Bone cancer, though a relatively rare type of cancer, can significantly impact those affected, originating in any bone, but most commonly affecting the long bones of the body, particularly the thighbone. Although osteosarcoma and Ewing sarcoma, the two most prevalent types of bone cancer, are more frequently diagnosed in teenagers and also young adults, cancers affecting cartilage cells, the flexible tissue found in many areas, tend to be more prevalent in older individuals.

And despite its supposed rarity, bone cancer features prominently in Singapore's health statistics. According to the Singapore Cancer Registry Annual Report 2021, bone cancer ranks within the top ten cancers for both males and females across the age range of 0 to 29, accounting for 43 cases in males (5.2%) and 33 in females (3.4%).

Cancers that form in the bone itself are called primary bone cancers. Tumours that begin in other organs can spread to the bones as well; these are called secondary or metastatic bone cancers. In this blog, we'll delve into bone ache, its significance, and when it warrants medical attention. By understanding the nature of bone aches and identifying potential symptoms of primary bone cancer, you can make informed choices regarding your well-being.

Understanding Bone Ache

Bone ache refers to the sensation of pain or discomfort in the bones or joints. But does experiencing bone ache, though unsettling, signal a severe health issue?

What Does Bone Pain Feel Like?

Bone pain typically presents as a persistent, dull and achy sensation that originates deep within the body. The affected area, be it the legs, hips and other areas, may be tender to the touch, and movement can exacerbate the pain or discomfort. And for those who have suffered from bone trauma or a fracture, the pain might be sharp and piercing, clearly arising from the injury's location.

However, do note that pain can be experienced in various ways by each individual: it could be constant or come and go, and while it often radiates, there is usually a specific, highly sensitive spot.

Describing the exact nature of your pain—whether it's sharp, dull, throbbing, or constant—can help healthcare providers diagnose the cause more accurately.

Difference Between Bone Pain and Muscle Pain

And when it comes to the argument of bone pain vs. muscle pain, there are some key distinctions to keep in mind, especially since distinguishing between bone pain and muscle pain is crucial for understanding the underlying causes of discomfort.

Bone pain is often described as deeper and more piercing compared to muscle pain. It tends to be localised, allowing you to pinpoint exactly where you feel discomfort, and it does not typically dissipate after resting or overnight. To assess bone pain, doctors may use imaging techniques such as X-rays to examine bone density or bone scans to detect infections or tumours.

On the other hand, muscle pain is usually associated with specific activities and feels more spread out across the affected muscle. To evaluate muscle pain, doctors might recommend an MRI to visualise muscles, ligaments, and tendons, or electromyography to assess the electrical activity of muscles and nerves.

Common triggers for muscle pain include sports injuries, muscle strains, repetitive movements, or overexertion. Plus, unlike bone pain, muscle discomfort often resolves with rest, ice, or over-the-counter pain relievers.

How to Tell the Difference Between Joint Pain and Bone Pain?

So, does it mean that bone pain and joint pain are the same thing?

To differentiate between joint and bone pain, consider the nature and triggers of your discomfort:

• Movement Sensitivity: Joint pain typically worsens with movement since the affected joint is under direct stress, while bone pain might remain constant regardless of movement.
• Localisation: Joint pain is usually confined to the joint area and may include visible swelling or redness, whereas bone pain might be felt more broadly around the affected bone.
• Accompanying Symptoms: Joint pain might come with visible inflammation or restriction in movement. Bone pain, however, could be accompanied by systemic symptoms such as fever or weight loss, especially if infection or malignancy is involved.
• Pain Onset: Joint pain often develops gradually and is linked to ongoing health issues like arthritis. In contrast, bone pain might appear suddenly, particularly if it is due to an injury or an acute condition.

Common Causes of Bone Pain

Bone pain is not exclusively linked to severe conditions like cancer; it can also stem from various non-cancerous causes. Potential causes include:

Injuries and Traumatic Events: 

• Car accidents
• Sports injuries
• Falls
• Bone fractures

Health Conditions:

• Osteoporosis
• Osteoarthritis
• Avascular necrosis
• Osteomyelitis
• Vitamin D deficiency
• Paget’s disease of bone

Benign Bone Tumours:

While not cancerous, certain growths can still cause discomfort or pain as they affect bone and surrounding tissues:

• Aneurysmal bone cysts
• Osteoblastomas
• Exostoses
• Osteochondromas

Cancer-Related Bone Pain:

Certain cancers are directly associated with bone pain:

• Primary bone cancers such as osteosarcoma directly affect the bones.
• Leukaemia can cause bone pain due to its impact on bone marrow.
• Metastatic cancers, which spread from other parts of the body to the bones, also contribute to significant bone pain.

What is a Red Flag for Bone Pain?

To differentiate between bone ache and bone cancer, it’s important to look at the symptoms of bone cancer, which encompass:

• Bone pain
• Swelling
• Tenderness near the affected area
• Weakened bones leading to fractures
• Fatigue
• Unintended weight loss

Can Bone Pain Not be Cancer?

So, if your bones hurt or if your loved one is experiencing bone pain, do not be alarmed just yet, but examine if the other bone cancer symptoms are present. If they are, it is advisable to speak to an oncology consultant in Singapore. However, if they aren’t, there could be other reasons for bone aches.

Red Flags For Bone Cancer

If you or your loved ones encounter bone pain that usually begins with a feeling of tenderness in the affected bone and gradually progresses to a persistent ache or ache that comes and goes, which continues or worsens at night, even when resting, and or does not respond to over-the-counter pain relievers, it is crucial to consult an oncology consultant in Singapore promptly.

What Does Cancerous Bone Pain Feel Like?

Cancerous bone pain varies widely in its presentation, often depending on the stage and location of the cancer. Understanding these sensations can help in early detection and timely treatment.

• Intensity and Nature: The pain can range from mild to intense and is typically described as throbbing or aching.
• Consistency: It might be constant or intermittent, worsening at night or with physical activity.
• Physical Changes: A noticeable lump or swelling might appear over the bone, varying in texture from firm to tender.

What Are the 7 Warning Signs of Bone Cancer?

Some common warning signs of bone cancer include:

• Pain. You might have pain or tenderness most of the time, even when you're resting.
• Swelling. You might have some swelling, but it is not always possible to see or feel a lump.
• Difficulties with movements of the affected limb or joint
• Feeling tired (fatigue)
• Fever
• Unexplained weight loss
• A break in the bone (fracture)

Therefore, if you find yourself experiencing pain in the bones all over your body and it worsens over time, in addition to any of the abovementioned symptoms, seeking timely medical evaluation is essential for identifying the underlying cause and commencing suitable treatment, if necessary. Consulting a cancer specialist in Singapore is essential for proper evaluation and timely intervention. Your doctor can provide guidance and address any concerns you may have.

Importance of Early Detection For Bone Cancer

Early detection of bone cancer plays a significant role in achieving better treatment outcomes and improving quality of life. This is because timely diagnosis allows for prompt intervention and the development of a tailored treatment plan. As a matter of fact, the 5-year survival rate for people with localised bone cancer is 70%, but once the cancer starts to spread, it reduces to 33%, which underscores why early detection and treatment are crucial.

When to See a Doctor if Dealing with Bone Pain

Bone aches can be a cause for concern, and it is important to pay attention to persistent or worsening bone pain.

Experiencing new or unusual bone pain is also a clear signal to consult a healthcare professional promptly.

As such, it’s essential to seek medical advice when:

• Persistent or Worsening Pain: Do not overlook bone pain, thinking it might subside on its own. Persistent or worsening pain needs immediate evaluation to determine its cause.
• Risk Factors: If you are at higher risk for bone conditions like osteoporosis, especially prevalent among women and individuals assigned female at birth, discuss how often you should be screened.
• Emergency Symptoms: Seek urgent medical attention if you experience:
  • Inability to move a limb
  • Visible bone protruding through the skin
  • Intense, severe pain following an injury

What Test Confirms Bone Cancer?

Confirming a diagnosis of bone cancer involves several steps, each critical in pinpointing the exact nature of the bone issues you might be facing. Doctors typically confirm whether bone symptoms are due to cancer through:

• Initial Consultation: A screening involving a physical exam allows doctors to gather essential details about your symptoms.
• Physical Examination: During this exam, your doctor might detect an abnormal mass or notice swelling. This can be an early indicator of a tumour.
• Detailed Imaging Tests:
  • X-rays: Often the first approach if a bone tumour is suspected, x-rays can show the structure of the bone and the presence of a tumour.
  • MRI (Magnetic Resonance Imaging): This test provides detailed images of bones and the surrounding soft tissues, helping to determine the extent of a tumour.
  • CT Scan: Used less frequently for detailed images of the bone but crucial for examining potential spread to other organs.
  • Bone Scan: Detects abnormal changes in the bone’s structure.
  • PET Scan: Helps show cancer activity throughout the body by highlighting fast-growing cells that consume more glucose.
• Biopsy: The definitive test for bone cancer. A biopsy involves taking a sample of the bone or mass to examine it more closely in the lab. It’s critical that this procedure is performed by specialists experienced in bone cancer to ensure accuracy and prevent complications.
• Lab Tests: While not diagnostic on their own, blood tests can support other findings, indicating the presence of bone turnover markers or other substances that might suggest cancer.

Limb Salvage Treatment for Bone Cancer Patients

Limb salvage surgery is a technique used to remove bone tumours without the need for amputation, resulting in improved functionality and quality of life for patients. This complex procedure involves the removal of the tumour and subsequent reconstruction of the bone and soft tissue. Surgical teams perform limb salvage surgery to achieve tumour-free margins, sometimes requiring the resection of significant portions of the bone. Reconstruction options include biologic methods using donor bone or recycled bone, as well as non-biologic approaches utilising metal implants. With limb salvage surgery, patients can benefit from better outcomes without compromising survival or increasing the risk of tumour recurrence.

Other treatment options include:

Radiation therapy: Radiation therapy shrinks the tumours with high doses of X-rays. Radiation therapy may be utilised in certain types of bone cancer before surgery to shrink the tumour or after the surgery to prevent the recurrence of the bone cancer.

Chemotherapy: Chemotherapy is a form of medicine used to get rid of bone cancer cells throughout the body. It is given before or after surgery for bone cancers to prevent cancer recurrence.

If you are seeking specialised cancer care, OncoCare offers a wide range of services to meet your needs.

Visit our website to explore the comprehensive care provided and learn more about our experienced team of cancer specialists in Singapore. Take the first step towards proactive cancer management by checking out our services and accessing our wealth of knowledge and expertise.

Remember, you are not alone. Consulting cancer doctors, like the experienced team at OncoCare, can provide the necessary support you need on your bone cancer journey.

“Expert knowledge means better care for cancer”

Written by:
Dr Angela Pang
MBBS (Singapore)
Grad Dip (GRM)
MRCP (UK)
M Med (Internal Med)