Bone cancer in New Zealand: Symptoms, treatment and how insurance can help

What is bone cancer?

Bone cancer is cancer that forms in the bones or in the cartilage around them. Doctors divide it into two groups: primary bone cancer, which starts in the bone itself, and secondary bone cancer, which has spread to the bone from another part of the body. Primary bone cancer is rare.

Types of bone cancer and where they usually begin?

The starting point varies quite a bit depending on which type is involved.

Primary bone cancers

• Osteosarcoma: Arises from osteoblasts, the cells responsible for building new bone. It most often develops at the ends of long bones around the knee, though other common sites include the upper leg, lower leg, or the upper arm bone near the shoulder. Because it can technically start in any bone, older adults may see it show up in less typical locations, while it primarily arises during the rapid growth spurts of adolescence.
• Chondrosarcoma: Originates in cartilage cells rather than bone-forming ones. Most cases develop in the pelvis, legs, or arms, and it's typically diagnosed in older adults.
• Ewing sarcoma: Can begin either in bone or in the soft tissue surrounding it. It most commonly develops in the long bones of the arm or leg, or in flat bones such as the pelvis, shoulder blade, or ribs, and roughly half of cases arise in the axial skeleton, including the pelvis or ribs. It usually develops between the ages of 10 and 30.

Secondary bone cancers

• Bone metastasis: This is far more common than any primary bone cancer. It doesn't originate in the bone at all; instead, cancer cells break away from a tumor elsewhere in the body—most often the breast, prostate, or lung, with kidney and thyroid cancers also capable of spreading this way—and travel through the bloodstream to settle in bone
• Multiple myeloma: Technically not a bone cancer at its root. It starts in plasma cells within the bone marrow, then spreads to other bones or areas of the body from there, which is why it's grouped with secondary bone involvement rather than true primary bone cancer even though it lives inside the bone.

How common is bone cancer in New Zealand?

New Zealand recorded 49 new registrations of primary bone and articular cartilage cancer (C40–C41) in 2023. This is the primary-cancer count only.

Digging into each primary bone cancer type, osteosarcoma accounts for 30% of all bone cancers in New Zealand. Meanwhile, chondrosarcoma is also around 30% (some institutions noted 37%), and Ewing’s sarcoma is at around 14-15%.

Bone cancer symptoms: early signs to look for

Early bone cancer often shows up as pain that gradually becomes more persistent, and may feel throbbing, aching, or stabbing. Bone pain is one of the main symptoms of bone cancer, and it's often worse at night. You may also observe a lump or swelling (but it may not always be easy to see or feel), and problems moving around.

Cancer Society NZ lists seven symptoms to watch for:

• pain in bones and joints
• swelling over the affected part of the bone
• stiffness or tenderness
• unexplained weight loss
• a fractured bone
• loss of feeling in the affected limb
• tiredness

If the cancer is close to a joint, it can also cause difficulty moving that joint, which can show up as a limp. These symptoms have other possible causes, so get any change checked by your doctor.

How long can you have bone cancer without knowing it?

Diagnosis can take months even once symptoms start, because they're often mistaken for other conditions. A 2025 systematic review of bone sarcoma found reported delays between first symptoms and diagnosis ranging from seven weeks to 28 months, and two large studies within it each reported a median delay of 16 weeks.

Localised pain or swelling is often put down to sports injuries or growing pains in younger patients, or mistaken for arthritis.

Where bone cancer pain shows up: leg, hip, knee, foot and spine

Bone cancer pain shows up wherever the tumour is. Osteosarcoma most often causes pain near the knee, hip, or shoulder, chondrosarcoma in the pelvis, upper leg, or shoulder, and Ewing sarcoma in the pelvis, legs, or ribs.

Osteosarcoma of the foot is rare, making up roughly 1% of all osteosarcoma cases. Cancer that has spread to the spine can also cause pain there. Metastatic spinal tumours can cause back or neck pain that is worse at night. Loss of bladder or bowel control is an emergency symptom.

What causes bone cancer?

It is not known what causes most primary bone cancers. Several factors are linked with a higher risk (most often inherited conditions and previous cancer treatment), and the five listed below are mostly things you cannot change.

Factors linked with a higher risk of bone cancer or sarcoma include:

• inherited conditions such as hereditary retinoblastoma, Li-Fraumeni syndrome, and Werner syndrome
• radiotherapy or chemotherapy for an earlier cancer, particularly during childhood
• another bone condition, such as Paget's disease of bone
• a change in the RB1 gene, or Rothmund-Thomson syndrome
• past exposure to vinyl chloride monomer, dioxin, or arsenic

Having one or more of these risk factors does not mean you will develop bone cancer. Even for osteosarcoma, the most studied case, not every child with these risk factors develops it, and it also develops in children who have no known risk factor at all. There is currently no known way to prevent it.

How bone cancer is diagnosed

If your doctor suspects bone cancer, diagnosis usually happens in stages. An X-ray of the affected bone comes first and often identifies the lesion; an MRI then characterises it further, and a biopsy is required for a definitive diagnosis.

Here’s a breakdown of each of the main tests:

• X-ray: Usually the first test ordered; it often identifies the lesion and gives an initial picture of the affected bone.
• MRI (magnetic resonance imaging): Provides more detailed images of the areas around the bone, helping characterise the tumour further.
• Blood tests: Used to learn more about your overall health or rule out other conditions; blood tests alone can't diagnose bone cancer. They're typically done alongside imaging rather than as a standalone diagnostic step.
• Biopsy: A procedure to remove a sample of tissue for lab testing, needed to confirm the diagnosis. Samples may be collected with a needle inserted through the skin, or removed surgically. A pathologist examines the tissue under a microscope, and this provides specific information about the cancer type that helps providers determine the best treatment.

Scans are also repeated afterwards to check whether the cancer has spread.

In New Zealand, anyone diagnosed with a sarcoma is referred to a specialist sarcoma team. The national cancer health target is for 90% of patients to receive cancer management within 31 days of the decision to treat.

Can an X-ray show bone cancer?

Yes, an X-ray can show bone cancer. X-rays show the location, size, and shape of a bone tumour, and are usually the first-line imaging for a suspected bone tumour because they are non-invasive, low-cost, and widely accessible. Early presentations can be subtle, which is why a biopsy is still required.

Does bone cancer show up in blood tests?

Blood tests cannot diagnose bone cancer on their own. Levels of alkaline phosphatase and lactate dehydrogenase (enzymes the blood test measures) may be raised in osteosarcoma or Ewing sarcoma, but a high alkaline phosphatase level is normal in growing children and adolescents, so the test is not a reliable indicator of bone cancer.

What does bone cancer look like on an MRI?

An MRI uses a powerful magnet and computer to create detailed images without X-rays, showing a bone tumour's extent through the bone and into nearby soft tissue in more detail than an X-ray. It characterises a lesion already found on an X-ray, but a biopsy is still needed to confirm the diagnosis.

How bone cancer is treated

If you're diagnosed with primary bone cancer, surgery and chemotherapy are the main treatments, with radiotherapy or targeted medicines also used for some types. Which combination you have depends on the type of bone cancer, where it is, and whether it has spread. In New Zealand, you are referred to a specialist sarcoma team for treatment.

• Surgery: Limb-sparing surgery cuts out the affected bone and replaces it with a metal implant or bone from elsewhere in your body. Amputation may be needed if the tumour has spread into the surrounding area.
• Chemotherapy: Effective for some types, particularly Ewing sarcoma. For osteosarcoma, it is often given before surgery, so less bone tissue needs to be removed.
• Radiotherapy: Used for Ewing sarcoma, and for osteosarcoma or chondrosarcoma when surgery is not possible.
• Targeted medicines: These aim to stop the cancer growing, and may be given alone or with chemotherapy.

New Zealand has two specialist sarcoma centres: the North Island Sarcoma Service at Auckland City Hospital, and Christchurch Hospital for the South Island

The chemotherapy drugs used in these regimens (such as cisplatin, doxorubicin, and methotrexate for osteosarcoma) are listed as funded on the New Zealand Hospital Medicines List, though this reflects general drug-funding status rather than a Pharmac statement specific to bone cancer.

Pharmac has separately confirmed funding for Ewing sarcoma specifically: its Special Authority criteria for temozolomide were confirmed unchanged for Ewing's sarcoma when access was widened for gliomas in 2023.

Bone cancer survival rates and outlook

Your outlook from primary bone cancer depends on the type and on whether the cancer has spread.

Due to the rarity of this condition, the New Zealand Ministry of Health doesn’t routinely publish five-year survival rate reports. But students from the University of Otago published a report for 2000 to 2009. It cites that the survival rate for 15- to 19-year-olds is 46%, while it’s 31% for those aged 20 to 24.

Given that these are figures from long ago, this doesn’t conclude that there’s a low survival rate among bone cancer patients. In fact, in United States registry data covering 2016 to 2022, five-year relative survival for bone and joint cancer was 68.7%.

The disease can be fatal. In 2023, 31 people died from bone and articular cartilage cancer (C40-C41) in New Zealand.

These numbers can be hard to take in when it's your own diagnosis. Survival statistics describe groups, not individuals, and are only ever a starting point for the conversation with your care team.

Can bone cancer be cured?

Yes, bone cancer can often be cured. A diagnosis does not always mean the cancer cannot be controlled. Your chances depend on the type, the grade, how early the diagnosis was made, whether the cancer has spread, and how well it responds to treatment.

But, like most cancers, there are still possibilities of recurrence. For example, reports reveal that even after a patient finishes treatment and shows no evidence of disease, osteosarcoma can still return. It may reappear in the original bone or turn up elsewhere in the body, most often in the lungs.

Most recurrences happen within two to three years of completing initial treatment. But these are found to be rare.

What is the life expectancy for someone with bone cancer?

There is no single life expectancy for bone cancer, because outcomes vary widely by type, grade, and whether the cancer has spread.

• Osteosarcoma: Five-year survival is around 70% when the cancer is localised, and between 11% and 36% once it has spread.
• Ewing sarcoma: 75% to 80% when non-metastatic, and around 30% when metastatic.
• Chondrosarcoma: 83% for Grade I, and 53% for Grades II and III combined.

How your insurance can help after a bone cancer diagnosis

If you already hold cover, a bone cancer diagnosis can trigger more than one policy at once: a trauma lump sum, health insurance for private treatment, and income or mortgage cover while you are off work.

NOTE: Limits and definitions vary by plan and by the terms.

Policywise's guide to trauma insurance vs income protection explains how these can work together. ACC does not help here, because it covers injury caused by an accident and expressly excludes illness.

A primary bone sarcoma is assessed under each insurer's general malignant tumour definition instead. Where cancer has spread to the bone from elsewhere, a claim is assessed against the cancer it started as, not against a bone-cancer diagnosis. Policywise's guide to what ACC does not cover sets out where the accident line sits.

How insurance can help bone cancer patients and their loved ones

A bone cancer diagnosis can bring significant treatment costs and time away from work, often during a person's working years or while they're supporting a family. Insurance can ease this financial burden and help fund treatment, recovery, and the transition back to normal life.

Here's how each type of insurance you may have can help support you if you're diagnosed with bone cancer:

• Trauma (critical illness) insurance: Most providers define cancer as a malignant tumour with uncontrolled growth that invades normal tissue, without naming bone cancer specifically. Fidelity Life is the only insurer to name sarcoma as an included condition. What you need to prove to claim varies: some providers require a minimum stage or tumour classification for cancers they don't name, while others require that major surgery or intervention is considered necessary. A lump sum from this cover can go toward living costs, medical bills, and rehabilitation while you focus on treatment.
• Cancer insurance: Rather than a broad list of conditions, some providers offer cover built specifically around cancer. Options range from a health-style policy covering unlimited surgery and a set amount toward treatment each year, to a lump sum paid on diagnosis, to plans that pay a set amount annually while attached to a health policy. These can be especially useful given the ongoing nature of bone cancer treatment, which often involves surgery, chemotherapy, radiotherapy, and follow-up scans.
• Health (medical) insurance: Private treatment for bone cancer, including surgery, chemotherapy, radiotherapy, and scans, can be costly, and a medicine that's approved but not government-funded still has to be paid for privately even in a public hospital. Health cover can help meet these costs, though how insurers treat a prior cancer diagnosis varies: some permanently exclude it, while others assess it individually at underwriting, sometimes covering it again after a period of continuous cover.
• Income protection or mortgage protection insurance: If treatment or recovery keeps you off work, these plans can replace part of your income so you can keep up with everyday bills or mortgage repayments. Waiting periods before payments start vary by provider, and some policies include a specified medical condition benefit that treats a cancer diagnosis as total disability, paying out for a set period regardless of whether you're still working.
• Life insurance: A terminal illness benefit can pay out your life cover early if you're diagnosed as terminally ill, typically where life expectancy is 12 months or less. Some insurers also offer an earlier advance benefit for a list of named late-stage cancers, though bone cancer generally doesn't appear on these specific lists, so it's worth checking your policy wording. If bone cancer leads to death, the lump sum can help your family cover funeral costs, pay off debts, and manage financially.
• Total & permanent disability (TPD) insurance: For most providers, cancer sits outside the accelerated condition lists on TPD cover, meaning a bone cancer claim generally has to meet the standard test of continuous incapacity to work, rather than being paid automatically on diagnosis. Many providers let you set an own-occupation or any-occupation definition when you apply, which can affect how a claim is assessed if bone cancer permanently affects your ability to work.

How pre-existing conditions and pre-cancer risk factors are treated varies by insurer and product, so it's worth speaking with an adviser about what cover may be available for your situation.

Even where a specific exclusion applies, having insurance in place can still offer meaningful protection, covering you for other major illnesses or injuries and helping support your income and your family if a different condition affects your ability to work.

Helping you navigate bone cancer with financial ease

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