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CANCER SERVICES

Diagnosis & Treatment

Bone Cancer

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How is Bone Cancer Diagnosed?

Diagnosis

Healthcare professionals at NewYork-Presbyterian can use various methods to confirm a bone cancer diagnosis. These methods include:

  • X-rays are often one of the first tests performed and will allow doctors to examine tumors or abnormalities in the body
  • Biopsies, in which a doctor examines a tissue sample under a microscope. A doctor can use a needle to remove a cylindrical tissue sample, or the doctor can surgically cut through the skin to remove a sample from a tumor.
  • MRI scans provide a more detailed look at suspect areas in the body. MRI scans will allow doctors to examine bone marrow, blood vessels in the area, and nearby tissue around tumors.
  • CT scans use X-ray imaging technology to take images of a body cross-section. These scans will determine if a suspected area of the body has cancerous cells and will determine if the cancer has spread to other parts of the body.
  • Bone scans involve injecting a radioactive substance into the blood. The radioactivity will accumulate in cancerous areas, and a special camera is used to view the entire skeleton to detect these areas. Other bone diseases can cause the accumulation of radioactive substances, so additional tests will need to be performed to confirm whether or not the observed results are due to bone cancer.
  • PET scans involve an injection of radioactive sugar into the blood. Cancer cells absorb large amounts of this sugar, and a special camera takes images of the body to detect these cancerous areas.

A doctor may also perform a blood test, which does not diagnose bone cancer but can help detect levels of chemicals in the body, like alkaline phosphatase and lactate dehydrogenase (LDH). Measuring these chemical levels can provide information about the severity of cancer.

How is Bone Cancer Treated?

Treatments

Bone cancer treatment options depend on the type and stage of cancer. Surgical and nonsurgical options can cause side effects that can also be treated at NewYork-Presbyterian. We participate in a number of cancer clinical trials, allowing eligible patients the opportunity to receive promising new treatments and therapies.

Surgical options

The goal of surgery is to remove all cancerous cells from your body. Surgeons will remove the tumor as well as some of the nearby tissue to decrease the likelihood that remaining cancerous cells will cause a tumor to grow back.

If surgery is part of your treatment plan, we’ll discuss your options and customize an approach that works for you, bringing in any experts you need to achieve the best outcome.

  • Making inoperable tumors operable - Some bone cancers may be challenging to remove surgically. We sometimes give chemotherapy for several months before surgery to shrink a bone tumor and make it operable. This approach is called neoadjuvant chemotherapy.
  • Limb-sparing surgery - About 90% of people with bone tumors in the arms or legs are candidates for limb-sparing surgery. NewYork-Presbyterian’s cancer surgeons, orthopedic surgeons, neurologists, and reconstructive surgeons are experts in these procedures and collaborate to perform these complex and innovative operations.
  • Reconstructive surgery - If you need surgery for bone cancer, you may be concerned that removing the tumor will affect your ability to use the affected arm or leg. At NewYork-Presbyterian, your team includes reconstructive surgeons who offer the latest techniques and tools to restore limb function. These include allografts (the use of donated bone tissue to replace removed bone) and metal prostheses (rods inserted where the bone was removed, including newer expandable prostheses for children).
  • Amputation - In certain cases, amputating a limb is the best option for the patient. If the tumor has grown to a size where it impacts the functionality of important blood vessels or nerves, removing the tumor alone may not be possible. Doctors will use imaging tests to determine how much of the limb needs to be amputated, and prosthetics can be implanted in place of the bone.

Physical rehabilitation is crucial after both limb-sparing surgery and amputation in order to restore functionality to the affected area.

Nonsurgical options

  • Radiation therapy - High-energy rays kill cancer cells. These rays can also affect neighboring healthy cells, so it is not the main treatment method, but it can be helpful in shrinking tumors before surgery. Radiation therapy can also be used to kill cancer cells that were left behind after surgery.
  • Chemotherapy - Cancer cells are killed by drugs injected directly into the vein or taken orally. Chemotherapy can act on cancer cells anywhere in the body, so this treatment method is effective if bone cancer has spread to other parts of the body. Chemotherapy is commonly used to treat osteosarcoma and Ewing sarcoma, but it does not work as effectively on chordomas and chondrosarcomas.

    Intravenous chemotherapy drugs that may be used for bone tumors include:
    • Doxorubicin
    • High-dose methotrexate
    • Gemcitabine
    • Docetaxel
    • Irinotecan
    • Ifosfamide
    • Cyclophosphamide
    • Vincristine
    • Regorafenib
    • Etoposide

​We use these drugs alone or in combination, depending on the type and stage of your cancer. We give chemotherapy in NewYork-Presbyterian’s modern infusion suites, which are staffed by oncology nurses with the skill, compassion, and experience to monitor you during treatment for bone cancer and ensure you are comfortable.

  • Targeted drug therapy - Cancer cells are killed by drugs that are different from chemotherapy drugs. Unlike chemotherapy drugs, targeted drugs contain toxins that kill cancerous cells but do not affect normal, healthy cells. They can also prevent cancerous cells from replicating themselves. At NewYork-Presbyterian, we perform genetic analysis of your tumor to identify the molecules that are driving its growth and to match you with available drugs that target those molecules.

Immunotherapy has been tried as a treatment for these diseases without much success.

Dietary changes

Since cancerous cells involve mutations that change biochemical levels in the body, your doctor may recommend specific foods to either try or avoid in combination with the drug therapies used in your treatment.

FAQs

FAQs

Some people are diagnosed with bone cancer only once they start experiencing symptoms. Symptoms will differ for each person depending on the location of the cancer, its type, and its stage. Some people do not experience symptoms early on, or they mistake their symptoms for other bone-related conditions like arthritis or osteoporosis.

This means that cancer can go undiagnosed for some time. It is important to consult with a doctor if you are experiencing bone cancer symptoms so that if you are diagnosed, you can start treatment as quickly as possible and increase the likelihood of recovery. Learn more about the symptoms associated with bone cancer.

Some people experience pain at the location of bone cancer that may start as a feeling of tenderness. This pain can be on-and-off pain, and it may worsen at night or with physical activity. Over time, the pain can become more constant and cause persistent aches. The pain is comparable to arthritis pain and can be mistaken as such in adults. Learn more about the symptoms and signs of bone cancer.

Bone cancer can start anywhere, though it is more commonly found in pelvic bones or long body bones, such as in the arms and legs. Bone cancer can also result from spreading another type of cancer, like lung, breast, or prostate cancer so that cancer may begin in a different body part altogether.

Each person’s case is different. The speed at which bone cancer spreads will depend on the type and stage of bone cancer and individual health conditions. Seeking early diagnosis and prompt treatment can slow or prevent the cancer’s spread.

A grading system (from 1-3) describes how abnormal the cancer cells look under a microscope. The higher the grade, the more abnormal the cells look and the more aggressively they tend to spread. Ongoing research and medical advancements have led to promising developments regarding the treatment of bone cancer, so consult with a medical professional about the best treatments for you.

It becomes easier to focus on pain at night when there are fewer distractions from the discomfort, but the increase in pain can also result from chemical changes in our bodies. For example, when we sleep, the cortisol levels in our bodies decrease. Cortisol is an anti-inflammatory hormone, so decreased levels at night can cause an increase in pain from bone cancer or other ailments such as arthritis, osteoporosis, or bone fractures.

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Trust NewYork-Presbyterian for Bone Cancer Treatment

At NewYork-Presbyterian, we are experts in diagnosing and treating bone cancer. We’ll work with you at every stage to track the progression of cancer and provide guidance on symptoms and recovery. Make an appointment today with one of our cancer specialists to begin your personalized treatment plan.