Update and review of the management of bone tumours

Bone tumours are a rare group of heterogeneous malignancies. Osteosarcoma and Ewing's sarcoma are the commonest of these, usually occurring in the absence of an underlying cause. Peak incidence occurs in adolescence. Patients and families commonly report delays prior to referral for appropriate investigation. There must be a high index of suspicion for those presenting with increasing, unexplained or persistent bone pain or tenderness, particularly pain at rest or limp. Rapid referral to a specialist oncological orthopaedic surgeon in a cancer centre is essential for suspected spontaneous fracture or suspicious radiographic appearances. Bone tumours should be managed within a multidisciplinary team in a cancer centre. Bone tumours are treated as a systemic disease and treatment incorporates neoadjuvant chemotherapy, primary tumour therapy (surgery radiotherapy or radiotherapy alone) followed by adjuvant chemotherapy. Treatment within a clinical trial is considered standard of care. Several new agents are the subject of ongoing research. Children and young adults with bone tumours require lifelong monitoring for potential late complications of treatment.