Bone cancer

There are different types of bone cancer. The most common types to affect teenagers and young adults are osteosarcoma and Ewing sarcoma. Both are more common in young men than in young women.

Young people playing football

The bones

Knowing what your bones do might help you understand what bone cancer is. Bones are like human scaffolding. They help keep us upright. The human skeleton has more than 200 bones of different shapes and sizes.

Bones do several important things:

  • they work together with our joints so we can move around
  • they protect parts of our bodies from injury – for example, the ribs protect the heart and lungs
  • they store calcium
  • some bones contain bone marrow, which makes our blood cells.


Joints help bones fit together so we can move. There are different types of joint. Some work as levers, like the finger joint. Others, such as the hip joint, are ball-and-socket joints. There are different types of tissue that help bones move:

  • Ligaments are tough cords of tissue that attach bones to each other.
  • Cartilage is a slippery material that covers the ends of bones, to stop them rubbing together.
  • Muscles are made of tough, stretchy tissue that gives us our strength.
  • Tendons are strong cords of tissue that attach muscles to bones.

Types of bone cancer


Osteosarcomas are most likely to affect bones in the leg, especially around the knee. But they can affect any bone.

Ewing sarcoma

Ewing sarcoma can affect any bone. But it is most common in the pelvis (the tail bone and the hip bones) or in leg bones. Ewing sarcoma sometimes starts outside the bone, in the soft tissue. This is called soft tissue Ewing sarcoma, but it is treated in the same way. Sarcoma is the name for a cancer that starts in any connective tissue such as muscle, fat or cartilage.


We do not know what causes bone cancer. It is more common in young people. Doctors think there may be a link between bone cancer and the changes that happen when bones are growing. Research is looking at possible reasons for this.

People worry that a knock or injury might have caused bone cancer. But there is no evidence for this.

Remember that nothing you have done has caused the cancer.

Signs and symptoms of bone cancer

Bone cancer symptoms vary, and not everyone will have the same ones. Many symptoms are similar to everyday aches and pains. You might mistake them for other things like strains, sports injuries or growing pains.

The main symptoms include:

Aches or pains that do not go away. Exercise might make this worse, or it may feel worse at night. If bone pain at night does not get better, it is important to get it checked by a doctor.

Swelling around the affected bone. Swelling may not show up until a tumour is quite large. You may not always see or feel a lump if the affected bone is deep inside the body.

Reduced movement. Sometimes, the bone cancer is near a joint (like an elbow or knee). This can make it harder to move the joint. If the cancer is in a leg bone, it may cause a limp.

Numbness or tingling. If the cancer is in the backbone (spine), it may press on nerves. This can cause tingling and numbness in the legs or arms.

A broken bone. If cancer has weakened a bone, it may break suddenly. Or it may break after a minor fall or accident.

Other symptoms

There might also be other symptoms, including:

  • tiredness
  • a high temperature
  • loss of appetite
  • weight loss.

If you have any of these symptoms or you are worried, you should see your doctor for a check-up. They can talk to you about your symptoms and arrange tests if you need them.

Remember, most people with these symptoms do not have bone cancer.

Having tests for bone cancers

Visiting your GP

If you think you might have some symptoms of bone cancer, you should see your GP.

There may be different reasons why you are feeling unwell, so they may not diagnose you straight away. Your GP will talk to you about your symptoms, examine you and usually arrange some tests. These tests can include x-rays and blood tests. After these tests, they may refer you to an orthopaedic (bone) team or a specialist bone cancer team at the hospital.

At the hospital

The hospital doctor will examine you and arrange for some of the following tests:

  • x-rays
  • bone scans
  • MRI scans
  • CT scans
  • biopsies

Further tests

If you are diagnosed with bone cancer, you might need a few more tests such as:

  • blood tests
  • tests to check your heart is healthy, for example an echocardiogram (ECG)
  • chest x-rays to check your lungs are healthy
  • tests to check your kidneys are healthy – you may need to give a sample of pee (urine).

This may feel like lots of tests, but they help doctors plan the best treatment for you.

Having tests and waiting for the results can be a nervous time. It can help to talk about how you feel. You can get support from family, friends, your specialist nurse or your doctor.

We have more information about tests and scans.

Treatment for bone cancer

The three main treatments for bone cancer are:

  • chemotherapy (chemo)
  • surgery
  • radiotherapy

Most people have a combination of these treatments. Your doctors will plan your treatment based on:

  • the type of bone cancer you have
  • where the cancer is
  • the stage of the cancer (whether it has spread outside the bone)
  • how fast the cancer has grown.

If you have any questions about your treatment, ask your doctor or nurse. They will help you understand what it involves.

You may have the chance to take part in a clinical trial. If your doctor thinks there is a trial that is suitable for you, they will discuss this with you. You will be able to talk about it with your specialist and family before you decide what to do. It will be your decision whether or not to take part in a trial.

Chemotherapy (chemo)

Chemotherapy is when you have anti-cancer drugs to destroy cancer cells. It is an important treatment for bone cancers. It helps shrink the cancer before surgery or radiotherapy. It can also kill cells that have spread outside the bone. After surgery or radiotherapy, you will usually have more chemotherapy.

Chemotherapy for bone cancer is given into a vein, usually through a central line, implantable port or PICC line.

You have chemotherapy over a few days. Then you have some time off to let your body recover from any side effects. The days you have the chemotherapy and the rest period afterwards are called a cycle. Most people have several cycles of chemotherapy. You probably need to stay in hospital for some of the time you are having chemotherapy.

We have more information about how you have chemotherapy. 

The type of chemotherapy you have depends on whether the tumour is an Ewing sarcoma or an osteosarcoma (see below). We also have more information about chemotherapy, written for teenagers and young adults with any type of cancer. 

Chemotherapy for Ewing sarcoma

For Ewing sarcoma, the most common drugs are:

  • vincristine
  • ifosfamide
  • doxorubicin
  • etoposide

Your doctor can tell you more about the drugs you will have.

After chemotherapy, you may have surgery. Or if doctors cannot remove the tumour with an operation, you will have radiotherapy. Some people have both surgery and radiotherapy. The team looking after you will decide on the best combination for you.

After surgery or radiotherapy, you will have more chemotherapy to help stop the cancer returning or spreading around the body.

Chemotherapy for osteosarcoma

Osteosarcoma is usually treated with three chemotherapy drugs:

  • methotrexate
  • doxorubicin (Adriamycin®)
  • cisplatin

When doctors give these drugs together, it is called MAP.

You will usually have 6 cycles of chemotherapy in total. Each cycle takes about 5 weeks. After the first 2 cycles, you may have surgery to remove the cancer.

If the cancer has spread, you may also need to have surgery on another part of your body. For example, if osteosarcoma spreads outside of the main tumour, it usually spreads to the lungs. You may need a second operation to remove the cancer in your lungs. If you have bone cancer that has spread, your doctors will talk to you about what happens next.

After surgery you will have 4 more cycles of MAP chemotherapy. You may also have a targeted therapy called mifamurtide (Mepact®). This helps your body’s immune system kill tumour cells. The most common side effect of mifamurtide is having a high temperature or feeling cold and shivery. This may last for a few hours after you have mifamurtide. Your doctor will tell you if you can have this drug as well as chemotherapy.

Side effects of chemotherapy

Different chemotherapy drugs cause different side effects. Some people have just a few side effects and others have more. It is hard to know how it is going to affect you. Your doctor or nurse can tell you more about what to expect. Most side effects are temporary and will stop when treatment finishes.

The most common side effects are:

  • a sore mouth
  • hair loss
  • tiredness
  • sickness
  • being more at risk of getting an infection.

We have more information about the side effects of chemotherapy.


The type of surgery you have depends on the type of bone cancer and where it is in the body.

Your surgeon will aim to remove all of the cancer. But they will also try to keep the body part working as well as possible.

Limb-sparing and non-amputation surgery

Most people with bone cancer in an arm or leg have an operation called limb-sparing surgery. This means the surgeon removes the cancer without removing the arm or leg.

In limb sparing and non-amputation surgery, the surgeon will remove all the cancer. This includes any affected bone and muscle.

Surgeons can usually remove the affected part of the bone. If needed, they replace it with:

  • a custom-made metal fitting (endoprosthesis or prosthesis)
  • a bone from another part of the body (bone graft).

The cancer may be affecting a bone that is in or near a joint. In this case, surgeons can often replace the whole joint with an artificial one.

Sometimes, removing the cancer will not affect the way you move. So you will not need any replacement joints. For example, this can happen with a cancer in the rib.

Before the operation

You may need 1 to 3 weeks to recover from chemotherapy before you can have your operation. This will depend on the chemotherapy drugs you have had. Your doctor will make sure that you are well enough to have the operation. You may have not felt like eating, or you may have lost weight. If this has happened, you may need to build yourself up before the operation. The hospital dietitian can help you do this. You will probably see a physiotherapist, who will give you exercises to strengthen your muscles.

You may want to know more about the replacement part or prosthesis that surgeons put in during your operation. Your surgeon or key worker can answer any questions. They can also show you pictures of the prosthesis they plan to use.

After the operation

You will have a bandage or splint on your limb, to support it and let it heal.

You may have a tube (a drain) coming out of your wound. This stops fluid collecting in your wound. A nurse will take it out after about 2 to 4 days.

You may not feel like eating or drinking much after your operation. If this happens, a drip will give you fluids directly into a vein.

You may feel a bit sore to begin with, but you will have strong painkillers to help. It’s important to tell the nurses if you need extra pain relief. The pain usually starts to get better within 2 to 3 days. As time passes, you will need fewer painkillers and will start to feel more comfortable.

Once you are home, you should start to feel better and stronger every day. But if you have any problems, it is important to tell your doctor or nurse right away. This means they can deal with any problems quickly.

After your operation, you will need to do exercises to help you recover. This can be hard work, but it is important. Your physiotherapist will show you these exercises and will help you do them regularly.

Tell your doctor straight away if you notice new redness, pain or swelling in the limb that’s been operated on. This means you might have an infection that needs treatment. You will need to see the surgeon who did your operation as quickly as possible.


Sometimes, the only way to get rid of the bone cancer is to remove the affected arm or leg. This is called an amputation, and will only happen if there is no other choice. You may need an amputation if the cancer has spread from the bone and grown around nearby blood vessels. The surgeon will remove these with the cancer.

Some people choose to have an amputation rather than limb-sparing surgery. You can discuss the benefits and disadvantages of both types of surgery with your team.

You may need an amputation if there is an infection in the bone that does not go away. Or you may need one if the cancer comes back in the bone. Every person and every cancer is different. You might meet other people with the same type of cancer having different surgery. Your specialist will talk to you about your operation and make sure you understand what it involves.

Before the operation

Your doctor will talk to you about the operation, so you understand what it involves. The thought of losing a limb can be frightening. It might help to talk to your specialist nurse, your keyworker or a counsellor about your feelings. You may be able to talk to someone who has had an amputation. Your nurse or doctor can often arrange this. It is important to get support during this time.

After the operation

You will have bandages on the area that has been operated on. There will be a tube (a drain) coming from the wound. This stops fluid building up. A nurse will usually take it out after 2 to 4 days. You will also have a drip put into a vein in your arm to give you fluids. You will have this until you feel like eating and drinking again.

You will probably feel sore after your operation, especially for the first 2 to 4 days. But you will have strong painkillers to help with this. It is important to tell the nurses if you need extra painkillers. As time passes, you will need fewer painkillers and will start to feel more comfortable.

You may have pain that feels like it is coming from the part of the limb that was removed. This is known as phantom pain. Let your doctor or nurse know if you have this. There are medicines that can help ease or take it away. It usually gets better and stops in time.

A physiotherapist will show you exercises to keep your muscles strong and flexible.

If you have an arm removed, you will be able to get up and move around once you have recovered from the anaesthetic. If you have a leg removed, the physiotherapist will show you how to move around in bed. They will also show you how to get from your bed to a chair. You will probably be moving around with crutches or in a wheelchair within a few days.

Once you are ready, you will go to the hospital gym for physiotherapy. This is a big part of your recovery. Your physiotherapist will give you more exercises to do as your wound heals and you get stronger.

It will take a few months for your limb to heal to its final shape after the operation. Doctors will not fit your permanent prosthesis until this happens. In the meantime, you will have a temporary prosthesis. You will learn how to use it in physiotherapy.

You should be able to go home about 5 days after your operation.


Radiotherapy treats cancer by using high-energy x-rays to destroy cancer cells.

You may have radiotherapy to treat Ewing sarcoma. You may have radiotherapy after you have had chemotherapy. Radiotherapy can be given before, after or instead of surgery.

If you have osteosarcoma, you are less likely to have radiotherapy. But you might have radiotherapy if it is not possible to remove the cancer with an operation. Sometimes, people with osteosarcoma have radiotherapy after surgery.

You usually have radiotherapy every weekday (Monday to Friday), for 5 weeks. Each treatment takes a few minutes.

Side effects of radiotherapy

Radiotherapy is not painful, but it can cause some side effects. After a few treatments, you may begin to feel tired. Your skin may go red or get darker. It could also feel sore or itchy around the area being treated. This gets better once your radiotherapy treatment is over.

Other side effects depend on the part of your body being treated. Having radiotherapy around a joint can make it feel stiff. But physiotherapy can help with this. Your doctor can talk to you about possible side effects before you start treatment.

We have more information about radiotherapy and about the side effects of radiotherapy.

How will you feel?

Things may be tough as you get used to living with the changes in your body. You might have lots of different emotions. You might be tearful, angry, fed up or sad at times. You might feel like you have lost all your confidence. Or you may feel that you will never be able to live a normal life or be in a relationship. These feelings are normal, and it's important to get support to help you cope with them. You could talk to:

  • your specialist nurse or keyworker
  • family or friends
  • a counsellor
  • other young people in a similar situation, for example through a support group.

The way other people react can be hard to cope with too. You might worry about what your friends will think or how they will treat you. The thought of going back into school, college or work can be scary. Even people in your family might not know what to say or do. Others might say things that sound stupid or seem hurtful.

Try to choose a couple of close relatives or friends who you can talk to if things upset you. You might find it useful to talk to someone outside your close circle. This might be your specialist nurse, keyworker or counsellor. Most people find it helps to talk about how they are feeling or what they are worried about. 

We have more information about living with and beyond cancer, including coping with changes to your body.

Sex and relationships

Sex and relationships might be something you worry about when you find out you have cancer. Or you may only start to think about your sex life as you go through treatment, or after it’s finished. We have information that explains some of the physical and emotional effects cancer can have on your sex life and relationships.

If you have sex during chemotherapy treatment, it is important to protect yourself and your partner. It is also important to prevent a pregnancy. If you have any questions about this, ask your doctor or nurse for advice. We talk more about this in our information about sex and relationships.

What happens after treatment?

Follow up

When you finish your treatment, your doctor will talk to you about what happens next. They will explain some of the long-term risks that bone cancer and its treatment could have for you. They will arrange to see you regularly in clinic to check how you are.

Life after limb-sparing surgery

The long-term effects of limb-sparing surgery depend on which part of your body is affected and the kind of operation you have. The best person to ask about possible effects is your surgeon.

After limb-sparing surgery, the limb might not work as well as it did before the operation. Physiotherapy is an important part of your recovery. You will have exercises to do to help get your limb working as well as possible. These can be hard work, but it’s important to keep going with them.

Knee joint replacement

If you have a knee joint replacement, you can still walk and swim afterwards. But your doctor might advise you not to play high-impact sports like hockey, football, tennis or rugby. These activities could damage or loosen the new joint.

It is usually okay to run a short distance, for example running to catch a bus. But regular running or jogging wears out the new joint. It is best to avoid this, or the joint might need replacing after a few years.

Hip joint replacement

After a hip joint replacement, you should be able to do most of your usual activities. But doctors will probably advise you to avoid running and high-impact sports.

Shoulder replacement

After having a shoulder replacement, you will be able to move your arm below shoulder height. But you might not be able to lift your arm above your shoulder.

Bone implant

You may have an implant put into a bone while you are still growing. If so, it will need lengthening as your leg or arm grows. Some types of implant can be lengthened without an operation. But with others, you will need surgery. Your specialist or key worker can tell you what kind of implant you have.

Life after amputation

After amputation, you usually have an artificial limb fitted. This is called a prosthesis. There are artificial limb designs that let you do all types of physical activity. This includes walking, swimming, running, cycling and playing sports.

Different types of prosthesis let you do different things. For example, some people have one for wearing day-to-day. But some people also have an extra one, designed for something like swimming or athletics.

Living with cancer

Find out about how cancer affects different parts of your life and what help and support is available to you.

Living with cancer

Useful organisations

There are a number of useful organisations who can help you with support and advice about bone cancer specifically.

Bone Cancer Research Trust

The Bone Cancer Research Trust aim to improve outcomes for people with primary bone cancer through research, awareness, information and support.

Sarcoma UK

Sarcoma UK is a national charity that funds research, offers support for anyone affected by sarcoma (including bone sarcomas) and campaigns for better treatments.

Find more organisations

Looking for something else?

Find information on other types of cancers effecting teenagers and young adults

Based on content originally produced by Macmillan Cancer Support.