DEAR MAYO CLINIC: My neighbor recently had an X-ray after hurting their leg, and the doctor found a bone lesion that needs more testing. They're terrified it could mean bone cancer. It got me wondering: Does every bone tumor or bone lesion mean cancer?  

ANSWER: Hearing that an imaging test found a bone tumor or bone lesion can be frightening. Fortunately, most bone tumors aren’t cancerous. The key is finding out exactly what type of tumor or lesion you have, so your healthcare team can recommend the right care. 

A bone tumor is an abnormal growth of cells within the bone. Some bone tumors are benign (noncancerous) and may simply be monitored over time. Others are malignant (cancerous) and require treatment because they can grow, damage the bone or spread to other parts of the body.  

It's also important to understand that primary bone cancer is different from cancer that has spread to the bone from another part of the body. Cancers are named for where they begin. For example, if lung cancer spreads to the bone, it's still lung cancer, not bone cancer. Likewise, if bone cancer spreads to the lungs, it's still bone cancer.  

Knowing where a cancer began helps your healthcare team recommend the most appropriate treatment. Primary bone cancers are also usually not caused by something you did or didn't do, which can be reassuring to know. 

Pain in your bones, muscles or joints is common and is usually caused by conditions other than cancer. However, pain that continues to worsen, doesn't improve over time, wakes you from sleep or is associated with other symptoms, such as swelling, fever, weight loss or limping, deserves medical evaluation. 

In children and teenagers, persistent pain shouldn't automatically be dismissed as growing pains. While growing pains are common, ongoing pain that interferes with sports, school or daily activities should be evaluated by a healthcare professional.  

Persistent back pain in children is also uncommon and should be checked. Another warning sign is a fracture that occurs after little or no trauma. Some bone tumors can weaken the bone enough that it breaks more easily than expected. 

Sometimes bone tumors don't cause symptoms at all. Instead, they’re discovered when an X-ray or other imaging test is performed after a sports injury or another unrelated problem. In these situations, the injury didn't cause the tumor; the imaging simply revealed something that was already there. 

When a bone tumor or lesion is found, your healthcare team will review your medical history, perform a physical examination and determine whether additional imaging, such as a CT scan or MRI, is needed to better understand the abnormality. Based on those imaging findings, a biopsy may be recommended. 

During a biopsy, a small tissue sample is removed and examined under a microscope to determine exactly what type of cells are present. The biopsy results help your healthcare team make an accurate diagnosis and recommend the most appropriate treatment. Waiting for answers can be difficult, but taking the time to make an accurate diagnosis helps ensure you receive the most appropriate treatment. 

Treatment depends on the type of bone tumor. Many benign tumors don't require treatment and can simply be monitored if they're not causing pain, limiting function or weakening the bone. Other benign bone tumors may require surgery. Malignant bone tumors, however, require treatment. Depending on the type of cancer, treatment may include surgery, chemotherapy, radiation therapy or a combination of these approaches. 

Because bone tumors are rare, it's important to be evaluated by a healthcare team with experience diagnosing and treating your specific condition. Specialists, including radiologists, pathologists, orthopedic surgeons and medical oncologists, work together to make an accurate diagnosis and recommend the most appropriate treatment plan. 

If you've been told you have a bone tumor or bone lesion, try not to assume the worst. Many bone tumors are benign, and even malignant bone cancers can often be treated successfully. If you have persistent pain, an abnormal imaging finding or symptoms that concern you, don't ignore them. Talk with your healthcare team. An accurate diagnosis is the first step toward getting the care that's right for you. 

Wendy Allen-Rhoades, M.D., Ph.D., Oncology, Mayo Clinic, Rochester, Minnesota

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