Patient's Complete Guide to Bone Cancer

Overview of Bone Cancer

Bone cancer (ہڈی رسولی/Hadi Rasoli) is a type of cancer that develops in the bones. It can affect any bone in the body but mostly develops in the pelvic region or long bones of the arm and legs. Its common symptoms can be bone pain, sudden weight loss and swelling around the affected area.
Bone cancer can only arise in the bones and is not spread from other organs of the body. However, some other cancers such as breast cancer can spread and invade bones. The best treatment option is surgery, however chemotherapy and radiation can also be employed.

Occurence of Bone Cancer

Bone cancer is the rarest form of cancer that accounts for only 1% of all cancers. Some types of bone cancer only affect children but others mostly develop in adults. This form of cancer is considered to be the most common in females as compared to males.
According to a study, in the last 5 years 261 cases of osteosarcoma have been recorded in Pakistan.

Signs and Symptoms of Bone Cancer

Some common signs and symptoms of bone cancer include:

  • Bone pain
  • Weakened bone, leading to fracture
  • Swelling and tenderness near the affected area
  • Unintended weight loss
  • Fatigue

Types of Bone Cancer

Bone cancers are categorized based on the type of cell affected. Following are some common types of bone cancer:

  • Osteosarcoma: Among different types of bone cancers osteosarcoma is the most common one. In this type, bone forming cells become cancerous. Osteosarcoma mostly occurs in children and young adults. The bones of legs or arms are affected.  In some rare cases, cancer can develop on the outside of bones-extraskeletal osteosarcomas.
  • Chondrosarcoma: In this type, cartilage producing cells become cancerous. Chondrosarcoma often develops in the pelvic region, legs or arms in middle aged or older people. It accounts for about 30% of all bone cancers.
  • Ewing Sarcoma: Ewing sarcoma tumors often develop in the pelvic region, legs or arms of children and young adults.

Stages of Bone Cancer

Bone cancer has been categorized into stages. These stages describe the site and spread of the tumor. There are four stages of bone cancer, including:

  • Stage 1: Bone cancer is confined to the bones and doesn’t spread.
  • Stage 2: Bone cancer may not metastasize, but can invade other tissues.
  • Stage 3: Bone cancer becomes invasive and spreads to other parts of the bone.
  • Stage 4: Bone cancer has invaded the nearby tissues and spread to the lungs or brain.

Causes of Bone Cancer

The causative agent of bone cancer is not known. Some types of bone cancer are considered to be caused by hereditary factors or exposure to radiation.

Risk Factors of Bone Cancer

There are some factors that increase the risk of bone cancer, such as:

  • Genetic Syndromes: Genetic disorders that increase the risk of bone cancer may include:
  • Neurofibromatosis 1
  • Noonan syndrome
  • Li-Fraumeni syndrome
  • Beckwith-Wiedemann syndrome
  • Costello syndrome
  • Paget's Disease of Bone: Older adults who have a history of Paget's disease are usually at high risk of developing bone cancer.
  • Exposure to Radiation: Previously radiation therapy usually increased the chances of bone cancer.


Imaging tests help to identify the site and size of bone. Through these tests the spread of the tumour is also determined. Diagnostic tests are recommended on the basis of signs and symptoms. These tests may include:

  • X-ray
  • Magnetic resonance imaging (MRI)
  • Computerized tomography (CT)
  • Positron emission tomography (PET)
  • Bone scan


Biopsy is performed to collect tissues from the area affected by the cancer. Biopsy can be performed by two different ways such as:

  • Needle Biopsy: In this biopsy procedure, a thin needle is inserted into the tumor to remove a small piece of tissue.
  • Surgical Biopsy: In surgical biopsy, either an incision is made to remove the entire tumor or a small part of the cancer is removed.

Diagnostic Labs for Bone Cancer

In Pakistan, some of the authentic and certified diagnostic labs involved in diagnosing bone tumor are:

  • Aga Khan University Hospital Laboratory Specimen Collection Unit (Lahore)
  • Aga Khan University Hospital Laboratory Specimen Collection Unit (Karachi)
  • Chughtai Lab Head Office (Lahore)
  • Alnoor Diagnostic Center (Lahore)
  • Shaukat Khanum Diagnostic Center (Lahore)
  • Karachi Laboratory Diagnostic Center (Karachi)
  • Chughtai Lab (Karachi)
  • Shaukat Khanum Diagnostic Center (Karachi)
  • Islamabad Diagnostic Center (G8 Branch)
  • Citi Lab Blue Area (Islamabad)
  • Medical Diagnostic Imaging Center in Islamabad
  • Diagnostic Care Lab (Faisalabad)

Treatment of Bone Cancer | When to Consult a Doctor

Treatment approach used for bone tumor depends on:

  • The location of the cancer
  • Size of the cancer
  • Aggressiveness of the cells
  • Spread of the tumor (localized or metastatic)
  • Surgery


By surgical method the entire tumor is removed. If the cancer can’t be removed completely by surgery, then other procedures such as chemotherapy or radiation are used.
The affected bone can also be replaced with another healthy bone through surgery. The bone is either from the bone bank or made up of plastic or metal and is used for this purpose.
Surgery is required for the bone tumors that are large or developed in sensitive areas.


Chemotherapy is considered as the most painful method of treatment. In this procedure, drugs are either administered orally or injected through the vein. For brain tumors, temozolomide is used orally. Although it is an effective treatment it also has many side effects such as loss of appetite, vomiting and chills. It also makes the body prone to infections.
This treatment can be used before or after the surgery. It specifically targets and kills the cancer cells.

Radiation Therapy

In radiation therapy high-energy waves such as X-rays and protons are used to kill cancer cells. This procedure can be performed either by applying radiation externally or internally.
In whole brain radiation, a radiation beam is focused on the entire brain. This approach is used if cancer has invaded from other parts of the body to the brain.
Radiation therapy is often the best treatment option after surgery to kill remaining cancer cells. Radiation therapy is also used if surgery is not possible due to the presence of cancer at a sensitive area.

However, there are some side effects of radiation therapy such as:

  • Fatigue
  • Memory loss
  • Headaches
  • Scalp Irritation

Speciality for Bone Cancer

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