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Bone Tumors and Soft Tissue Tumors

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What are bone tumors and soft tissue tumors?

are growths that are not normal. They are lumps of tissue that form when abnormal cells grow without the normal controls to stop them. In most cases, doctors do not know why this happens.

  • Bone tumors start in the skeleton, such as in the spine, leg bones, ribs or arm bones.
  • Soft tissue tumors start in muscles, , fat, blood vessels or other tissues.

Tumors can be either benign or malignant.

  • Benign tumors are not cancer and do not spread from their original site. Some require specialized treatment and may grow back at the site where they started.
  • Malignant tumors are a form of cancer and may spread (metastasize) to more distant parts of the body. They can come back at their original site as well. Most malignant tumors in bone and soft tissue are a type of tumor called sarcomas. These include , and .

 

Bone and Soft Tissue Tumor Care at Seattle Children’s

Seattle Children’s provides the best care in the Pacific Northwest for children, teens and young adults with bone and soft tissue tumors.. Our highly experienced Solid Tumors Program brings together experts from our Cancer and Blood Disorders Center, Orthopedics, Pediatric Surgery and other specialties. 

Types of Bone Tumors and Soft Tissue Tumors

Benign bone tumors

Benign bone tumors are much more common than malignant bone tumors. They rarely become cancerous.

These types of benign bone tumors are found most often in children and young adults:

  • Nonossifying fibromas are usually found in the long bones that are still growing, such as the thighbone (femur).
  • Exostoses or osteochondromas contain both bone and and usually grow out from a bone.
  • Unicameral bone cysts are holes in a bone that fill with fluid. They are most common in the upper arm bone (humerus) and the upper thighbone. They are also called simple or solitary bone cysts.

Read more about types of benign bone tumors (PDF) (Spanish).

Benign soft tissue tumors

There are many types of benign soft tissue tumors. They are much more common than cancerous soft tissue tumors.

These are three common types of benign soft tissue tumors in children:

  • Fibromas usually happen in the hands and feet.
  • Lipomas and lipoblastomas are made up of fat cells.
  • Neurofibromas and schwannomas grow in nerves branching off the spinal cord.

Vascular malformations look like tumors but are not. They are collections of abnormal blood or .

Cancerous bone tumors

Malignant bone tumors usually start inside the bone. They can spread to other parts of the body. Bone cancer can threaten your child’s limbs and life.

These are the most common types of bone cancer in young people: 

  • Osteosarcoma (OS-tee-oh-sar-KOH-muh) can start in any bone in the body but is most common in the legs and arms. The tumor cells make abnormal bone. Sometimes osteosarcoma spreads to other parts of the body, most often the lungs.
  • Ewing sarcoma (YOO-ing sar-KOH-muh) is the second most common bone tumor in young people. It can start in any bone or in the soft tissues. Ewing sarcoma may spread to other areas, such as the lungs, bone marrow, lymph nodes, or other bones and soft tissues.

Cancerous soft tissue tumors

Malignant soft tissue tumors (soft tissue sarcomas) are less common in children than in adults.

These cancers can start in any of the soft tissues that connect or support other structures in the body. These tissues include muscles, tendons, fat, blood vessels, , nerves and the soft tissues in and around joints. We treat all types of soft tissue sarcoma.

Rhabdomyosarcoma (rab-doh-my-o-sar-KOH-muh) is the most common type of soft tissue sarcoma in children. This cancer can happen in almost any area of the body. A child who develops rhabdomyosarcoma at a young age may have a . Our Cancer Predisposition Clinic screens and cares for children born with these syndromes.

What are the symptoms of bone tumors and soft tissue tumors?

Symptoms of tumors in the bones and soft tissues can be hard to identify and describe. It’s important to see a doctor about pain or a physical change, such as a lump or swelling.

The symptoms depend on:

  • The type of tumor
  • Where it is
  • How much it has grown or spread

Here are general guidelines.

  • Bone tumor symptoms

    The most common symptom of bone tumors is pain.

    • A bone or joint may be painful.
    • The pain may get worse over time.
    • The pain can happen at night or when resting.

    Bone tumors may also cause:

    • A lump
    • Swelling
    • A broken bone

    Bone tumors in and around the spine may cause:

    • Muscle weakness
    • Tingling or numbness in the legs
    • Problems with bowel or bladder control
  • Soft tissue tumor symptoms

    The most common symptom of soft tissue tumors is a lump or mass. They are less likely than bone tumors to cause much pain.

    Cancer in a muscle often causes a lump. It may grow slowly or quickly.

    Other symptoms may depend on where the tumor is. For example:

    • A tumor in or around the can cause problems with peeing (urination).
    • A tumor at the base of the skull can press on nerves, causing weakness or pain in the head or face.

How are bone tumors and soft tissue tumors diagnosed?

Your child’s doctor will:

  • Start with a thorough exam
  • Ask about your child’s health background

Then the doctor may suggest tests to help tell:

  • If your child has a tumor
  • The type of tumor
  • If it is cancerous
  • If it has spread
  • Imaging studies

    The doctor may want to have pictures taken of the inside of the body ().

    Often, we can detect bone tumors by taking an of the bone.

    If an X-ray does not give enough information about the tumor, we may use the following:

    • MRI (magnetic resonance imaging) scan
    • CT (computed tomography) scan
    • PET (positron emission tomography) scan
    • Ultrasound
  • Biopsy

    If suggest that the tumor may be cancer or a benign tumor that requires specialized treatment, we do a . In the operating room, doctors will cut out a small piece of the tumor and check it under a microscope to see what it is. This information helps us plan any recommended treatment.

    Our surgeons use extra care when doing the biopsy to avoid the risk of spreading the tumor cells. In certain cases, our surgeons or do a biopsy using a needle instead of with surgery.

How are bone tumors and soft tissue tumors treated?

Our treatment goal is to give your child or teen the best chance of a long and healthy life. Everyone on your team works to cure your child’s disease, support your family during treatment, prevent serious side effects and provide follow-up care. You are in the hands of the most experienced pediatric solid tumor team in the Pacific Northwest.

We tailor treatment to your unique needs. Treatment will depend on:

  • Whether the tumor is benign or cancerous
  • The specific diagnosis (type of tumor)
  • The location and size of the tumor
  • Whether it has spread to other parts of the body
  • Age and medical history

Treating Benign Bone Tumors

Some benign bone tumors only need to be checked by a doctor once or twice a year. Some may go away on their own.

Sometimes, a benign bone tumor can cause problems while it grows. It can weaken a bone and make it more likely to break. Tumors also can press on nerves, muscles or tendons and cause pain. If this happens, see an orthopedic surgeon.

Some benign bone tumors may need surgery, but some can be treated with less invasive approaches, including medicines. Others can just be checked to make sure they do not cause problems.

Treating Benign Soft Tissue Tumors

With some types of benign soft tissue tumors, we simply watch for changes (monitor) over time. If a benign soft tissue tumor is causing symptoms such as pain or is growing larger, it may need to be treated with surgery, medicine or a combination of treatments.

After surgery, physical therapy will help rebuild strength, movement and confidence.

Treating Cancerous Bone Tumors

We tailor treatment to your child’s unique needs. U.S. News & World Report consistently ranks our Cancer and Blood Disorders Center among the top pediatric oncology programs in the country. 

We offer state-of-the-art treatments that include anticancer medicine (), complex surgeries and radiation therapy, including .

Many children, teens and young adults with bone cancers have more than 1 type of treatment. Most have chemotherapy, then surgery or radiation to treat the specific tumor sites. 

Our surgeons are skilled in many types of procedures, including and . For some young children who have part of a leg removed, we use a “growing prosthesis” to lengthen their affected leg as they grow. 

"Our goal is always the same: Cure the disease and get these kids back to their lives.”

– Dr. Katie Albert, medical director of the Seattle Children's Solid Tumor team

  • Chemotherapy

    Doctors may use anticancer medicine ():

    • As the main treatment for bone cancer
    • Before surgery to shrink or kill a tumor
    • After surgery to kill any cancer cells that might remain

    The kind of medicines and how long they are given depend on the type of cancer.

    We will use scans and physical exams to see if the chemotherapy is working to slow tumor growth or shrink it.

    We provide chemotherapy for sarcomas at our Seattle hospital campus in:

    See more about getting chemotherapy at Seattle Children’s.

  • Surgery

    The kind of surgery done for bone cancer depends on:

    • The size of the tumor
    • Where it is located
    • If the cancer cells have spread

    Our surgeons are skilled and experienced in doing many types of procedures. These include:

    • Limb-sparing surgery, where surgeons remove the tumor and any bone and cartilage affected by it. This usually leaves the nerves, muscles and tendons around the area to preserve the leg or arm. This is also called limb salvage. Depending on where the tumor is, the surgeon may use a bone transplant (also known as a bone graft) or a metal implant, such as a special type of joint replacement, to replace the bone that was removed. Some of these joint replacements can be made longer to match a child’s or teen’s growth.
    • Amputation, where surgeons remove large parts of an arm or leg. Sometimes we amputate because of the size or location of the tumor. But sometimes patients choose it over other options. For many, this is best for disease control and for keeping active after they get better. After an amputation, we can fit an artificial limb (prosthesis) and help you adjust to using it.
    • Rotationplasty, a unique way to rebuild a child’s leg after part of it has been removed because of cancer around the knee. After removing the part affected by cancer, surgeons reattach the healthy lower leg at the thigh, facing backward. With a lower-leg prosthesis, the backward ankle works like a knee joint. For some growing children, this is the best choice for staying active and playing sports.
    • Chest wall resection for a bone tumor in a rib. We work as a team to decide if surgery is the best plan for tumors in this location and to ensure that we get the whole tumor out. After removing the tumor, we rebuild the chest with Gore-Tex or metal constructs as needed. Seattle Children’s regional anesthesia team offers pain control options like extreme cold to treat chest wall pain (intercostal nerve cryoablation).
    • Pulmonary metastasectomy for certain bone tumors that have spread to the lungs. We perform these operations using or .  We may use extreme cold (cryoablation) and to help manage pain during the operation.
  • Radiation therapy, including proton therapy

    Radiation therapy uses a machine to send high-energy beams to destroy cancer cells and shrink tumors. Doctors aim the radiation at the place where they know or suspect there is cancer.

    Radiation therapy works well to shrink or kill many types of tumors. Doctors sometimes use radiation before surgery so the tumor is easier to remove or after surgery to kill any cancer cells that may still be in the body. In other cases, radiation is the main form of treatment for the tumor.

    The best radiation treatment depends on the tumor. Our options include proton therapy, which may be better for tumors in places where side effects of treatment tend to be serious or lasting. We offer this treatment through our partner, Fred Hutchinson Cancer Center, which has the only proton therapy center in the Northwest.

    Learn more about Seattle Children’s Radiation Therapy Service.

  • Physical and occupational therapy

    No matter which treatment you have, extensive physical therapy can help improve flexibility and mobility and return to usual activities. The physical therapist (PT) uses play and exercise to help build strength and coordination and reduce pain.

    Some people may need crutches or other adaptive equipment after surgery. Our occupational therapists (OTs) help you learn to use equipment or a prosthesis. The OT can show you new ways to do tasks of daily life, if needed.

Treating Cancerous Soft Tissue Tumors

We offer state-of-the-art treatments and clinical trials for malignant soft tissue tumors. Our advanced options include anticancer medicine (), complex surgeries, radiation therapies, and . Year after year, U.S. News & World Report ranks Seattle Children’s Cancer and Blood Disorders Center among the nation’s best.

Treatment often depends on where the tumor is. Most patients have surgery to remove the tumor, as well as and. We custom-make your treatment plan.

  • Chemotherapy

    Our doctors use chemotherapy to kill cancerous tumor cells in some people with soft tissue sarcoma. Some people with soft tissue sarcomas do not need chemotherapy. They are treated only with surgery or radiation or both. 

    The kinds of medicines and length of treatment depend on the type of cancer. Researchers are studying new types and mixes of medicines to find the best for each type of disease.

    To check if the chemotherapy is working to shrink the tumor or slow its growth, we do regular physical exams and .

    Our patients receive chemotherapy at our hospital campus in Seattle. They may stay overnight in our Cancer and Blood Disorders Center – Inpatient or get treatment at our outpatient infusion unit without having to stay overnight.

    See more about getting chemotherapy at Seattle Children’s.

  • Radiation therapy, including proton therapy

    We use radiation therapy to treat some soft tissue sarcomas. Radiation therapy may be your main form of local treatment or may be combined with other therapy.

    The best radiation treatment depends on the tumor. Our options include proton therapy, offered at Fred Hutch Proton Therapy, the only proton therapy center in the Northwest.

    Learn more about Seattle Children’s Radiation Therapy Service.

  • Surgery

    During surgery, we remove as much of the tumor as possible, along with some of the healthy tissue around it. For larger tumors in certain parts of the body, our surgical teams do complex to improve how your child’s body works or how it looks after their tumor is removed.

    After surgery, your child may have physical therapy.

  • Targeted therapy

    We do  if the tumor:

    • Is a type linked to certain genetic changes
    • Does not respond to treatment
    • Comes back after treatment
    • Has spread to other areas before treatment begins

    If tests show that the cancer is caused by specific genetic changes, treatment options may include medicines.

Research and Clinical Trials for Bone Tumor and Soft Tumors

Many of our patients with sarcomas take part in research studies of new treatments along with their standard treatment. These studies — called clinical or therapeutic trials — include studies of new medicines or new ways to combine medicines.

Your doctor will talk with you about any new treatment options. Then you can decide whether you want to take part.

Seattle Children’s doctors are leaders in national research groups such as the Children’s Oncology Group (COG) and the National Pediatric Cancer Foundation (Sunshine Group). COG is the world’s largest consortium of childhood cancer specialists. We also partner with many companies that are working to develop new cancer medicines. 

The STRIvE-01 phase 1 trials may be an option for children and young adults with tumors that do not respond to standard therapy (refractory) or that come back after treatment (relapsed). In these studies, researchers reprogram the body’s infection-fighting T cells to find and destroy cancer cells.

Learn more about cancer clinical trials at Seattle Children’s

Follow-Up Care for Bone Tumor and Soft Tissue Tumors

Follow-up care is important for all types of tumors and treatments. We will check regularly for years after treatment and take care of any health concerns that arise. Some tumors — even benign tumors — have a risk of coming back, so it is important to watch your health closely.

Most of our patients who had cancerous tumors visit Seattle Children’s for follow-up care. The doctor will let you know the best follow-up routine. If you live far from Seattle, you may get some blood tests or in your own community.

Our Cancer Survivor Program provides long-term follow-up care to help young people stay healthy after cancer treatment.

Why choose Seattle Children’s for bone and soft tissue tumor treatment?

We are experts at treating all types of bone and soft tissue tumors in children and young adults. We will diagnose your tumor and provide the right treatment, whether the tumor is benign or malignant. Seattle Children’s program in pediatric bone and soft tissue tumors is the largest in the Northwest and among the most experienced in the nation.

Year after year, U.S. News & World Report (USNWR) ranks Seattle Children’s the best in the Pacific Northwest and among the nation’s best for Orthopedics, Urology, Neurosurgery and cancer care. Our Solid Tumor Program is part of our nationally ranked Cancer and Blood Disorders Center.

Multidisciplinary team for complete care

  • Our highly experienced Solid Tumors Program brings together experts from our Cancer and Blood Disorders Center, Orthopedics, Pediatric Surgery and other specialties.
  • Bone and soft tissue tumors may affect many parts of the body. Depending on your illness, the care team may include general surgeons; neurosurgeons; ear, nose and throat (ENT) surgeons; urologists; gynecologists; or plastic surgeons. Other hospitals refer patients to us for tumors that are difficult to safely remove.
  • Seattle Children’s pediatric orthopedic surgeons are trained in treating bone, muscle and joint problems in children, teens and young adults. Some have specialized dual training in both pediatrics and tumors, including extra training in how to treat a wide range of that cause benign musculoskeletal tumors.
  • Our Bone Tumor and Sarcoma Clinic team meets as a group each week to discuss each patient’s care in detail. This way all our specialists can work together to provide the safest, most effective care.
  • Our patients who have cancer benefit from the work of physician-scientists at Fred Hutchinson Cancer Center and UW Medicine, as well as at Seattle Children’s. The National Cancer Institute has named our partnership a comprehensive cancer center.

Specialists in caring for children and young adults 

  • Our specialty is treating disease while helping our patients grow to be healthy and productive adults.
  • Our team cares for the whole person. Specialists in nutrition, pain management, palliative care, pharmacy, physical therapy and emotional health will provide care as needed. Read more about the supportive care we offer.
  • Treatment for these tumors may be very different for children and young adults than for older patients because pediatric tumors respond to therapy in different ways than adult tumors. We plan treatment based on years of experience and the newest research on what works best and is safest. Our experts focus on how treatments today affect growing bodies in the future.
  • We know that teens and young adults with cancer have different challenges than young children. Our Adolescent and Young Adult Cancer Program focuses on their needs. An important part of planning for life after cancer is protecting your ability to have biological children (fertility preservation).

Support for your whole family

  • Being diagnosed with a tumor can be scary. We help all along the way.
  • During visits, we take time to explain your condition. We help you fully understand your treatment options so you can make the choices that are right for your family.
  • Our doctors, nurses, child life specialists and social workers help you through the challenges. We connect you to community resources and support groups.
  • At Seattle Children’s, we work with families from around the Northwest and beyond. Whether you live nearby or far away, we can help with financial counseling, schooling, housing, transportation, interpreter services and spiritual care. Read about our services for patients and families.

What to Expect

See how to prepare and what to expect when coming to Seattle Children’s Orthopedics and Sports Medicine.

See how to prepare and what to expect when coming to Seattle Children’s Cancer and Blood Disorders Center.

Who's on the team?

Seattle Children’s Solid Tumor team cares for children, teens and young adults with many types of tumors affecting bone or soft tissue, both benign and cancerous. As needed, you may be treated by a radiation oncologist or surgeons who specialize in:

If you have been diagnosed with a benign bone tumor, experts in Orthopedics and Sports Medicine may provide most of your treatment. Your care team may also include physical therapists and experts in prosthetics.

Contact Us

Benign bone tumors

For a benign bone tumor,  contact Orthopedics and Sports Medicine at 206-987-2109 for an appointment, a second opinion or more information. You do not need a referral to make an appointment.

Providers, see how to refer a patient to Orthopedics. 

Known or suspected cancerous tumors of bone or soft tissue

For diagnosis and treatment of a bone or soft tissue tumor that may be cancerous, ask your primary care provider to refer you to our Solid Tumor Program, which is part of our Cancer and Blood Disorder Center.

If you have a referral or would like to make an appointment, contact the Cancer and Blood Disorders Center at 206-987-2106 or by email.

Providers, see how to refer a patient to the Solid Tumor Program in our Cancer and Blood Disorder Center.

Related Links

Paying for Care

Learn about paying for care at Seattle Children’s, including insurance coverage, billing and financial assistance.

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