Primary Bone Cancer: Types, Symptoms, Diagnosis & Treatment

Primary bone sarcoma is rare (<0.2% of cancers); distinct from metastatic bone disease.

Common Types

• Osteosarcoma: Peak 10–30 yr; metaphysis of long bones (distal femur, proximal tibia); osteoid production.
• Ewing sarcoma: 10–20 yr; diaphysis flat bones (pelvis, ribs); EWSR1‑FLI1 translocation.
• Chondrosarcoma: >40 yr; pelvis, femur, humerus; cartilage matrix; grade‑dependent behavior.
• Chordoma: Skull base, sacrum; notochord remnants; locally aggressive.

Presenting Symptoms

• Deep, dull, progressive pain (worse at night/activity).
• Palpable mass, swelling.
• Pathologic fracture (minor trauma).
• Systemic: weight loss, fatigue (advanced).

Diagnostic Workup

1. X‑ray (sunburst periosteal reaction, Codman triangle, lytic/sclerotic).
2. MRI (local extent, neurovascular involvement).
3. Chest CT (lung mets most common).
4. Bone scan or PET‑CT (skip lesions).
5. Core needle biopsy (by treating sarcoma team) – critical before any resection.

Multimodal Treatment

• Neoadjuvant chemotherapy (osteosarcoma, Ewing) → response assessment → wide resection → adjuvant chemo.
• Surgery: Limb‑salvage (endoprosthesis, allograft, rotationplasty) or amputation.
• Radiation: Ewing (radiosensitive); chondrosarcoma (resistant – only unresectable/recurrent).

Prognosis

• Localized osteosarcoma/Ewing: 60–70% 5‑yr survival.
• Metastatic at diagnosis: 20–30%.
• Chondrosarcoma: Grade‑dependent (low grade >90% 5‑yr).

Referral to high‑volume sarcoma center improves outcomes.