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Bone Cancer (Sarcoma of Bone) - Introduction

Approved by the Cancer.Net Editorial Board, 09/2022

ON THIS PAGE: You will find some basic information about this disease and the parts of the body it may affect. This is the first page of Cancer.Net’s Guide to Bone Cancer (Sarcoma of Bone), which covers connective tissue cancers that start in the bone. Use the menu to see other pages. Think of that menu as a roadmap for this entire guide.

About bones

An illustration of the human skeleton.

The adult human skeletal system is made up of 206 bones. Bones protect the internal organs, allow people to stand upright, and attach to muscles, which allow movement. Bones are connected to other bones by bands of tough, fibrous tissue called ligaments. Cartilage covers and protects the joints where bones come together. Bones are hollow and filled with bone marrow, which is the spongy, red tissue that produces blood cells. The cortex is the hard, outer portion of the bone.

The image is a drawing of a full adult skeleton. The adult human skeleton consists of 206 bones. A cross section of the femur (thigh bone) shows 3 different parts of a human bone. It shows cartilage as a thin layer at the head of the femur where it connects to the pelvis. The hard outer surface of the bone (called compact bone) surrounds a spongy red tissue called marrow. Copyright 2004 American Society of Clinical Oncology. Robert Morreale/Visual Explanations, LLC.

Bone consists of collagen, which is a soft, fibrous tissue, and calcium phosphate, a mineral that helps harden and strengthen the bone. There are 3 types of bone cells:

  • Osteoclasts: Cells that break down and remove old bone.

  • Osteoblasts: Cells that build new bone.

  • Osteocytes: Cells that carry nutrients to the bone.

About bone sarcoma

Cancer can start in any part of any bone. Cancer begins when healthy cells in the bone change and grow out of control, forming a mass called a tumor. A bone tumor can be cancerous or benign.

A cancerous tumor is malignant, meaning it can grow and spread to other parts of the body. A malignant tumor can destroy the bone and spread to nearby tissue. If these bone tumor cells get into the bloodstream, they can spread to other parts of the body, especially the lungs, through a process called metastasis.

A benign tumor means the tumor can grow, but it will not spread to other parts of the body. Even though a benign tumor does not spread outside the bone, it can grow large enough to press on surrounding tissue, weaken the bone, and cause the bone to fracture.

There are different types of connective tissue cancers of the bone:

  • Chondrosarcoma. Chondrosarcoma is cancer of the cartilage. It is more common in adults.

  • Chordoma. This type of bone sarcoma typically starts in part of the spinal cord.

  • Ewing sarcoma. Ewing sarcoma is most common in children and younger adults. Ewing sarcoma is unusual in that it can occur in bone or soft tissue.

  • Osteosarcoma. Osteosarcoma is most common in children and younger adults, although it can occur in older adults. Refer to the guide to osteosarcoma to learn more.

It is rare for soft-tissue sarcoma to begin in the bone, but when it does, it can cause different types of cancer, such as:

  • Undifferentiated pleomorphic sarcoma (UPS). UPS is an uncommon bone tumor, most closely related to osteosarcoma (see above). UPS of bone is usually found in adults.

  • Fibrosarcoma. This type of soft-tissue sarcoma is also more common among adults, particularly during middle age.

There are other cancers that start in bone marrow, such as myeloma or leukemia. These are different from bone sarcoma and are discussed in their own guides on this website.

Cancer that has spread to the bone

Cancer that started in another area of the body and has spread to the bone is called metastatic cancer, not bone cancer or bone sarcoma. While this section contains information about primary bone sarcoma, which is cancer that begins in the bone, it is much more common for other cancers, such as breast, lung, or prostate cancers, to spread to the bone. For example, lung cancer that has spread to the bone is called metastatic lung cancer.

For information about cancer that has started in another part of the body and spread to the bone, please see the information for that type of cancer or read a fact sheet about when cancer spreads to the bone (PDF).

Looking for More of an Introduction?

If you would like more of an introduction to bone sarcoma, explore these related items. Please note that these links will take you to another section on Cancer.Net:

The next section in this guide is Statistics. It helps explain the number of people who are diagnosed with bone sarcoma and general survival rates. Use the menu to choose a different section to read in this guide.

Bone Cancer (Sarcoma of Bone) - Statistics

Approved by the Cancer.Net Editorial Board, 02/2023

ON THIS PAGE: You will find information about the estimated number of people who will be diagnosed with bone sarcoma each year. You will also read general information on surviving the disease. Remember, survival rates depend on several factors, and no 2 people with cancer are the same. Use the menu to see other pages.

Every person is different, with different factors influencing their risk of being diagnosed with this cancer and the chance of recovery after a diagnosis. It is important to talk with your doctor about any questions you have around the general statistics provided below and what they may mean for you individually. The original sources for these statistics are provided at the bottom of this page.

How many people are diagnosed with bone sarcoma?

As explained in the Introduction, primary bone sarcoma is cancer that starts in the bone. Less than 1% of all cancers are primary bone sarcomas. For adults, it is much more common for cancer that started in another place in the body to spread to the bone. The statistics below are about primary bone sarcoma.

In 2023, an estimated 3,970 people of all ages (2,160 men and boys and 1,810 women and girls) in the United States will be diagnosed with primary bone sarcoma. In 2020, it was estimated that about 400 of these cases occurred in people ages 15 to 19.

It is estimated that 2,140 deaths (1,200 men and boys and 940 women and girls) from this disease will occur in the United States in 2023.

In adults, chondrosarcoma makes up most primary bone sarcomas. The next most common type of bone sarcoma in adults is osteosarcoma, followed by chordoma and Ewing sarcoma. The remaining types of bone sarcoma are rare.

In teens and children, osteosarcoma and Ewing sarcoma are diagnosed far more often than chondrosarcoma and other bone cancers.

What is the survival rate for bone sarcoma?

There are different types of statistics that can help doctors evaluate a person’s chance of recovery from bone sarcoma. These are called survival statistics. A specific type of survival statistic is called the relative survival rate. It is often used to predict how having cancer may affect life expectancy. Relative survival rate looks at how likely people with bone sarcoma are to survive for a certain amount of time after their initial diagnosis or start of treatment compared to the expected survival of similar people.

Example: Here is an example to help explain what a relative survival rate means. Please note this is only an example and not specific to this type of cancer. Let’s assume that the 5-year relative survival rate for a specific type of cancer is 90%. “Percent” means how many out of 100. Imagine there are 1,000 people without cancer, and based on their age and other characteristics, you expect 900 of the 1,000 to be alive in 5 years. Also imagine there are another 1,000 people similar in age and other characteristics as the first 1,000, but they all have the specific type of cancer that has a 5-year survival rate of 90%. This means it is expected that 810 of the people with the specific cancer (90% of 900) will be alive in 5 years.

It is important to remember that statistics on the survival rates for people with bone sarcoma are only an estimate. They cannot tell an individual person if cancer will or will not shorten their life. Instead, these statistics describe trends in groups of people previously diagnosed with the same disease, including specific stages of the disease.

The survival rates for bone sarcoma vary based on several factors. These include the stage of cancer, a person’s age and general health, and how well the treatment plan works. Other factors that can affect outcomes include the type of bone sarcoma that is diagnosed (see Introduction).

The 5-year relative survival rate of people with chordoma is 79%. If the cancer is diagnosed at the localized stage, the 5-year relative survival rate is 86%. If the cancer has spread to surrounding tissues or organs and/or the regional lymph nodes, the 5-year relative survival rate is 85%. If the cancer has spread to distant parts of the body, the 5-year relative survival rate is 61%.

There are multiple types of chondrosarcoma. Some are slow growing (low grade), while others are faster growing (high grade). The rates given here are the average for all types of chondrosarcoma. The 5-year relative survival rate of people with chondrosarcoma is 79%. If the cancer is diagnosed at the localized stage, the 5-year relative survival rate is 91%. If the cancer has spread to surrounding tissues or organs and/or the regional lymph nodes, the 5-year relative survival rate is 75%. If the cancer has spread to distant parts of the body, the 5-year relative survival rate is 23%.

The 5-year relative survival rate for Ewing sarcoma is 62%. If the cancer is diagnosed at the localized stage, the 5-year relative survival rate is 82%. If the cancer has spread to surrounding tissues or organs and/or the regional lymph nodes, the 5-year relative survival rate is 70%. If the cancer has spread to distant parts of the body, the 5-year relative survival rate is 39%.

The 5-year relative survival rate for osteosarcoma is 60%. If the cancer is diagnosed at the localized stage, the 5-year relative survival rate is 77%. If the cancer has spread to surrounding tissues or organs and/or the regional lymph nodes, the 5-year relative survival rate is 65%. If the cancer has spread to distant parts of the body, the 5-year relative survival rate is 26%.

Experts measure relative survival rate statistics for bone sarcoma every 5 years. This means the estimate may not reflect the results of advancements in how bone sarcoma is diagnosed or treated from the last 5 years. Talk with your doctor if you have any questions about this information. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society's (ACS) publications, Cancer Facts & Figures 2023 and Cancer Facts & Figures 2020, and the ACS website. (All sources accessed February 2023.)

The next section in this guide is Medical Illustrations. It offers drawings of body parts often affected by bone sarcoma. Use the menu to choose a different section to read in this guide.

Bone Cancer (Sarcoma of Bone) - Medical Illustrations

Approved by the Cancer.Net Editorial Board, 09/2022

ON THIS PAGE: You will find a drawing of the skeleton, which is the part of the body affected by bone sarcoma, as well as a close-up view of the inside of a bone. Use the menu to see other pages.

An illustration of the human skeleton.

The image is a drawing of a full adult skeleton. The adult human skeleton consists of 206 bones. A cross section of the femur (thigh bone) shows 3 different parts of a human bone. It shows cartilage as a thin layer at the head of the femur where it connects to the pelvis. The hard outer surface of the bone (called compact bone) surrounds a spongy red tissue called marrow. Copyright 2004 American Society of Clinical Oncology. Robert Morreale/Visual Explanations, LLC.

Copyright 2004 American Society of Clinical Oncology. Robert Morreale.

The next section in this guide is Risk Factors and Prevention. It describes the factors that may increase the chance of developing bone sarcoma. Use the menu to choose a different section to read in this guide.

Bone Cancer (Sarcoma of Bone) - Risk Factors and Prevention

Approved by the Cancer.Net Editorial Board, 09/2022

ON THIS PAGE: You will find out more about the factors that increase the chance of developing primary bone sarcoma. Use the menu to see other pages.

What are the risk factors for bone sarcoma?

A risk factor is anything that increases a person’s chance of developing cancer. Most often, bone sarcomas are not related to any particular risk factor. Although risk factors can often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. Knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.

Although most cancers are not related to any known risk factor, the following factors may raise a person’s risk of developing bone sarcoma:

  • Genetics. Children with familial retinoblastoma, which is a type of eye cancer, have an increased risk of developing osteosarcoma. People with a history of sarcoma in their family, such as with Li-Fraumeni syndrome, are also at high risk for osteosarcoma. Researchers are finding genes that are passed from generation to generation that give people a higher risk of developing osteosarcoma than the general population. All of these conditions are rare.

  • Previous radiation therapy. People who have had radiation treatment for other conditions have a higher risk of developing bone sarcoma at the site of the radiation therapy. Bone sarcomas related to radiation therapy appear many years, even decades, after the treatment, so it is a good idea to watch for any symptom arising in an area previously treated with radiation, even if you are an adult and were treated as a child. The majority of sarcomas caused by radiation therapy include angiosarcoma, undifferentiated pleomorphic sarcoma (UPS) of soft tissue, or osteosarcoma, but other types may occur.

  • Chemotherapy for another cancer. Some drugs used to treat cancer, including alkylating agents and anthracyclines, may increase the risk of developing a secondary cancer, usually osteosarcoma.

  • Benign tumors or other bone conditions. Paget’s disease of the bone may lead to osteosarcoma. Other noncancerous bone diseases, such as fibrous dysplasia, may increase the risk of osteosarcoma.

Are there ways to prevent bone sarcoma?

Different factors cause different types of cancer. Researchers continue to look into what factors cause bone sarcoma, including ways to prevent it. Currently, there is no known way to prevent bone sarcoma.

Early detection offers the best chance for successful treatment, so people with known risk factors are encouraged to visit their doctor regularly and discuss their personal risk for developing bone sarcoma. This includes people with Li-Fraumeni syndrome, retinoblastoma, or other conditions in which the risk of sarcoma is inherited (see above). Talk with your health care team for more information about your personal risk of cancer. Still, most bone sarcoma occurs in people with no known risk factors.

The next section in this guide is Symptoms and Signs. It explains what changes or medical problems bone sarcoma can cause. Use the menu to choose a different section to read in this guide.

Bone Cancer (Sarcoma of Bone) - Symptoms and Signs

Approved by the Cancer.Net Editorial Board, 09/2022

ON THIS PAGE: You will find out more about the changes and medical problems that can be a sign of bone sarcoma. Use the menu to see other pages.

What are the symptoms and signs of bone sarcoma?

People with bone sarcoma may experience one or more of the following symptoms or signs. Symptoms are changes that you can feel in your body. Signs are changes in something measured, like taking your blood pressure or doing a lab test. Together, symptoms and signs can help describe a medical problem. Sometimes, people with bone sarcoma do not have any of the symptoms and signs described below. Or, the cause of a symptom or sign may be a different medical condition that is not cancer.

When a bone tumor grows, it presses on healthy bone tissue and can destroy it, which causes the following symptoms:

  • Pain. The earliest symptoms of bone sarcoma are pain and swelling where the tumor is located. The pain may come and go at first. Then it can become more severe and steady later. The pain may get worse with movement, and there may be swelling in nearby soft tissue. The pain may not go away, and it can occur while resting or at night. Most bone sarcomas in children appear around the knees and may be first thought to be "growth pain," leading to a delay in diagnosis.

  • Joint swelling and stiffness. A tumor that occurs near or in a joint may cause the joint to swell and become tender or stiff. This means a person may have a limited and painful range of movement.

  • Limping. If a bone with a tumor breaks, or fractures, in a leg, it can lead to a pronounced limp. Limping is usually a symptom of later-stage bone sarcoma.

  • Other less common symptoms. Rarely, people with a bone sarcoma may have symptoms such as fever, generally feeling unwell, weight loss, and anemia, which is a low level of red blood cells.

If you are concerned about any changes you experience, please talk with your doctor. Your doctor will try to understand what is causing your symptom(s). They may do an exam and order tests to understand the cause of the problem, which is called a diagnosis.

If cancer is diagnosed, relieving symptoms remains an important part of cancer care and treatment. Managing symptoms may also be called "palliative and supportive care," which is not the same as hospice care given at the end of life. You can receive palliative and supportive care at any time during cancer treatment. This type of care focuses on managing symptoms and supporting people who face serious illnesses, such as cancer. You can receive palliative and supportive care at any time during cancer treatment. Learn more in this guide’s section on Coping With Treatment.

Be sure to talk with your health care team about the symptoms you experience, including any new symptoms or a change in symptoms.

The next section in this guide is Diagnosis. It explains what tests may be needed to learn more about the cause of the symptoms. Use the menu to choose a different section to read in this guide.

Bone Cancer (Sarcoma of Bone) - Diagnosis

Approved by the Cancer.Net Editorial Board, 09/2022

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find the cause of a medical problem. Use the menu to see other pages.

Doctors use many tests to find, or diagnose, cancer. They also do tests to learn if cancer has spread to another part of the body from where it started. If the cancer has spread, it is called metastasis. For example, imaging tests, such as an x-ray, may be used to diagnose bone sarcoma and to find out whether the cancer has spread. Imaging tests show pictures of the inside of the body. Benign and cancerous tumors usually look different on imaging tests, which are described below.

Although imaging tests may suggest a diagnosis of bone sarcoma, a biopsy will often be performed to confirm the diagnosis and to find out the subtype. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis.

Bone sarcomas are rare, and the way a biopsy is performed can affect the outcomes of surgery and risk of recurrence. Whenever a bone sarcoma is suspected, it is extremely important to see a surgeon who specializes in sarcomas, such as an orthopedic oncologist, before any surgery or a biopsy is performed.

How bone sarcoma is diagnosed

There are different tests used for diagnosing bone sarcoma. Not all tests described here will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

  • The type of cancer suspected

  • Your signs and symptoms

  • Your age and general health

  • The results of earlier medical tests

In addition to a physical examination, the following tests may be used to diagnose or determine the stage (or extent) of a bone sarcoma:

  • Biopsy. A biopsy is the only way to make a definite diagnosis, even if other tests can suggest that cancer is present. During biopsy, a small amount of tissue is removed for examination under a microscope. A pathologist analyzes the sample(s). A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. Whether a needle biopsy or incisional biopsy is performed depends on where the cancer is located. During a needle biopsy, a small hole is made in the bone, and a tissue sample is removed from the tumor with a needle-like instrument. During an incisional biopsy, the tissue sample is removed after a small cut is made in the tumor. Sometimes it may not be possible to do a biopsy.

    The type of biopsy and how it is done are important in diagnosing and treating sarcoma, so patients should be seen in a sarcoma specialty center even before the biopsy is performed. At the sarcoma center, the treating surgeon can identify the location for the biopsy. It is also important to have an expert pathologist review the sample of tissue removed to appropriately diagnose a sarcoma.

  • X-ray. An x-ray creates a picture of the structures inside of the body using a small amount of radiation.

  • Bone scan. A bone scan may be used to help determine the stage of a bone sarcoma. A bone scan looks at the inside of the bones using a radioactive tracer. The amount of radiation in the tracer is too low to be harmful. The tracer is injected into a patient’s vein. It collects in areas of the bone and is detected by a special camera. Healthy bone appears lighter to the camera, and areas of injury, such as those caused by cancerous cells or sometimes a broken bone, stand out on the image.

  • Computed tomography (CT or CAT) scan. A CT scan takes pictures of the inside of the body using x-rays taken from different angles. A computer combines these pictures into a detailed, 3-dimensional image that shows any abnormalities or tumors. A CT scan can be used to measure the tumor’s size. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a pill or liquid to swallow.

  • Magnetic resonance imaging (MRI). An MRI produces detailed images of the inside of the body using magnetic fields, not x-rays. MRI can be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein. MRI scans are used to check for any tumors in nearby soft tissue. MRIs provide a road map for the orthopedic oncology surgeon to perform the best cancer surgery possible.

  • Positron emission tomography (PET) or PET-CT scan. A PET scan may be used to help determine the stage of a bone sarcoma. A PET scan is a way to create picture of organs and tissues inside the body. A PET scan is usually combined with a CT scan (see above), called a PET-CT scan. However, you may hear your doctor refer to this procedure just as a PET scan. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. However, the amount of radiation in the substance is too low to be harmful. A scanner then detects this substance to produce images of the inside of the body.

  • Blood tests. Sarcomas are never diagnosed by a laboratory blood test. People with osteosarcoma or Ewing sarcoma can occasionally have higher alkaline phosphatase and lactate dehydrogenase levels in the blood, but high levels of these substances may also have any of a number of benign causes, such as growing in children or a healing broken bone.

After diagnostic tests are done, your doctor will review the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer. This is called staging and grading.

The next section in this guide is Stages and Grades. It explains the system doctors use to describe the extent of the disease. Use the menu to choose a different section to read in this guide.

Bone Cancer (Sarcoma of Bone) - Stages and Grades

Approved by the Cancer.Net Editorial Board, 09/2022

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread, as well as the way the tumor cells look when viewed under a microscope. This is called the stage and grade. Use the menu to see other pages.

READ MORE BELOW:

What is cancer staging?

Staging is a way of describing where the cancer is located, if and where it has spread, and whether it is affecting other parts of the body.

Doctors use diagnostic tests to find out the cancer's stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor recommend the best kind of treatment, and it can help predict a patient's prognosis, which is the chance of recovery. There are different stage descriptions for different types of cancer.

In general, bone sarcomas are described as:

  • Localized. A sarcoma that is able to be surgically removed.

  • Locally advanced. A sarcoma that has not spread to other body parts but cannot be easily surgically removed.

  • Metastatic. A sarcoma that has spread to other body parts, such as the lungs or other bones.

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TNM staging system

While not commonly used to make treatment decisions for bone sarcomas, one tool that doctors use to describe the stage is the TNM system. Doctors use the results from diagnostic tests and scans to answer these questions:

  • Tumor (T): How large is the primary tumor? Where is it located?

  • Node (N): Has the tumor spread to the lymph nodes? If so, where and how many?

  • Metastasis (M): Has the cancer spread to other parts of the body? If so, where and how much?

The results are combined to determine the stage of cancer for each person.

In most primary bone sarcomas, there are 4 stages: stages I through IV (1 through 4).

Here are more details on each part of the TNM system for bone sarcoma:

Tumor (T)

Using the TNM system, the “T” plus a letter or number (0 to 4) is used to describe the size and extent of the tumor, and it differs depending on where the bone sarcoma is located. Tumor size is measured in centimeters (cm).

Node (N)

The “N” in the TNM staging system stands for lymph nodes. These small, bean-shaped organs help fight infection. Lymph nodes near where the cancer started are called regional lymph nodes. Lymph nodes in other parts of the body are called distant lymph nodes. Bone sarcomas rarely spread to lymph nodes, so removing them is not generally needed.

NX: The regional lymph nodes cannot be evaluated.

N0 (N zero): The cancer has not spread to the regional lymph nodes.

N1: The cancer has spread to the regional lymph nodes. This is rare for primary bone sarcoma.

Metastasis (M)

The “M” in the TNM system describes whether the cancer has spread to other parts of the body, called metastasis.

M0 (M zero): The cancer has not metastasized.

M1: The cancer has metastasized to another part of the body.

  • M1a: The cancer has metastasized to a lung.

  • M1b: The cancer has metastasized to other bones or another organ.

Grade (G)

Doctors also describe primary bone sarcoma by its grade (G). The grade describes how much cancer cells look like healthy cells when viewed under a microscope.

The doctor compares the cancerous tissue with healthy tissue. Healthy tissue usually contains many different types of cells grouped together. If the cancer looks similar to healthy tissue and has different cell groupings, it is called "well differentiated" or a "low-grade tumor." If the cancerous tissue looks very different from healthy tissue, it is called "poorly differentiated" or a "high-grade tumor." The cancer’s grade may help the doctor predict how quickly the cancer will spread. In general, the lower the tumor’s grade, the better the prognosis.

GX: The tumor grade cannot be identified.

G1: The cancer cells are well differentiated (low grade).

G2: The cancer cells are moderately differentiated (high grade).

G3: The cancer cells are poorly differentiated (high grade).

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Stage groups for bone sarcoma

Doctors assign the stage of the cancer by combining the T, N, M, and G classifications (see above). There are no stage groupings for primary bone sarcoma in the spine or pelvis. These stage groupings are only for skeleton, trunk, skull, and facial bones:

Stage IA: The tumor is low grade or cannot be graded (G1 or GX) and 8 cm or smaller (T1). It has not spread to any lymph nodes or to other parts of the body (N0, M0).

Stage IB: The tumor is low grade or cannot be graded (G1 or GX) and larger than 8 cm (T2) or there are more than 1 separate tumors in the primary bone site (T3). It has not spread to any lymph nodes or to other parts of the body (N0, M0).

Stage IIA: The tumor is high grade (G2 or G3) and 8 cm or smaller (T1). It has not spread to any lymph nodes or to other parts of the body (N0, M0).

Stage IIB: The tumor is high grade (G2 or G3) and larger than 8 cm (T2). It has not spread to any lymph nodes or to other parts of the body (N0, M0).

Stage III: There are multiple high-grade (G2 or G3) tumors in the primary bone site (T3), but they have not spread to any lymph nodes or to other parts of the body (N0, M0).

Stage IVA: The tumor is of any size or grade and has spread to the lung(s) (any G, any T, N0, M1a).

Stage IVB: The tumor is of any size or grade and has spread to the lymph nodes (any G, any T, N1, and any M), or the tumor is of any size or grade and has spread to another bone or organ besides the lung (any G, any T, any N, M1b).

Recurrent: Recurrent cancer is cancer that has come back after treatment. If the cancer does return, there will be another round of tests to learn about the extent of the recurrence. These tests and scans are often similar to those done at the time of the original diagnosis.

In general, patients with the best prognosis have:

  • A T1 or T2 tumor

  • A low-grade tumor (G1)

  • A tumor that is easily removed with surgery, such as those located in an arm or leg

  • A localized tumor that has not spread

  • Certain genetic changes

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Used with permission of the American College of Surgeons, Chicago, Illinois. The original and primary source for this information is the AJCC Cancer Staging Manual, Eighth Edition (2017), published by Springer International Publishing.

Information about the cancer’s stage and grade will help the doctor recommend a specific treatment plan. The next section in this guide is Types of Treatment. Use the menu to choose a different section to read in this guide.

Bone Cancer (Sarcoma of Bone) - Types of Treatment

Approved by the Cancer.Net Editorial Board, 09/2022

ON THIS PAGE: You will learn about the different types of treatments doctors use for people with bone sarcoma. Use the menu to see other pages.

This section explains the types of treatments, also known as therapies, that are the standard of care for bone sarcoma. “Standard of care” means the best treatments known. Information in this section is based on medical standards of care for bone sarcoma in the United States. Treatment options can vary from one place to another.

When making treatment plan decisions, you are encouraged to discuss with your doctor whether clinical trials offer additional options to consider. A clinical trial is a research study that tests a new approach to treatment. Doctors learn through clinical trials whether a new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Clinical trials are an option for all stages of cancer. Your doctor can help you consider all your treatment options. Learn more about clinical trials in the About Clinical Trials and Latest Research sections of this guide.

How bone sarcoma is treated

Bone sarcoma is rare, and research shows that patients have better outcomes if they are treated at a center with experience treating sarcomas. These are called "sarcoma specialty centers."

In cancer care, different types of doctors who specialize in cancer, called oncologists, often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. Cancer care teams include other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, physical therapists, occupational therapists, social workers, pharmacists, counselors, dietitians, physical therapists, occupational therapists, and others. Learn more about the clinicians who provide cancer care.

Treatment options and recommendations depend on several factors, including the type, stage, and grade of cancer; possible side effects; and the patient’s preferences and overall health. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Talk with your doctor about the goals of each treatment and what you can expect while receiving the treatment. These types of conversations are called “shared decision-making.” Shared decision-making is when you and your doctors work together to choose treatments that fit the goals of your care. Shared decision-making is important for bone sarcoma because there are different treatment options. Learn more about making treatment decisions.

The common types of treatments used for primary bone sarcoma are described below. Primary bone sarcoma is cancer that starts in the bone. Your care plan also includes treatments for symptoms and side effects, an important part of cancer care.

READ MORE BELOW:

For a low-grade primary bone tumor, the main treatment is surgery. The goal of surgery is to remove the tumor and a margin of healthy bone or tissue around the tumor to make sure all of the cancer cells are gone.

For a high-grade primary bone tumor, doctors often use a combination of treatments. These include surgery, medication, and radiation therapy.

Surgery

Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. Surgical oncologists and orthopedic oncologists are doctors who specialize in treating bone sarcoma using surgery.

Surgery for bone sarcoma often involves a wide excision of the tumor. A wide excision means that the tumor is surgically removed, along with a margin of healthy tissue around it in all directions. Before surgery, talk with your health care team about the possible side effects from the specific surgery you will have. Learn more about the basics of cancer surgery.

If the tumor is in an arm or leg, techniques to keep the arm or leg intact are used whenever possible. This is sometimes called "limb salvage" or "limb sparing." However, amputation, which is the removal of the arm or leg with the tumor, is sometimes necessary. This depends on the tumor’s size and/or location.

Wide excision surgical techniques have reduced the number of amputations performed for people with bone sarcoma. More than 90% of patients can be treated with limb-sparing surgery rather than amputation. Limb-sparing surgeries often require prostheses, such as metal plates or bone from other parts of the body, to replace the missing bone and provide strength to the leftover bone. This is called reconstructive surgery. Surgeons use soft tissue, such as muscle, to cover the reconstruction area. The tissue helps with healing and reduces the risk of infection.

For some patients, amputation may offer the best option for treating the sarcoma. These include people whose sarcoma is located where it cannot be completely removed by surgery, patients who cannot undergo reconstruction, and patients in whom the surgical area cannot be fully covered with soft tissue.

After an amputation, prostheses will be needed. Because children's bones are often still growing, some children can be fitted for expandable joint prostheses that adjust as the skeleton grows. These prostheses require several procedures to adjust bone length as the child grows.

Surgery may also be used to treat bone sarcoma that has spread, or metastasized, to other parts of the body. For instance, surgery can be effective at removing lung metastases, which is where bone sarcomas most often spread. If there are few tumors in the lung and if they have appeared a long time after the primary bone tumor was removed, surgery offers a high chance of curing the disease.

It is important to remember that the operation that results in the most useful and strongest limb may be different from the one that gives the most normal appearance. Rehabilitation can be very helpful after surgery for bone sarcoma. This includes physical therapy, which can help maximize the patient’s physical abilities. Rehabilitation can also help a person cope with the social and emotional effects of surgery, including the challenges of losing a limb if amputation was necessary. Talk with your health care team about support options.

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Therapies using medication

The treatment plan may include medications to destroy cancer cells. Medication may be given through the bloodstream to reach cancer cells throughout the body. When a drug is given this way, it is called systemic therapy. Medication may also be given locally, which is when the medication is applied directly to the cancer or kept in a single part of the body.

This treatment is generally prescribed by a medical oncologist, a doctor who specializes in treating cancer with medication.

Medications are often given through an intravenous (IV) tube placed into a vein using a needle or as a pill or capsule that is swallowed (orally). If you are given oral medications to take at home, be sure to ask your health care team about how to safely store and handle them.

The types of medications used for bone sarcoma may include:

  • Chemotherapy

  • Targeted therapy

  • Immunotherapy

Each of these types of therapies is discussed below in more detail. A person may receive 1 type of medication at a time or a combination of medications given at the same time. They can also be given as part of a treatment plan that includes surgery and/or radiation therapy.

The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications.

It is also important to let your doctor know if you are taking any other prescription or over-the-counter medications or supplements. Herbs, supplements, and other drugs can interact with cancer medications, causing unwanted side effects or reduced effectiveness. Learn more about your prescriptions by using searchable drug databases.

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells.

A chemotherapy regimen, or schedule, usually consists of a specific number of cycles given over a set period of time. A patient may receive 1 drug at a time or a combination of different drugs given at the same time. Chemotherapy for bone sarcoma can usually be an outpatient treatment, which is treatment given at a clinic or doctor’s office instead of needing to stay in a hospital.

Fast-growing types of bone sarcoma are often treated with chemotherapy before surgery. Chemotherapy that is given before surgery is called preoperative chemotherapy, neoadjuvant chemotherapy, or induction chemotherapy. For most high-grade tumors, the oncologist may give chemotherapy for 3 to 4 cycles before surgery to shrink the primary tumor or make it easier to remove. Chemotherapy before surgery may also increase the chance of cure and/or help patients live longer because it destroys cancer cells that have spread from the original tumor. The tumor’s response to chemotherapy can be used to better determine the prognosis.

After the patient has recovered from surgery, they may receive more chemotherapy to destroy any remaining tumor cells. This is called postoperative or adjuvant chemotherapy. The use of chemotherapy to shrink the tumor before surgery combined with chemotherapy after surgery has saved many lives and many patients’ limbs.

The specific chemotherapy drugs used depend on the type of bone sarcoma. Each type of bone sarcoma is different, in much the same way as breast cancer is different from lung cancer.

The side effects of chemotherapy depend on the individual and the dose used, but they may include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhea. These side effects usually go away after treatment is finished. However, your doctor will monitor you for potential long-term side effects (see Follow-up Care).

Learn more about the basics of chemotherapy.

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Targeted therapy

Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells and limits damage to healthy cells.

Not all tumors have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor. This helps doctors better match each patient with the most effective treatment whenever possible. In addition, research studies continue to find out more about specific molecular targets and new treatments directed at them. Learn more about the basics of targeted treatments.

A small percentage of sarcomas, less than 1%, have a mutation in the neurotrophic receptor tyrosine kinase (NTRK) gene. Larotrectinib (Vitrakvi) and entrectinib (Rozlytrek) are NTRK inhibitors that are now approved for any cancer that has a specific mutation in the NTRK gene. The most common side effects include fatigue, nausea, dizziness, vomiting, increased liver enzymes, cough, constipation, and diarrhea.

Talk with your doctor about possible side effects for a specific medication and how they can be managed.

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Immunotherapy

Immunotherapy uses the body's natural defenses to fight cancer by improving your immune system's ability to attack cancer cells.

Immunotherapy is generally not approved for the treatment of sarcomas, including bone sarcomas, because they have not been tested well enough. Many recent approved immunotherapy treatments for other types of cancer involve immune checkpoint inhibitors. These drugs are given to take the brakes off the body’s natural immune response against the cancer in the body. The current methods of immunotherapy do have problems because these drugs also activate immune responses against normal body parts, a process called autoimmunity. Some of these drugs are approved to treat other cancers.

However, if testing on your bone tumor shows that it has specific problems with repairing DNA damage, called microsatellite instability-high (MSI-H) or mismatch repair deficiency (dMMR), then a checkpoint inhibitor called pembrolizumab (Keytruda) or dostarlimab (Jemperli) may be used if it has spread or metastasized. This occurs in less than 1% of sarcomas.

Different types of immunotherapy can cause different side effects. Common side effects may include skin reactions, flu-like symptoms, diarrhea, and weight changes. Talk with your doctor about possible side effects for the immunotherapy recommended for you. Learn more about the basics of immunotherapy.

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Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is a radiation oncologist. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy. A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time.

For bone sarcoma, radiation therapy is most often used for a tumor that cannot be removed with surgery. Radiation therapy may also be done before surgery to shrink the tumor, or it may be done after surgery to destroy any remaining cancer cells. Radiation therapy makes it possible to do less extensive surgery, often preserving the arm or leg. A type of radiation therapy called stereotactic body radiotherapy (SBRT) may be used to treat bone sarcomas that have spread to the lungs. SBRT uses a small number of very focused, very intense radiation treatments to control or destroy a small area of tumor. Radiation therapy may also be used to relieve pain for people as part of supportive or palliative care (see below).

Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Most side effects go away soon after treatment is finished. Learn more about the basics of radiation therapy.

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Physical, emotional, social, and financial effects of cancer

Cancer and its treatment may cause physical symptoms and side effects, as well as emotional, social, and financial stress. Managing all of these effects is called palliative and supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.

Palliative and supportive care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative and supportive care along with treatment for cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments, such as chemotherapy, surgery, or radiation therapy, to improve symptoms.

Before treatment begins, talk with your doctor about the goals of each treatment in the recommended treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative and supportive care options. Many patients also benefit from talking with a social worker and participating in support groups. Ask your doctor about these resources, too.

Cancer care is often expensive, and navigating health insurance can be difficult. Ask your doctor or another member of your health care team about talking with a financial navigator or counselor who may be able to help with your financial concerns.

During treatment, your health care team may ask you to answer questions about your symptoms and side effects and to describe each problem. Be sure to tell the health care team if you are experiencing a problem. This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future.

Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative and supportive care in a separate section of this website.

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Metastatic bone sarcoma

If cancer spreads to another part in the body from where it started, doctors call it metastatic cancer. If this happens, it is a good idea to talk with doctors who have experience in treating it. Doctors can have different opinions about the best standard treatment plan. Clinical trials might also be an option. Learn more about getting a second opinion at a sarcoma specialty center before starting treatment, so you are comfortable with your chosen treatment plan.

Your treatment plan may include a combination of surgery, medication, and radiation therapy. Palliative and supportive care will also be important to help relieve symptoms and side effects.

For many people, a diagnosis of metastatic cancer is very stressful and difficult. You and your family are encouraged to talk about how you feel with doctors, nurses, social workers, or other members of your health care team. It may also be helpful to talk with other patients, such as through a support group or other peer support program.

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Remission and the chance of recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED.

A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it is important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.

If the cancer returns after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).

If a recurrence happens, a new cycle of testing will begin to learn as much as possible about it. After this testing is done, you and your doctor will talk about the treatment options. Often the treatment plan will include the treatments described above, such as surgery, chemotherapy, and radiation therapy, but they may be used in a different combination or given at a different pace. Your doctor may suggest clinical trials that are studying new ways to treat recurrent bone sarcoma. Whichever treatment plan you choose, palliative and supportive care will be important for relieving symptoms and side effects.

People with recurrent cancer sometimes experience emotions such as disbelief or fear. You are encouraged to talk with your health care team about these feelings and ask about support services to help you cope. Learn more about dealing with cancer recurrence.

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If treatment does not work

Recovery from bone sarcoma is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and for some people, advanced cancer is difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.

Planning for your future care and putting your wishes in writing is important, especially at this stage of disease. Then, your health care team and loved ones will know what you want, even if you are unable to make these decisions. Learn more about putting your health care wishes in writing.

People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with your doctor or a member of your palliative care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

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The next section in this guide is About Clinical Trials. It offers more information about research studies that are focused on finding better ways to care for people with cancer. Use the menu to choose a different section to read in this guide.

Bone Cancer (Sarcoma of Bone) - About Clinical Trials

Approved by the Cancer.Net Editorial Board, 09/2022

ON THIS PAGE: You will learn more about clinical trials, which are the main way that new medical approaches are studied to see how well they work. Use the menu to see other pages.

What are clinical trials?

Doctors and scientists are always looking for better ways to care for people with bone sarcoma. To make scientific advances, doctors create research studies involving volunteers, called clinical trials. Every drug that is now approved by the U.S. Food and Drug Administration (FDA) was tested in clinical trials.

Clinical trials are used for all types and stages of bone sarcomas. Many focus on new treatments to learn if a new treatment is safe, effective, and possibly better than the existing treatments. These types of studies evaluate new drugs, different combinations of treatments, new approaches to radiation therapy or surgery, and new methods of treatment. People who participate in clinical trials can be some of the first to get a treatment before it is available to the public. However, there are some risks with a clinical trial, including possible side effects and the chance that the new treatment may not work. People are encouraged to talk with their health care team about the pros and cons of joining a specific study.

Some clinical trials study new ways to relieve symptoms and side effects during treatment. Others study ways to manage the late effects that may happen a long time after treatment. Talk with your doctor about clinical trials for symptoms and side effects.

Deciding to join a clinical trial

People decide to participate in clinical trials for many reasons. For some, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Others volunteer for clinical trials because they know that these studies are a way to contribute to the progress in treating bone sarcoma. Even if they do not benefit directly from the clinical trial, their participation may benefit future people with bone sarcoma.

Insurance coverage and the costs of clinical trials differ by location and by study. In some programs, some of the expenses from participating in the clinical trial are reimbursed. In others, they are not. It is important to talk with the research team and your insurance company first to learn if and how your treatment in a clinical trial will be covered. Learn more about health insurance coverage of clinical trials.

Sometimes people have concerns that, in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” When used, placebos are usually combined with standard treatment in most cancer clinical trials. Study participants will always be told when a placebo is used in a study. Find out more about placebos in cancer clinical trials.

Patient safety and informed consent

To join a clinical trial, people must participate in a process known as informed consent. During informed consent, the doctor should:

  • Describe all of the treatment options so that the person understands how the new treatment differs from the standard treatment.

  • List all of the risks of the new treatment, which may or may not be different than the risks of standard treatment.

  • Explain what will be required of each person in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment.

  • Describe the purposes of the clinical trial and what researchers are trying to learn.

Clinical trials also have certain rules called “eligibility criteria” that help structure the research and keep patients safe. You and the research team will carefully review these criteria together. You will need to meet all of the eligibility criteria in order to participate in a clinical trial. Learn more about eligibility criteria in clinical trials.

People who participate in a clinical trial may stop participating at any time for personal or medical reasons. This may include that the new treatment is not working or there are serious side effects. Clinical trials are also closely monitored by experts who watch for any problems with each study. It is important that people participating in a clinical trial talk with their doctor and researchers about who will be providing their treatment and care during the clinical trial, after the clinical trial ends, and/or if they choose to leave the clinical trial before it ends.

Finding a clinical trial

For specific topics being studied for bone sarcoma, learn more in the Latest Research section.

Cancer.Net offers more information about cancer clinical trials in other areas of the website, including a complete section on clinical trials.

There are many resources and services to help you search for clinical trials for bone sarcoma, including the following services. Please note that these links will take you to separate, independent websites:

  • ClinicalTrials.gov. This U.S. government database lists publicly and privately supported clinical trials.

  • World Health Organization (WHO) International Clinical Trials Registry Platform. The WHO coordinates health matters within the United Nations. This search portal gathers clinical trial information from many countries’ registries.

Read more about the basics of clinical trials matching services.

PRE-ACT, Preparatory Education About Clinical Trials

In addition, you can find a free video-based educational program about cancer clinical trials in another section of this website.

The next section in this guide is Latest Research. It explains areas of scientific research for bone sarcoma. Use the menu to choose a different section to read in this guide.

Bone Cancer (Sarcoma of Bone) - Latest Research

Approved by the Cancer.Net Editorial Board, 09/2022

ON THIS PAGE: You will read about the scientific research being done to learn more about bone sarcoma and how to treat it. Use the menu to see other pages.

Doctors are working to learn more about bone sarcoma, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the best diagnostic and treatment options for you.

  • Immunotherapy. As described in Types of Treatment, immunotherapy is designed to boost the body's natural defenses to fight the cancer. It is an active area of cancer research. Immunotherapy comes in many forms.

    For bone sarcoma, mifamurtide (Mepact) is a nonspecific immune system stimulator approved as a treatment in some countries but not in the United States.

    Another area of immunotherapy is immune checkpoint inhibitors, which have created a lot of excitement in the field of cancer research. These drugs block a specific molecule, which then takes the brakes off the immune system and allows the immune system to fight the cancer cells. The molecules that are blocked have names such as CTLA4, PD-1, OX40, LAG3, and TIM3. They have proved helpful in many other types of cancers. Checkpoint inhibitors are being tested in clinical trials in sarcomas.

    Vaccines
    against specific sarcoma proteins or other molecules are another type of immunotherapy being studied, often in addition to immune checkpoint inhibitors.

    Learn more about the basics of immunotherapy.

  • Targeted therapy. As outlined in Types of Treatment, targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment is able to specifically block the growth and spread of cancer cells and limit damage to healthy cells. Regular chemotherapy can damage the DNA of both cancer cells and normal cells. For example, PARP (poly ADP-ribose polymerase) inhibitors are a type of targeted therapy being studied in the treatment of Ewing sarcoma. Learn more about targeted treatments.

  • Radiation therapy techniques. Clinical trials are evaluating the usefulness of radiation therapy given inside the body during surgery for some Ewing sarcoma tumors. This is called intraoperative radiation therapy or internal radiation therapy. Other techniques are being used when bone sarcoma recurs at a distant, or metastatic, location in the body.

  • Palliative and supportive care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current bone sarcoma treatments to improve comfort and quality of life for patients.

Looking for More About the Latest Research?

If you would like more information about the latest areas of research in bone sarcoma, explore these related items that take you outside of this guide:

The next section in this guide is Coping with Treatment. It offers some guidance on how to cope with the physical, emotional, social, and financial changes that cancer and its treatment can bring. Use the menu to choose a different section to read in this guide.

Bone Cancer (Sarcoma of Bone) - Coping with Treatment

Approved by the Cancer.Net Editorial Board, 09/2022

ON THIS PAGE: You will learn more about coping with the physical, emotional, social, and financial effects of cancer and its treatment. Use the menu to see other pages.

Cancer treatment may cause side effects or changes to your body and how you feel. For many reasons, people do not experience the same side effects even when they are given the same treatment for the same type of cancer. This can make it hard to predict how you will feel during treatment.

READ MORE BELOW:

As you prepare to start cancer treatment, it is normal to fear treatment-related side effects. It may help to know that your health care team will work to prevent and relieve side effects. This part of cancer treatment is called palliative and supportive care. It is an important part of your treatment plan, regardless of your age or the stage of disease.

Coping with physical side effects

Common physical side effects from each treatment option for bone sarcoma are described in the Types of Treatment section. Learn more about side effects of cancer and its treatment, along with ways to prevent or control them. Changes to your physical health depend on several factors, including the cancer’s stage, the length and dose of treatment, and your general health.

Talk with your health care team regularly about how you are feeling. It is important to let them know about any new side effects or changes in existing side effects. If they know how you are feeling, they can find ways to relieve or manage your side effects to help you feel more comfortable and potentially keep any side effects from worsening.

You may find it helpful to keep track of your side effects so it is easier to talk about any changes with your health care team. Learn more about why tracking side effects is helpful.

Sometimes, side effects can last after treatment ends. Doctors call these long-term side effects. Side effects that occur months or years after treatment are called late effects. Treating long-term side effects and late effects is an important part of survivorship care. Learn more by reading the Follow-up Care section of this guide or talking with your doctor.

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Coping with emotional and social effects

You may have emotional and social effects after a cancer diagnosis. This may include dealing with a variety of emotions, such as sadness, anxiety, fear, or anger, or managing stress. Sometimes, people find it difficult to express how they feel to their loved ones. Some have found that talking to an oncology social worker, counselor, or member of the clergy can help them develop more effective ways of coping and talking about cancer.

You can also find coping strategies for emotional and social effects in a separate section of this website. This section includes many resources for finding support and information to meet your needs.

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Coping with the costs of cancer care

Cancer treatment can be expensive. It may be a source of stress and anxiety for people with cancer and their families. In addition to treatment costs, many people find they have extra, unplanned expenses related to their care. For some people, the high cost of medical care stops them from following or completing their cancer treatment plan. This can put their health at risk and may lead to higher costs in the future. Patients and their families are encouraged to talk about financial concerns with a member of their health care team. Often, oncology social workers are aware of resources that may help reduce the burden for patients and families. Learn more about managing financial considerations in a separate part of this website.

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Coping with barriers to care

Some groups of people experience different rates of new cancer cases and experience different outcomes from their cancer diagnosis. These differences are called “cancer disparities.” Disparities are caused in part by real-world barriers to quality medical care and social determinants of health, such as where a person lives and whether they have access to food and health care. Cancer disparities more often negatively affect racial and ethnic minorities, people with fewer financial resources, sexual and gender minorities (LGBTQ+), adolescent and young adult populations, adults older than 65, and people who live in rural areas or other underserved communities.

If you are having difficulty getting the care you need, talk with a member of your health care team or explore other resources that help support medically underserved people.

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Talking with your health care team about side effects

Before starting treatment, talk with your doctor about possible side effects. Ask:

  • Which side effects are most likely?

  • When are they likely to happen?

  • What can we do to prevent or relieve them?

  • When and who should I call about side effects?

Be sure to tell your health care team about any side effects that happen during treatment and afterward, too. Tell them even if you do not think the side effects are serious. This discussion should include physical, emotional, social, and financial effects of cancer.

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Caring for a loved one with bone sarcoma

Family members and friends often play an important role in taking care of a person with bone sarcoma. This is called being a caregiver. Caregivers can provide physical, practical, and emotional support to the patient, even if they live far away. Being a caregiver can also be stressful and emotionally challenging. One of the most important tasks for caregivers is caring for themselves.

Caregivers may have a range of responsibilities on a daily or as-needed basis, including:

  • Providing support and encouragement

  • Talking with the health care team

  • Giving medications

  • Helping manage symptoms and side effects

  • Coordinating medical appointments

  • Providing a ride to and from appointments

  • Assisting with meals

  • Helping with household chores

  • Handling insurance and billing issues

A caregiving plan can help caregivers stay organized and help identify opportunities to delegate tasks to others. It may be helpful to ask the health care team how much care will be needed at home and with daily tasks during and after treatment. Use this 1-page fact sheet to help make a caregiving action plan. This free fact sheet is available as a PDF, so it is easy to print.

Learn more about caregiving or read the ASCO Answers Guide to Caring for a Loved One With Cancer in English or Spanish.

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Looking for More on How to Track Side Effects?

Cancer.Net offers several resources to help you keep track of your symptoms and side effects. Please note that these links will take you to other sections of Cancer.Net:

The next section in this guide is Follow-up Care. It explains the importance of checkups after you finish cancer treatment. Use the menu to choose a different section to read in this guide.

Bone Cancer (Sarcoma of Bone) - Follow-Up Care

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ON THIS PAGE: You will read about your medical care after cancer treatment is completed and why this follow-up care is important. Use the menu to see other pages.

Care for people diagnosed with cancer does not end when active treatment has finished. Your health care team will continue to check that the cancer has not come back, manage any side effects, and monitor your overall health. This is called follow-up care.

Your follow-up care may include regular physical examinations, medical tests, or both. Doctors want to keep track of your recovery in the months and years ahead. For bone sarcoma, follow-up care typically includes general physical examinations, blood tests, and imaging tests, such as a bone scan, computed tomography (CT) scan, or x-rays, to check for signs that the cancer has come back. Tell your doctor about any new symptoms, such as swelling or bone pain, because they may be signs that the cancer has come back or signs of another medical condition.

Cancer rehabilitation may be recommended, and this could mean any of a wide range of services, such as physical therapy, occupational therapy, career counseling, pain management, nutritional planning, and/or emotional counseling. The goal of rehabilitation is to help people regain control over many aspects of their lives and remain as independent as possible. Learn more about cancer rehabilitation.

Learn more about the importance of follow-up care.

Watching for recurrence

One goal of follow-up care is to check for a recurrence, which means that the cancer has come back. Cancer recurs because small areas of cancer cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms. During follow-up care, a doctor familiar with your medical history can give you personalized information about your risk of recurrence. Your doctor will ask specific questions about your health. Some people may have blood tests or imaging tests, such as x-rays or CT scans, done as part of regular follow-up care, but testing recommendations depend on several factors, including the type and stage of cancer first diagnosed and the types of treatment given.

The anticipation before having a follow-up test or waiting for test results may add stress to you or a family member. This is sometimes called “scanxiety.” Learn more about how to cope with this type of stress.

Managing long-term and late side effects

Most people expect to have side effects when receiving treatment. However, it is often surprising to survivors that some side effects may linger beyond the treatment period. These are called long-term side effects. In addition, other side effects called late effects may develop months or even years after treatment has ended. Long-term and late effects can include both physical and emotional changes.

Talk with your doctor about your risk of developing such side effects based on your diagnosis, your individual treatment plan, and your overall health. If you had a treatment known to cause specific late effects, you may also have certain physical examinations, scans, or blood tests to help find and manage them.

People with a family history of cancer

Some people with sarcoma have strong family histories of cancer. This means that other relatives have also had cancer. If there is a strong history of cancer in the family, genetic counselors can talk about what this diagnosis may mean for other people in the family. In some cases, special blood test screening can be done to determine who in the family is at risk to develop cancer. Learn more about the genetics of cancer and talk with your doctor for more information about your family's medical history.

Keeping personal health records

You and your doctor should work together to develop a personalized follow-up care plan. Be sure to discuss any concerns you have about your future physical or emotional health. The American Society of Clinical Oncology (ASCO) offers forms to help keep track of the cancer treatment you received and develop a survivorship care plan when treatment is completed.

This is also a good time to talk with your doctor about who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the care of their primary care doctor or another health care professional. This decision depends on several factors, including the type, stage, and grade of cancer; treatments received; side effects; health insurance rules; and your personal preferences.

If a doctor who was not directly involved in your cancer care will lead your follow-up care, be sure to share your cancer treatment summary and survivorship care plan forms with them and with all future health care providers. Details about your cancer treatment are very valuable to the health care professionals who will care for you throughout your lifetime.

The next section in this guide is Survivorship. It describes how to cope with challenges in everyday life after a cancer diagnosis. Use the menu to choose a different section to read in this guide.

Bone Cancer (Sarcoma of Bone) - Survivorship

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ON THIS PAGE: You will read about how to cope with challenges in everyday life after a cancer diagnosis. Use the menu to see other pages.

What is survivorship?

The word “survivorship” is complicated because it means different things to different people. Common definitions include:

  • Having no signs of cancer after finishing treatment.

  • Living with, through, and beyond cancer. According to this definition, cancer survivorship begins at diagnosis and continues during treatment and through the rest of a person's life.

For some, the term “survivorship” itself does not feel right, and they may prefer to use different language to describe and define their experience. Sometimes long-term treatment will be used for months or years to manage or control cancer. Living with cancer indefinitely is not easy, and the health care team can help you manage the challenges that come with it. Everyone has to find their own path to name and navigate the changes and challenges that are the results of their cancer diagnosis and treatment.

Survivors may experience a mixture of feelings, including joy, concern, relief, guilt, and fear. Some people say they appreciate life more after a cancer diagnosis and have gained a greater acceptance of themselves. Others become very anxious about their health and uncertain about coping with everyday life. Feelings of fear and anxiety may still occur as time passes, but these emotions should not be a constant part of your daily life. If they persist, be sure to talk with a member of your health care team.

Survivors may feel some stress when their frequent visits to the health care team end after completing treatment. Often, relationships built with the cancer care team provide a sense of security during treatment, and people miss this source of support. This may be especially true when new worries and challenges surface over time, such as any late effects of treatment, emotional challenges including fear of recurrence, sexual health and fertility concerns, and financial and workplace issues.

Every survivor has individual concerns and challenges. With any challenge, a good first step is being able to recognize your fears and other feelings and talk about them. Effective coping requires:

  • Understanding the challenge you are facing

  • Thinking through solutions

  • Asking for and allowing the support of others

  • Feeling comfortable with the course of action you choose

Many survivors find it helpful to join an in-person support group or an online community of survivors. This allows you to talk with people who have had similar first-hand experiences. Other options for finding support include talking with a friend or member of your health care team, individual counseling, or asking for assistance at the learning resource center of the place where you received treatment.

A new perspective on your health

For many people, survivorship serves as a strong motivator to make lifestyle changes.

People recovering from bone sarcoma are encouraged to follow established guidelines for good health, such as not smoking, limiting alcohol, eating well, exercising regularly, maintaining a healthy weight, and managing stress. Regular physical activity can help rebuild your strength and energy level. Your health care team can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about making healthy lifestyle choices.

It is important to have recommended medical checkups and tests (see Follow-up Care) to take care of your health.

Talk with your health care team to develop a survivorship care plan that is best for your needs.

Changing role of caregivers

Family members and friends may also go through periods of transition. A caregiver plays a very important role in supporting a person diagnosed with cancer, providing physical, emotional, and practical care on a daily or as-needed basis. Many caregivers become focused on providing this support, especially if the treatment period lasts for many months or longer.

However, as treatment is completed, the caregiver's role often changes. Eventually, the need for caregiving related to the cancer diagnosis will become much less or come to an end. Caregivers can learn more about adjusting to life after caregiving.

Looking for More Survivorship Resources?

For more information about cancer survivorship, explore these related items. Please note that these links will take you to other sections of Cancer.Net:

  • ASCO Answers Guide to Cancer Survivorship: Get this 48-page booklet that helps people transition into life after treatment. It includes blank treatment summary and survivorship care plan forms. The free booklet is available as a PDF, so it is easy to print.

  • Survivorship Resources: Cancer.Net offers information and resources to help survivors cope, including specific sections for children, teens and young adults, and people over age 65. There is also a main section on survivorship for people of all ages.

The next section offers Questions to Ask the Health Care Team to help start conversations with your cancer care team. Use the menu to choose a different section to read in this guide.

Bone Cancer (Sarcoma of Bone) - Questions to Ask the Health Care Team

Approved by the Cancer.Net Editorial Board, 09/2022

ON THIS PAGE: You will find some questions to ask your doctor or other members of the health care team to help you better understand your diagnosis, treatment plan, and overall care. Use the menu to see other pages.

Talking often with the health care team is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment. It may also be helpful to ask a family member or friend to come with you to appointments to help take notes.

Questions to ask after getting a diagnosis

  • What type of bone sarcoma do I have?

  • Can you explain my pathology report (laboratory test results) to me?

  • Has this diagnosis been reviewed by a pathologist who is experienced in the diagnosis and classification of sarcoma?

  • What stage and grade is the bone sarcoma? What does that mean?

  • Where exactly is the cancer located?

  • Was my case discussed in a tumor board or other multidisciplinary conference? What does this mean?

  • What experience does your center have in treating this rare type of sarcoma? Should I be referred to a sarcoma specialty center?

Questions to ask about choosing a treatment and managing side effects

  • What are my treatment options?

  • What types of research are being done for bone sarcoma in clinical trials? Do clinical trials offer additional treatment options for me?

  • What treatment plan do you recommend? Why?

  • What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both?

  • What are the possible side effects of this treatment, both in the short term and the long term?

  • What is the expected timeline for my treatment plan?

  • Who will be part of my health care team, and what does each member do?

  • Is there someone who provides supportive counseling? If not, can you refer me to a therapist in the community?

  • Who will be leading my overall treatment?

  • How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?

  • Could this treatment affect my sex life? If so, how and for how long?

  • Could this treatment affect my ability to become pregnant or have children? If so, should I talk with a fertility specialist before cancer treatment begins?

  • If I’m worried about managing the costs of cancer care, who can help me?

  • If I have questions or problems, who should I call?

Questions to ask about having surgery

  • What type of surgery will I have? Will lymph nodes be removed?

  • What is the goal of this surgery?

  • How long will the operation take?

  • How long will I be in the hospital?

  • Can you describe what my recovery from surgery will be like?

  • Who should I contact about any side effects I experience? And how soon?

  • If needed, what types of rehabilitation services are available?

  • What are the possible long-term effects of having this surgery?

  • What can be done to relieve the side effects?

  • Will I need additional treatment after surgery?

Questions to ask about having therapies using medication

  • What type of treatment is recommended?

  • What is the goal of this treatment?

  • How long will it take to give this treatment?

  • Will I receive this treatment at a hospital or clinic? Or will I take it at home?

  • What side effects can I expect during treatment?

  • Who should I contact about any side effects I experience? And how soon?

  • What are the possible long-term or late effects of having this treatment?

  • What can be done to prevent or relieve the side effects?

Questions to ask about having radiation therapy

  • What type of treatment is recommended?

  • What is the goal of this treatment?

  • How long will it take to give this treatment?

  • What side effects can I expect during treatment?

  • Who should I contact about any side effects I experience? And how soon?

  • What are the possible long-term or late effects of having this treatment?

  • What can be done to prevent or relieve the side effects?

Questions to ask about planning follow-up care

  • What is the chance that the cancer will come back? Should I watch for specific signs or symptoms?

  • What long-term side effects or late effects are possible based on the cancer treatment I received?

  • What follow-up tests will I need, and how often will those tests be needed?

  • How do I get a treatment summary and survivorship care plan to keep in my personal records?

  • When should I return to my primary care doctor for regular medical care?

  • Who will be leading my follow-up care?

  • What survivorship support services are available to me? To my family?

The next section in this guide is Additional Resources. It offers more resources on this website that may be helpful to you. Use the menu to choose a different section to read in this guide.

Bone Cancer (Sarcoma of Bone) - Additional Resources

Approved by the Cancer.Net Editorial Board, 07/2021

ON THIS PAGE: You will find some helpful links to other areas of Cancer.Net that provide information about cancer care and treatment. This is the final page of Cancer.Net’s Guide to Bone Cancer (Sarcoma of Bone). Use the menu to go back and see other pages.

Cancer.Net includes many other sections about the medical and emotional aspects of cancer for the person diagnosed and their family members and friends. This website is meant to be a resource for you and your loved ones from the time of diagnosis, through treatment, and beyond.

Here are a few links to help you explore other parts of Cancer.Net:

This is the end of Cancer.Net’s Guide to Bone Cancer (Sarcoma of Bone). Use the menu to choose a different section to read in this guide.