Bone tumors, as the name implies, are tumor cells that grow and proliferate in bone tissue, forming a mass and being able to be detected by imaging instruments such as X-rays and CT, which may result in a series of uncomfortable clinical symptoms. According to the origin of tumor cells in bone tissue, bone tumors are usually divided into three types: the first type is the malignant transformation of tumor cells from bone itself, such as myeloma and lymphoma, which are formed by the malignant transformation of bone marrow cells, or osteosarcoma and chondrosarcoma, which are formed by the malignant transformation of bone cells such as osteogenic, osteoblastic and chondrogenic bone, etc. We call these tumors primary bone tumors. The second type is tumor cells in bone tissue metastasized from bloodstream, such as cancer cells from lung, breast, prostate and other parts metastasized to bone tissue, which is usually called bone metastasis or bone metastatic cancer, referred to as bone metastasis. There is another type of bone tumor which is neither formed by malignant transformation of bone cells nor metastasis from distant tumor cells, but due to direct spread of tumor cells from peri-osseous tissues, such as soft tissues around long bones, pleura around ribs and lung tissues, and invade to bone. Usually, the first type of bone tumor has benign and malignant, and benign is the most common, while the latter two types of bone tumors are basically malignant. Although bone tumors are not as familiar as common malignant tumors such as lung cancer, breast cancer, colorectal cancer and stomach cancer, they are not as uncommon as commonly believed. Taking malignant primary bone tumors derived from bone cells as an example, there were about 4720 new cases in the United States in 2007, and the annual incidence rate in China is about 1/100,000, with more than 15,000 new cases, the most common of which is osteosarcoma, accounting for about 35% of the total. Primary bone tumors such as myeloma occurring from bone marrow cells are many times higher than osteosarcoma, with a new incidence rate of about 4/100,000. Bone metastases are the most common bone tumors, and their incidence is several times, if not tens of times, higher than that of primary bone tumors. According to the literature, the most common bone metastases are from lung cancer, breast cancer and prostate cancer, etc. Among them, 50% of lung cancer patients, 60% of breast cancer patients and about 70% of prostate cancer patients will have bone metastases. According to the report of Shanghai CDC, 134,873 tumor patients survived in Shanghai in 2004, of which breast cancer accounted for 16.88%, about 225,000 people, according to 60% of breast cancer patients may have bone metastasis, about 13,000 people. In recent years, the incidence of bone metastases from kidney cancer, colon cancer, stomach cancer, ovarian cancer and melanoma has also been on the rise significantly. The age of onset of bone tumors varies greatly, and there are obvious peaks in the age of onset of certain primary malignant bone tumors. Most patients have a history of primary tumors, such as lung cancer or breast cancer several months or years ago, but not all patients with bone metastases have a history of primary tumors, such as lung cancer or breast cancer, etc. About 10% or even a higher percentage of patients have bone metastases as the first symptom, such as bone pain, impaired bone and joint movement or even pathological fracture. About 10% of the patients have a history of primary tumors such as lung cancer, breast cancer, etc., and even a higher percentage of patients present with bone metastases such as bone pain, bone and joint mobility disorders or even pathological fractures as their first symptoms, and finally find out the primary tumor by following the trail. It is worth noting that 90-95% of plasma cell tumors and 60% of prostate cancer patients present with bone pain as the first symptom. The clinical symptoms of bone tumors mentioned above are often bone pain, bone and joint movement disorders, and a few patients come to the hospital with pathological fractures. Unbeknownst to us, most of the patients have already entered the middle or late stage when these symptoms occur. Most of the bone tumors are asymptomatic or mildly symptomatic in the early stage, which often go unnoticed by patients. Take osteosarcoma as an example, according to the statistics of the Department of Medical Oncology of the Sixth People’s Hospital of Shanghai Jiaotong University, more than 90% of the patients with osteosarcoma who come to the clinic are at stage IIb, i.e. above the middle stage, and about 30% of them have been found to have metastases visible in both lungs. Further study also found that the majority of patients had a history of delayed diagnosis, with 38.3% delayed diagnosis due to the patient, 36.17% due to the physician, and 25.5% delayed diagnosis for both parties. What is worse than delayed diagnosis is misdiagnosis coupled with mistreatment, such as misdiagnosis as post-exercise sprain, bone growth pain, etc., giving massage, closure, fire cupping, or even wrong surgical treatment, the proportion of which is as high as 59.51%, resulting in amputation of limbs and even double lung metastasis in a few patients. As we all know, the effect of tumor treatment depends on early diagnosis, and bone tumor is no exception. Early diagnosis of bone tumor lies in early detection, which depends on the vigilance of patients, their families and the treating physicians for bone tumor. Although there are no characteristic clinical symptoms in the early stage of bone tumor, for primary bone tumor, if you find persistent bone pain or dysfunction in a certain area, especially if the bone pain is progressively aggravated, heavier at night or during activities than during the day, and does not improve significantly even after rest or symptomatic physical therapy, regardless of whether there is a local mass in the pain, you should go to hospital in time. It is worth mentioning that if the above symptoms occur in adolescents, they should be taken more seriously. Of course, adolescents have obvious causes for the occurrence of the above symptoms, such as sports injuries, sprains and so on, and should refrain from self-justification, and should not receive inappropriate treatment without a clear diagnosis, otherwise it will cause serious adverse consequences. Most of the malignant tumors occurring in tissues other than bone are disseminated to bone through bloodstream. At the beginning, due to the small tumor tissues growing in bone tissue, even if there may be multiple bone metastases, it will not lead to obvious clinical symptoms or only slight intermittent bone pain, which is almost unnoticed by patients. As the tumor tissue keeps growing, clinical symptoms will gradually appear, with the highest incidence of bone pain at the metastatic site. Unlike primary bone tumors, bone metastases usually occur in cancellous bones such as vertebrae, pelvis, ribs, etc. Tumors that metastasize to vertebrae may invade the peripheral nerves and cause corresponding nerve compression symptoms, such as severe neuropathic pain, and once they invade the spinal cord, they may lead to paralysis. Like primary bone tumors, if the metastases are located near the joints of long bones causing bone destruction, pathological fractures may occur if care is not taken. Since most patients with bone tumors have a history of primary tumors, bone metastases mostly occur after the end of treatment, and the onset of the disease is insidious, according to the rules of follow-up after treatment of various tumors, regular follow-up is more important than going to hospital for examination after symptoms occur. Although the treatment effect of bone tumor varies greatly, the key to the treatment of either primary or metastatic bone tumor depends on the early diagnosis, and the early diagnosis must follow the triple combination of clinical manifestation, imaging and pathological diagnosis. The diagnosis of primary bone tumor is different from that of metastatic bone tumor. The diagnosis of primary bone tumor must firstly clarify the nature of bone tumor, and the specimen is usually obtained by fine needle aspiration or surgical biopsy under the guidance of imaging, and finally the diagnosis of benign or malignant is clearly made by pathology. For most patients with metastatic bone tumors with a history of primary tumors, if clear signs of worm-like destruction of bone are found on imaging, pathology or cytology may not be necessary to obtain a diagnosis. The principle of treatment for clearly diagnosed early malignant primary bone tumors is to preserve the function of the affected limb as much as possible with the aim of improving the patient’s quality of life while ensuring an improved cure rate. Since metastatic bone tumors mostly occur in elderly patients and are often combined with osteoporosis, they mostly invade the backbone of the spine or long bones, and the metastatic lesions are mainly fused bone destruction, which may cause bone related events such as pathological fracture or amputation. Therefore, the prevention of these bone-related events is particularly important. As with common malignancies, malignant bone tumors require comprehensive treatment. According to the pathological nature of bone tumors and the extent of invasion, chemotherapy, radiotherapy, surgery and other major treatments should be used in a planned and rational manner to develop individualized treatment plans, so as to improve the cure rate or prolong the survival period as much as possible, while reducing patients’ pain and improving their quality of life. Just as there are different types of bone tumors, their treatment plans vary greatly, and the implementation of different treatment plans determines the quality of life and prognosis of patients. For example, the treatment of osteosarcoma, with the main goal of improving the cure rate, requires close cooperation between chemotherapy and surgery. With high-dose or even mega-dose and multi-course chemotherapy, some of the early and mid-stage osteosarcoma can not only obtain good chances of limb preservation, but also, more importantly, significantly improve the cure rate of patients. According to statistics, the five-year survival rate of patients treated with a single surgical amputation before the 1970s was about 20%, but since the introduction of combined chemotherapy with high-dose MTX and other drugs, the limb preservation rate can reach more than 50%, and at the same time, the survival rate rose to 60%. According to the statistics of the Department of Medical Oncology of the Sixth People’s Hospital of Shanghai Jiaotong University, the 3-year survival rate of patients with stage IIb or above osteosarcoma has reached 60%, and there is no significant difference between the survival rate of patients with about 50% of preserved limbs and those with amputated limbs. Unlike primary bone tumors, patients with metastatic, especially multiple metastatic bone tumors, try to avoid more traumatic treatments such as chemotherapy, radiotherapy and surgery, with the main goal of improving patients’ quality of life. Under the premise of bisphosphonate support and symptomatic treatment, targeted therapy, endocrine therapy and herbal medicine are applied as much as possible according to the type of primary tumor and the actual situation of patients. For patients with rapid disease progression or the possibility of serious bone-related events, timely combination with medium- and low-dose chemotherapy and radiotherapy may achieve long-term disease control. Some foreign clinical comparative studies have shown that for bone metastases of breast cancer and prostate cancer, excessive chemotherapy and radiotherapy may shorten the survival of patients, and it goes without saying that in most cases, it will reduce the quality of life of patients.