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Overview of Bone Tumors

By

Michael J. Joyce

, MD, Cleveland Clinic Lerner School of Medicine at Case Western Reserve University;


Hakan Ilaslan

, MD, Cleveland Clinic Lerner College of Medicine at Case Western Reserve University

Last full review/revision Jun 2020| Content last modified Jun 2020
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Topic Resources

Bone tumors are growths of abnormal cells in bones.

  • Bone tumors may be cancerous (malignant) or noncancerous (benign).

  • Cancerous tumors may start in the bone (primary cancer) or start in other organs (such as the breast or prostate) and spread to the bone (metastatic cancer).

  • Tumors may cause unexplained, progressively worsening bone pain, swelling, or a tendency to fracture easily.

  • The diagnosis is sometimes based on the results of an imaging test (such as x-ray, computed tomography, or magnetic resonance imaging) but often requires removing a tissue sample of the tumor or bone for examination under a microscope (biopsy).

Bone tumors may be noncancerous or cancerous and primary or metastatic.

In adults, most cancerous bone tumors are metastatic. Overall, noncancerous bone tumors are relatively common, but cancerous primary bone tumors are rare, occurring in only about 2,500 people yearly in the United States. This number does not include multiple myeloma Multiple myeloma Tumors that originally start in the bone are called primary bone tumors. Primary bone tumors may be noncancerous (benign) or cancerous (malignant). (See also Overview of Bone Tumors and Overview... read more Multiple myeloma , a cancer that develops in the marrow inside the bone rather than in the hard bone tissue that makes up the bone.

Although benign bone tumors do not metastasize, some types grow rapidly and destroy nearby tissues.

Symptoms of Bone Tumors

A personmay sometimes have a painless lump, which may eventually become painful, but often the first symptom of a bone tumor is bone pain. The pain can be severe. Pain may occur when at rest or at night and tends to progressively worsen. Sometimes a tumor, especially if it is cancerous, gradually weakens a bone. The weakness makes it much easier for the bone to break (fracture) while doing routine activities (this type of fracture is called a pathologic fracture).

Diagnosis of Bone Tumors

  • X-rays

  • Often magnetic resonance imaging (MRI) and sometimes computed tomography (CT)

  • Sometimes bone scan

  • Biopsy

When people have a joint or limb that is always painful, even when they are not using it, doctors typically do x-rays X-rays A doctor can often diagnose a musculoskeletal disorder based on the history and the results of a physical examination. Laboratory tests, imaging tests, or other diagnostic procedures are sometimes... read more X-rays . X-rays can show doctors that the bone has an abnormal appearance or can show a growth or a hole in the bone. However, although doctors can see such abnormalities on x-rays, they usually cannot tell whether a tumor is noncancerous or cancerous. However, some tumors can be identified as noncancerous by an x-ray. For example, this identification is often possible with Paget disease of bone Paget Disease of Bone Paget disease of bone is a chronic disorder of the skeleton in which areas of bone undergo abnormal turnover, resulting in areas of enlarged and softened bone. The breakdown and formation of... read more Paget Disease of Bone , enchondromas Enchondromas Noncancerous bone tumors are benign, which means they are not cancer and in general never or rarely spread to other areas of the body. However, they can cause problems because they may weaken... read more Enchondromas , bone cysts Bone Cysts Many noncancerous (benign) bone abnormalities may resemble bone tumors but are not. (See also Overview of Bone Tumors.) Aneurysmal bone cysts usually develop before people reach age 25, and... read more Bone Cysts , nonossifying fibromas Nonossifying fibroma (fibrous cortical defect, fibroxanthoma) Noncancerous bone tumors are benign, which means they are not cancer and in general never or rarely spread to other areas of the body. However, they can cause problems because they may weaken... read more Nonossifying fibroma (fibrous cortical defect, fibroxanthoma) , and fibrous dysplasia Fibrous dysplasia Noncancerous bone tumors are benign, which means they are not cancer and in general never or rarely spread to other areas of the body. However, they can cause problems because they may weaken... read more Fibrous dysplasia .

If cancer is a reasonable possibility, a biopsy is usually necessary for diagnosis. Three types of biopsies may be done depending on the tumor:

  • Aspiration biopsy

  • Core biopsy

  • Open biopsy

Many tumors can be biopsied.

In an aspiration biopsy, doctors insert a needle into the tumor and withdraw some cells. No incision is needed. However, because the needle used is very small, sometimes normal cells may be sampled and cancer cells are missed, even when cancer cells are lying right beside the normal cells.

A core biopsy is done with a larger needle and often done so that more cells can be withdrawn and examined. Because both aspiration and core biopsies are done by using needles, they are considered needle biopsies.

An open biopsy (also called an incisional biopsy) is a surgical procedure. Sometimes an open biopsy is done when more tissue is needed for the doctor to make an adequate diagnosis. In this procedure, a surgeon cuts through the skin and into the deeper tissues to obtain an adequate sample for diagnosis. This procedure can sometimes be done at the same time that surgery is done to treat the tumor. If the entire tumor is removed, the procedure is called an excisional biopsy.

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