Diagnosis and tumour types

Bone tumours: types and differences

The same bone symptom can represent very different conditions.

Bone tumour AJCC 8 staging

Clinical TNM, pathological groups, site distinctions and staging limitations.

Important: not every bone lesion is cancer. Imaging terms such as "lytic lesion" or "bone cyst" are not histological diagnoses. Suspected malignancy should be assessed by a specialist bone sarcoma team.

Three clinical groups

Benign lesionsEnchondroma, osteochondroma and bone cysts. Some require monitoring only; others need treatment because of pain, fracture or diagnostic uncertainty.

Intermediate behaviourGiant cell tumour of bone can be locally aggressive and recurrent, with rare distant spread.

Malignant lesionsPrimary bone sarcomas, bone metastases and plasma cell malignancies have different treatment pathways.

Osteosarcoma

A malignant bone-forming tumour. Most high-grade cases require both systemic chemotherapy and definitive local control. Limb-sparing resection is considered when appropriate margins and useful reconstruction are possible.

Chondrosarcoma

Cartilage-forming malignancies are heterogeneous in subtype and grade. A low-grade central cartilaginous lesion is not equivalent to high-grade chondrosarcoma. Surgery is central in many conventional localised cases. Curettage in carefully selected low-grade situations versus wide excision must be decided by a specialist team.

Ewing sarcoma

Can originate in bone or soft tissue, particularly in younger people. Histology, immunohistochemistry and appropriate molecular confirmation are important. Treatment generally combines multiagent chemotherapy with surgery and/or radiotherapy.

Giant cell tumour of bone

Often involves bone close to a joint. Treatment depends on site, joint preservation, fracture risk and recurrence. Denosumab may be considered in selected circumstances but does not replace assessment of surgical feasibility and local recurrence risk.

Bone metastases and myeloma

In older adults a metastatic lesion or plasma cell disorder may be more likely than a primary bone sarcoma. Assessment includes previous cancer history, likely primary site, the mechanical strength of the bone, and whether biopsy, radiotherapy, fixation or reconstruction is indicated.

Important mimics

Osteomyelitis, trauma, cystic lesions, benign cartilage lesions and periarticular soft-tissue masses can resemble neoplasms. Imaging, clinical information and pathology must be correlated.

BiopsyPlanning the biopsy tract →MRI, CT and real casesAn evidence-aware imaging atlas →Treatment by tumour typeDifferent diagnoses require different approaches →

Clinical sources

Clinical images and videos from the author’s archive. Patient identifiers have been removed. Diagnoses are stated only where supported by source records. This information does not replace an individual multidisciplinary decision.

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