Malignant Bone and Soft Tissue Tumours
Bone and soft tissue sarcomas are rare and should be treated by an experienced multidisciplinary team. Early diagnosis and a well-planned biopsy directly affect the outcome.
Malignant bone and soft tissue tumours are generally known as sarcomas. They are rare among all cancers. In addition, a large proportion of malignant tumours found in bone do not start in the bone itself but come from cancers elsewhere that have spread to bone (metastases). Diagnosis and treatment require a multidisciplinary approach, with orthopaedic oncology, medical oncology, radiation oncology, radiology and pathology working together.
Main types
- Osteosarcoma: The most common primary bone cancer, mostly in children and young people, often around the knee.
- Ewing sarcoma: Occurs in bone and soft tissue in children and young people.
- Chondrosarcoma: Arises from cartilage tissue, mostly in adults.
- Soft tissue sarcomas: Many different types arising from muscle, fat, connective tissue and nerve sheaths.
- Bone metastases: Spread of breast, lung, prostate, kidney and thyroid cancers to bone.
- Multiple myeloma and lymphoma: Blood cancers that can affect bone.
Warning signs
- Bone pain that is worse at night, not relieved by rest and getting steadily worse
- A soft tissue lump that is growing, lies deep or is larger than 5 centimetres
- A fracture after minor trauma
- Unexplained weight loss, fever and fatigue
- New bone pain in someone previously treated for cancer
These signs usually have simpler causes, but they should always be assessed.
Diagnosis and biopsy
X-rays, MRI and CT show the site and extent of the tumour. Whether the disease has spread elsewhere is checked with PET-CT or other methods.
A firm diagnosis is made by biopsy. The site and method of the biopsy should be decided by the team that will plan any later surgery. A poorly planned biopsy can spread tumour into surrounding tissue and make limb-sparing surgery harder.
Treatment
Treatment is planned according to the type and stage of the tumour and the patient’s condition, and often combines several methods:
- Surgery: The aim is to remove the tumour with a margin of healthy tissue. Today, limb-sparing surgery is possible in most patients. Tumour prostheses, bone grafts or other reconstruction methods replace the removed bone.
- Chemotherapy: Given before and after surgery for tumours such as osteosarcoma and Ewing sarcoma.
- Radiotherapy: An important part of treatment for some sarcomas and metastases.
- Orthopaedic treatment in metastatic disease: Aims to relieve pain, prevent or treat fractures and keep the patient mobile.
Follow-up
After treatment, regular check-ups and imaging monitor both the chance of recurrence and the condition of the reconstruction.
When does bone pain need attention?
Most bone and joint pain comes from benign causes such as injuries, overuse or arthritis. Some features, however, need a more detailed assessment: pain that does not ease with rest, wakes you at night, gets steadily worse over weeks and does not respond to painkillers. In children and teenagers, persistent pain around the knee is often put down to “growing pains” or a sports injury; if it does not go away and swelling is present, an X-ray is important.
Why the right biopsy matters
For a lump suspected of being a sarcoma, the biopsy is one of the most critical steps in treatment. The route chosen for the biopsy determines the tissue that must be removed with the tumour at later surgery. A biopsy from the wrong place or by the wrong method can spread tumour cells into healthy tissue and make more extensive surgery necessary. The biopsy should therefore be planned by, or together with, the team that will plan the surgery. In most cases an image-guided needle biopsy is enough.
Limb-sparing surgery
In the past, limb loss was a common outcome of treatment for malignant bone tumours. Today, thanks to advances in chemotherapy, imaging and reconstruction, the limb can be preserved in most patients. After the tumour is removed with a margin of healthy tissue, the gap in the bone is rebuilt with tumour prostheses, bone bank grafts, the patient’s own bone or a combination of these. In growing children, expandable prostheses can be used to prevent leg length differences.
Orthopaedic care for bone metastases
In people with cancer, spread to bone can cause pain and fractures. Orthopaedic treatment aims to reduce pain, assess fracture risk, strengthen the bone before a fracture in high-risk cases and, if a fracture has occurred, get the patient up as soon as possible. Nails, plates or prostheses may be used. Treatment is planned with the patient’s oncologist and radiation oncologist, always putting the patient’s general condition and quality of life first.
Support during treatment
Treatment of a malignant tumour is a long and demanding process for both patient and family. Physiotherapy and rehabilitation play an important role in regaining mobility after surgery. Nutritional support, pain management and psychological support are also integral parts of treatment. Answering patients’ and families’ questions openly allows them to take an active part in treatment decisions.
Frequently asked questions
I have bone pain. Could it be cancer?
The vast majority of bone pain is not caused by cancer. But pain that is worse at night, keeps getting worse or comes with a lump should be assessed.
Is losing the limb unavoidable?
No. Today, most patients with malignant bone tumours can be treated while preserving the limb.
Where should I be treated?
Because sarcomas are rare, diagnosis and treatment are best carried out in centres with experienced multidisciplinary teams. We will plan the right path for you together during your consultation.
Are malignant bone tumours inherited?
Most malignant bone and soft tissue tumours are not inherited. Some rare genetic syndromes carry a higher risk and are assessed separately.
How long does a tumour prosthesis last?
Tumour prostheses can be used for many years, but because they carry more load than standard joint replacements, revision may be needed over time. Regular check-ups are therefore important.
Can I do sport after treatment?
After rehabilitation, many patients return to walking, swimming and cycling. Suitable activities depend on the type of reconstruction.
When does treatment start after a sarcoma diagnosis?
Once diagnosis and staging are complete, treatment starts as soon as possible, following the plan prepared by the multidisciplinary team.
Is chemotherapy given before or after surgery?
It depends on the tumour type. Some tumours are treated with chemotherapy before and after surgery; for others, surgery alone or surgery with radiotherapy is enough.
Is it right to get a second opinion?
Yes. With rare diseases, a second opinion is every patient's right and increases confidence in the treatment plan.
The information on this page is general and does not replace an examination. An examination is needed to decide which treatment suits you.