Benign Bone Tumors

What are benign bone tumors? Most tumors that start in your bones are benign (not cancer). This means that benign tumors will not spread from their original site to a new location. Tumors can form in any of the bones of your skeletal system and in any part of the bone. In general, the most common bones involved are also some of the largest: the femur, tibia, humerus, pelvis, spine and ribs. Some types of tumors are most common in specific locations, such as the spine or near the growth plates in your hip, knee or shoulder.

How common are benign bone tumors? Benign bone tumors are most common in people who are under 30 years old. A large portion of benign bone tumors are found in children while their skeletons are still growing. Many benign tumors actually stop growing once a child reaches skeletal maturity, which is the term used to describe the time at which bones stop growing in length. Skeletal maturity usually happens between the ages of 14 to 16 in girls and between the ages of 16 to 19 in boys.

What are some common types of benign bone tumors? The most common types of benign bone tumors include: Enchondroma: This type of tumor starts in the cartilage. These tumors are found inside the bone, in the marrow space. Osteochondroma: This type of tumor is made up of cartilage and bone and can get bigger while the skeleton is growing. These tumors grow outside the bone. Non-ossifying fibroma: This bone tumor is the most common bone tumor found in children. They often go away on their own and are most commonly discovered incidentally on X-rays after an injury. Chondroblastoma: This type of tumor is usually removed because its growth affects nearby joints. It’s found in children and can cause significant pain. Osteoid osteoma: This type of tumor usually affects the long bones of the body and is more common in males. It can cause significant pain at nighttime due to hormone interaction and can be relieved with nonsteroidal anti-inflammatory medications (NSAIDs). Osteoblastoma: This type of tumor is also more common in males. Treatment is almost always surgery. Periosteal chondroma: These tumors are made up of cartilage and are located on the surface of a bone. Treatment is almost always surgery. Giant cell tumor: These tumors, though rare, grow aggressively. Females are slightly more likely to develop giant cell tumors. Treatment is almost always surgery. Chondromyxoid fibroma: This very rare type of tumor begins in the bone marrow. Treatment is almost always surgery. Aneurysmal bone cyst (ABC): These tumors can grow very large. Treatment with repeated injections of a sclerotherapy medication or with surgery is commonly needed. The sclerotherapy medication helps the space fill in. Unicameral[simple] bone cysts (UBC): These tumors are generally found near growth plates and are often found when they weaken the bone enough to cause a fracture. Treatment is usually surgery to do a bone graft or add a sclerotherapy medication. Fibrous dysplasia: This is a common bone tumor that shows up as a single bone tumor or multiple bone tumors. Generally, it doesn’t need surgery unless the bone becomes weakened by the size of the tumor.

What causes benign bone tumors?

Bone tumors form when bone cells divide and grow out of control, forming a lump or a mass of cells. We don’t know why this happens in most cases.

What are the symptoms of benign bone tumors?

Symptoms of benign bone tumors include:

- An obvious swelling or lump.

- Pain, possibly severe, that increases in intensity. It may hurt even when you’re resting.

- Breaks or fractures due to bones made weaker by a growing bone tumor.

- In most cases, these tumors have no symptoms and are incidentally discovered on an X-ray obtained for an injury.

How are benign bone tumors diagnosed?

If you’re concerned about a lump or swelling on a bone, first make an appointment with your healthcare provider. They will start with a complete physical examination and are likely to order tests, such as:

- Imaging tests, including X-rays, computed tomography (CT) scans and magnetic resonance imaging (MRI) scans.

- Bone scan.

It’s rare that your provider will order blood or urine tests to diagnose a benign blood tumor. A bone tumor specialist will likely order a bone scan, CT scan, MRI scan or biopsy. The appropriate first step is an initial evaluation and X-rays. Your pediatrician or primary care provider can order these first tests.

How are benign bone tumors treated?

There is no single treatment for benign bone tumors. Treating a benign bone tumor depends on things like the specific type of tumor, its size, its location and the effect has on bone strength.

In many cases, your provider may suggest just watching and waiting (observation). In other cases, your provider may suggest medication, specialized imaging, a biopsy, or removing the tumor surgically.

Most benign tumors respond well to surgical removal. In many cases, the likelihood that the tumor will come back is low — usually less than 5%. Some benign bone tumors, like giant cell tumors of bone, have a higher rate of return, but there are good methods to treat these tumors if they do come back.

What procedures treat benign bone tumors?

Treating benign bone tumors using surgery calls for removing the tumor as well as promoting the growth of new healthy bone at the site of the tumor. The surgeon caring for these tumors should try to remove the tumor with the least amount of trauma to surrounding normal bone tissue.

Surgeons should also have experience with proper stabilization of the bone with orthopedic hardware and bone grafting — as necessary. The combination of these techniques allows people with benign bone tumors, especially young people, to be able to return to full and unlimited activities after treatment.

Other treatments can be used for certain types of bone tumors. One treatment for osteoid osteoma may include radiofrequency ablation or thermal necrosis. These procedures require anesthesia, are often done as a combined approach and involve orthopedic surgeons and radiologists. Aneurysmal bone cysts (ABCs) can be treated with serial (repeated) injections of a medication called doxycycline and have a good chance of resolving without an open surgery.

What are the risks of surgery for treating benign bone tumors?

It’s unusual to have major problems with these surgeries because they are mostly straightforward. However, rare (but possible) risks include nerve injury, infection, bleeding, stiffness and an inability to return to a high level of sport.