Symptoms of bone cancer can be a bit tricky to pin down at first because these types of symptoms are much more commonly caused by noncancerous conditions such as sports injuries or joint problems, including forms of arthritis. Additionally, symptoms of bone cancer vary and can depend on factors such as the location and type of tumor.
Frequent Symptoms
Symptoms are usually present for several months before a diagnosis is made—about three months, on average.
Pain
Overall, pain is the most common symptom of osteosarcoma, the most common type of primary bone cancer.
At first, the pain may not be constant. It is often attributed to a physical injury or vigorous physical exercise, both of which are common in the younger population that tends to be affected by osteosarcoma.
Pain from bone cancer may be worse at night or when you move the bone.
With primary bone cancer, the pain most often occurs in the long bones of the body, like those of the arms and legs. With metastatic bone cancer, the spine is the most common area affected, and back pain is the most common symptom.
About half of all osteosarcomas start in the region around the knee. The most frequent starting point is near the end of the femur (thighbone), followed by the tibia (below the knee). The humerus (arm bone near the shoulder) is the third most common location. Involvement of other parts of the skeleton, most commonly the hips, occurs in less than 10% of cases in pediatric osteosarcoma.
Swelling
The painful area of bone may also develop swelling around it, although this may not occur until weeks after the onset of the bone pain.
Pain and swelling can have a variable pattern, depending on the type of bone cancer. For instance, in the case of osteosarcoma, the shin, thigh, and upper arm are common tumor sites in children and adolescents. It is in these areas that pain and swelling occur with the disease.
Some people who have bone cancer are able to feel a lump or mass if the bone tumor is in a location that can be detected by touch.
Pathological Fractures
These are fractures that wouldn’t normally occur in healthy bones. When cancer develops within the bone, the bone can be weakened. A pathological fracture causes sudden severe pain in a bone that may have been sore for weeks or months.
Osteosarcoma is sometimes discovered when a bone that has been weakened by cancer breaks as a result of a minor fall or accident.
Less Common Symptoms
As bone cancer advances, systemic effects may arise, in addition to the local effects near the bone.
These include:
Fatigue and sleepiness Fever Unintentional weight loss Low energy, pale skin, or tachycardia (rapid heart rate) due to anemia (low red blood cell count)
These systemic symptoms tend to occur with very advanced disease.
Rare Symptoms
Different locations and types of osteosarcoma can cause characteristic symptoms along with the more common effects of bone cancer.
Head and Neck Osteosarcomas
Osteosarcomas of the skull and facial bones are relatively rare and represent less than 10% of all osteosarcomas. The male-to-female ratio is close to one.
The most commonly affected bones of the head and neck are the jawbone, followed by the upper mouth portion of the skull (maxilla). Osteosarcomas of the other skull bones are extremely rare. Cancers that develop in the bones of the neck may cause a mass to develop and enlarge in the back of the throat, which may result in difficulty swallowing or breathing. Cancer in the bones of the spine can enlarge to press on nerves, causing numbness, tingling, or muscle weakness.
Parosteal Osteosarcomas
Parosteal osteosarcoma causes minimal pain and tenderness over the cancerous site. these tumors can limit the ability to flex and extend the knee joint.
The tumor may be present for a long time before it is diagnosed, enlarging before pain develops in the late phases.
Multifocal Sclerosing Osteosarcomas
Multifocal sclerosing osteosarcoma is a condition in which multiple tumors in the skeleton are present at diagnosis. Each tumor looks like it’s the original site of disease, suggesting that the bone tumors developed independently, at the same time, and at multiple sites.
Symptoms are similar to more typical osteosarcomas except that they may occur in very young children and are more widespread.
It is not known for sure whether such bone cancer arises in multiple sites or if one of the tumors is the true start of the disease and has metastasized rapidly to other skeletal sites.
Post-Irradiation Osteosarcoma
Post-irradiation osteosarcoma can develop after radiation therapy treatment for another cancer. It develops in less than 1% of people who have had radiation treatment for cancer.
Evidence suggests that osteosarcomas occur more frequently in patients who receive higher doses of radiation therapy. Symptoms typically include painful swelling in the area of the body that had been targeted by radiation therapy.
Complications
A variety of complications are possible with osteosarcoma and/or its treatment. The list may feel overwhelming.
Possible complications of osteosarcoma or its treatment include:
InfectionBleeding from surgeryProblems after limb-salvage surgeryProblems due to chemotherapy: Hair loss, mouth sores, nausea, vomiting, diarrhea, increased infections, easy bruising and bleeding, and feeling tiredProblems due to radiation therapy: Burns, hair loss, nausea, diarrhea, poor bone growth, organ damage, and new cancersEmotional and physical challenges after amputationHeart and lung problemsProblems with growth and developmentLearning problemsChanges in sexual developmentProblems with fertilityReturn of the cancerGrowth of other cancers
Metastasis
The most frequent site of metastasis (spread of cancer) from the bone is the lung.
Much less frequently, metastases are detected in other bones and soft tissues. When osteosarcoma has become more widespread, this is frequently the consequence of recurrence. Widespread osteosarcoma can spread to involve the central nervous system or gastrointestinal tract.
Death from osteosarcoma is almost always the result of respiratory failure. This can involve bleeding into the lungs, collapse of one or both lungs, and compression of the blood vessels that are near the lungs.
When to See Your Healthcare Provider
Many of the common symptoms of bone cancer, such as pain and swelling, tend to occur much more commonly in association with less serious conditions—such as traumatic injuries. In addition, leg and arm pain are common in growing children, and there is often no cause for concern. However, if the pain persists, intensifies, or if other symptoms are present, you should seek medical attention.
If you or a loved one has a cancer-predisposing condition such as retinoblastoma or Li-Fraumeni syndrome, you need to be particularly vigilant for the signs and symptoms of malignancy.
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If you have already been diagnosed with bone cancer, you should speak to your healthcare provider if your symptoms are getting worse, you are having new symptoms, or you are having side effects from treatment.
Other early symptoms may include:
Limping or trouble walkingTrouble moving or lifting a limbPain, swelling, warmth, or redness near a jointBreaking a bone without a traumatic injury
Primary tumor locationSize of the primary tumorHow far cancer has spread (if at all)AgeWhether the tumor is resectable (can be surgically removed)
A healthcare provider will use classification systems to help determine the stage of cancer, which describes how much it has spread in the body ,and can offer an estimated prognosis.
