Bone cancer can be either primary or secondary.

• Primary bone cancer starts in the cells of the bone.
• Secondary bone cancer. This is cancer while starts in another organ of your body but has spread to the bones. This cancer behaves like the original cancer that it spread from and not like bone cancer.
  

There are many types of primary bone cancer. The main ones are listed below.

• Osteosarcoma. This is the most common type of bone cancer. Children and young people between the ages of 10 and 20 are more commonly affected, but it can occur at any age. It is slightly more common in males than females.
• Ewing's sarcoma. This cancer also tends to develop between the ages of 10 and 20. Like osteosarcoma, it is slightly more common among males than females. This cancer can also occur in soft tissues in the body such as muscle.
• Chondrosarcoma. This is the second most common type of bone cancer. It is more common in adults between the ages of 40 and 60. It starts in the cartilage cells in joints.
• Spindle cell sarcoma. There are four types of bone cancer: undifferentiated sarcoma of the bone, malignant fibrous histiocytoma, fibrosarcoma and leiomyosarcoma. They all behave like osteosarcoma but are more common in adults.
  

The symptoms of bone cancer vary depending on where it develops and how severe it is. Different types of bone cancer tend to form in different areas. For example:

• Osteosarcoma is most common in the lower thigh, shins and arms.
• Ewing's sarcoma most commonly occurs in the pelvis, thigh and shins.
• Chondrosarcoma is most common in the thigh, pelvis, ribs, upper arm and shoulder bone.
• Spindle cell sarcoma most commonly develops in the lower thigh, shins and arms.

Bone cancer often causes pain and tenderness in the affected area. This is often worse at night. As the cancer grows it can also cause swelling in the affected area. If it is near a joint it may make movement in that area difficult.

Less common symptoms of bone cancer include:

• tiredness
• fever
• weight loss

It's important to remember that these symptoms can be caused by many problems other than bone cancer. So although not necessarily a result of bone cancer, if you have these symptoms you should visit your doctor.

The type of surgery you have depends on how far the cancer has spread.

• Limb salvage surgery involves removing the area of bone where the tumour is. Because of the recent advances in surgery, this method of treating bone cancer is becoming more common. The area of bone removed is replaced with either a metal prosthesis (an artifical replacement part) or a piece of healthy bone taken from another part of your body (a bone graft).
• Despite ongoing improvements in surgical technique, sometimes a limb salvaging operation isn't possible. If the cancer has spread into surrounding tissues, amputating the limb may be the only way to get rid of the cancer. Support from the medical staff looking after you can help you come to terms with this news. Advances in prosthetics (artificial limbs) mean that you can often have a fully active life after this surgery. A specialist in artificial limbs will visit you at hospital to arrange one for you. A physiotherapist will be able to teach you how to adapt to and best use it.