook, and support.

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According to the American Cancer Society, bones are an uncommon place for cancer to form. Bone cancer begins when any of the cells that make up bone start to grow uncontrollably.

If cancer develops in the bones, it is usually due to advanced cancer elsewhere in the body that has spread into the bones. This type of bone cancer is called bone metastasis, or secondary bone cancer.

Primary bone cancer is rare. Doctors have identified several types of primary bone cancer:

Doctors also refer to secondary bone cancer as bone metastasis. While any advanced cancer can spread to the bone, the most common types of cancer that cause secondary bone cancer include:

Possible symptoms of bone metastasis may include:

  • severe pain
  • fractures
  • broken bones
  • spinal compression

Blood tests can also show high levels of calcium from broken-down bone.


The medications doctors commonly prescribe for secondary bone cancer are:

Doctors usually administer these drugs intravenously (into a vein though an IV) or subcutaneously (under the skin).

Osteosarcoma is also known as osteogenic sarcoma. It is the most common type of primary bone cancer.

According to the American Cancer Society, it tends to affect children and young adults between 10 and 30 years old. Approximately 1 in 10 osteosarcomas occur in people over 60 years old.

This type of bone cancer usually starts in the femur and tibia, which are in the leg, and the humerus, which is in the arm. Primitive bone cells called mesenchymal cells begin growing out of control and form bone tumors.


People may not have significant symptoms for weeks or months as the cancer starts to form.

The first main symptom of osteosarcoma is often bone pain, usually during activity. The resulting pain may cause a limp.


The National Comprehensive Cancer Network provides guidelines for treating osteosarcoma. The treatment for osteosarcoma depends on its grade, location, and whether the cancer has spread.

In certain cases, surgery can treat the cancer. In other instances, a person may first require chemotherapy if the bone cancer cells show features of advanced cancer.

Another option is to provide chemotherapy before surgery or vice versa and use further chemotherapy treatments after surgery.

Chondrosarcoma is the second most common type of primary bone cancer. It starts to form in the cartilage cells of bone. The risk of chondrosarcoma increases with age.

The most common areas where chondrosarcoma occurs are the pelvis, legs, and arms. However, some may originate in the:

  • trachea
  • larynx
  • chest wall
  • shoulder blades
  • ribs
  • skull

While uncommon, doctors further divide chondrosarcomas into three subtypes. Each chondrosarcoma type has unique features when viewed under a microscope.


People with chondrosarcomas have long lasting swelling and pain in a specific bone. If the cancer forms within the skull, people may have neurological symptoms.


Cancer specialists treat chondrosarcomas with one of the following:

The treatment choice depends on the location and grade of cancer. Doctors usually reserve radiation therapy if surgery is not successful in removing high grade chondrosarcomas.

Among children, teenagers, and young adults, Ewing sarcoma is the second most common type of primary bone cancer. Overall, it is the third most common type of primary bone cancer.

Ewing sarcoma may form in the following bones:

  • pelvic
  • chest wall
  • spinal
  • long bones of the legs


People with Ewing sarcoma have pain, stiffness, or swelling locally for a few weeks or months. Half of the time, symptoms are worse at night.

Depending on its location, other symptoms may arise. For example, back pain may occur in people with Ewing sarcoma of the pelvic bone.


Treatment options for Ewing sarcoma include:

  • chemotherapy
  • radiotherapy
  • surgery

Treatments tend to be limited for recurring Ewing sarcoma, which can decrease the likelihood of a positive outcome.

Spindle cell sarcoma occurs in soft tissue or bone cells. It is a rare type of bone cancer. It occurs mostly in older adults.


The symptoms of spindle cell sarcoma may resemble those of osteosarcoma, such as bone pain.

According to the Bone Cancer Research Trust, commonly reported symptoms include:

  • fracture
  • swelling
  • a lump or mass
  • tenderness in the area
  • reduced mobility of the area
  • fatigue
  • malaise


Treatment options for spindle cell sarcoma include chemotherapy followed by surgery and additional chemotherapy after surgery.

Another rare type of bone cancer is chordoma. It occurs in the spinal bones, typically at the bottom of the spine toward the sacrum. It can also occur at the base of the skull.

Chordomas usually affect people 40–60 years old, but there are some reports of it in children and older people.


Symptoms of chordoma depend on the location of the cancer. For example:

  • Chordomas at the skull base cause headaches and certain nerve dysfunctions in the brain.
  • A chordoma around the neck causes neck, shoulder, or arm pain.
  • Chordomas of the sacrum cause pain and bladder and bowel dysfunction.


Treating chordomas requires surgery to remove the cancer, followed by high dose radiation therapy due to its high recurrence rate.

Before doctors can discuss a person’s outlook and treatment plan, they need to stage the cancer. Staging depends on the results of physical exams, imaging tests, and biopsies.

To stage the cancer, doctors consider:

  • the likelihood of the cancer growing and spreading
  • the extent of its growth or spreading outside of the bone
  • the presence of metastases
  • the size of the tumor
  • any affected lymph nodes
  • the appearance of the cells under a microscope

Read more about the stages of cancer.

Different types of bone cancer have varying causes. While experts have identified some causes of bone cancer, how these factors affect bone cells is not yet certain.

Some risk factors for bone cancer may include:

  • smoking
  • older age
  • previous radiation therapy

Certain genes may encourage bone cells to become cancerous. The American Cancer Society notes some research suggests that gene changes usually associated with bone cancer are acquired later in life rather than inherited from a parent.

Symptoms and results of physical exams and imaging tests can help a doctor diagnose bone cancer.

In the majority of cases, a doctor uses additional tests to confirm a cancer diagnosis. For example, a biopsy of the bone allows a doctor to see whether cancerous cells are present.

Other tests that might help confirm a diagnosis of bone cancer include blood tests. High levels of alkaline phosphatase and lactate dehydrogenase can suggest advanced cancers.

According to the American Cancer Society, the outlook for people with bone cancer depends on many factors, including:

  • the type of bone cancer
  • the location of the tumor
  • if the cancer has spread
  • when a person receives a diagnosis
  • a person’s age and overall health
  • how well the cancer responds to treatment

Advanced cancers causing bone metastases may have a limited outlook but are treatable in the short term.

People can discuss their diagnosis and treatment with their doctor or cancer specialist. Support systems may also come from family and friends.

Other sources of support are available through the American Cancer Society. The organization helps people connect with other cancer survivors and many resources.

Bone cancer originating in bone is rare. However, advanced cancers may cause bone metastases. Different types of bone cancers affect various bones in the body but have overlapping symptoms and treatments.

Before doctors can provide a person with an outlook and treatment plan, they stage the cancer based on the location of the tumor and the spread of the cancer, among other factors.

Experts have identified certain risk factors for bone cancer, such as smoking and previous radiation therapy.

Doctors consider a person’s symptoms and results from physical, imaging, and blood tests to diagnose bone cancer. They recommend treatment based on the type and stage of cancer. Treatment may include chemotherapy, radiation therapy, or surgery.

People can speak with their doctor, family or friends, or other organizations for support in managing a diagnosis and treatment plan.