Treatment for bone cancer

Tuesday 30 November, 2010

Reviewed: Annie Angle, cancer nurse (Dip. Oncology Nursing, Royal Marsden, London)

On this page: Surgery ι Chemotherapy ι Radiotherapy ι Side effects of treatment ι Making decisions about treatment ι Questions for your doctor ι Getting support

Your doctor will help you decide on the best treatment for your bone cancer, depending on:

  • the type of bone cancer you have
  • whether or not the cancer has spread (its stage)
  • your age, fitness and general health
  • what you want.

Treatment may include surgery, chemotherapy and radiotherapy, given alone or in combination.

Surgery

Surgery is the main treatment for most types of bone cancer. This usually means removing the cancer as well as some healthy tissue around the cancer. Doctors call this a wide local excision. The healthy tissue is taken away to help decrease the risk of the cancer coming back in that area.

There are different types of surgery. Limb sparing surgery is the most common treatment. Amputation is less common.

Limb sparing surgery

This means taking out part or all of the bone in the arm or leg where the cancer is growing. The surgeon replaces the bone with a metal implant (prosthesis) or a bone graft. A graft means taking a piece of healthy bone from somewhere else in your body or from a ‘bone bank'.

After this type of surgery, a physiotherapist will work with you to plan an exercise program that will help you get strength and function back in your limb.

After limb sparing surgery there will be some changes in the way the limb looks, feels or functions. The aim is for your limb to return to as normal a state as possible. This can happen in about 85 out of every 100 people who have this type of surgery.

This complex surgery needs to be done by a surgeon with a lot of experience in treating bone cancer. This may mean that you have to travel to a treatment centre that has a team of experts. Good surgery will decrease the risk of the cancer cells spreading to nearby areas or other parts of the body.

Amputation

Sometimes it's not possible to remove all of the cancer without badly affecting the arm or leg. The doctor may advise that the only effective treatment will be to remove the limb (amputation).

Amputation can be very distressing emotionally and physically. Most people will need a lot of support at this time. It could have a huge effect on you and the people who share your life.

After surgery you will have a carefully planned rehabilitation program. This will include seeing a specialist who makes false (prosthetic) limbs. A physiotherapist will work with you to help you become as independent and mobile as possible.

Other types of support are also useful. You may find it helps to speak with a social worker or counsellor or even someone else who has had the same operation. They may be able to offer advice on ways to cope and what to expect.

Surgery for cancer in other parts of the body

When possible, bone cancer in the pelvis is treated with a wide local excision. Some people may need to have bone grafts to rebuild the pelvic bones.

If the cancer is in the lower jawbone, the surgeon will remove the affected bone. Once healed, bones from other parts of the body can be used to replace the bone that was removed.

If the cancer is in your spine or skull, wide local excision may not be possible. You may need to have a combination of treatments such as radiotherapy, cryotherapy (using freezing methods) and curettage. Curettage involves scooping out the cancer. Sometimes cryotherapy is used to destroy any remaining cells nearby. If you need these treatments, your doctor will discuss them with you.

Surgery for cancer that has spread

Bone cancer is one of the few cancers that may still be cured even if it has spread. This is usually only possible if the cancer has spread into the lungs. Bone cancer that has spread to the lungs can be taken out with surgery. It will depend on how many cancers there are and where they are in the lung. Generally, up to 15 secondary lung cancers can be removed.

You may also have chemotherapy after surgery to help stop the cancer coming back.

Chemotherapy

Chemotherapy drugs are given to destroy cancer cells. Certain types of bone cancer respond well to this type of treatment. In recent years using chemotherapy along with surgery has improved cure rates for bone cancer.

Chemotherapy is given:

  • to reduce the size of the tumour before surgery, making it easier for the surgeon to remove after surgery
  • to help stop the cancer coming back
  • to help stop the growth or control symptoms of an advanced cancer (this is known as palliative treatment).

Your treatment will depend on the type of bone cancer you have and the type of chemotherapy you have. Your doctor will discuss this with you before you begin your treatment.

Chemotherapy is given as a course of several treatment cycles. You may have one or a combination of drugs. For example, one cycle commonly lasts three weeks. You may have the drug over several hours or days as an inpatient or outpatient, and then let your body have a rest until the start of the next cycle.

You may have between 3 and 5 cycles before surgery and then more after your surgery.

Chemotherapy for bone cancer can be given as an injection or a drip into a vein in your arm. The doctor may recommend a ‘central line' (portacath, Hickman line) in your chest or ‘PICC line' in your arm.

These are put in under local or general anaesthetic and stay in throughout your treatment. Their main advantage is that the chemotherapy can be given safely through the line: you don't have to have lots of needles. You can also have your blood taken from this line without having a needle.

If you have a central line, you will need to take good care of it. It needs flushing and cleaning regularly to prevent any infection or blockage. A nurse will teach you before you go home or you may have a district nurse to help you take care of it. The line is taken out when treatment is finished.

Chemotherapy may cause unwanted side effects such as nausea and tiredness. Your doctor will discuss these with you before treatment starts. See Coping with chemotherapy for more information.

Radiotherapy

Radiotherapy uses high energy rays to destroy cancer cells. Radiotherapy aims to destroy the cancer cells as well as create a ‘rind' around the tumour. This may help to make surgery easier and safer. Sometimes chemotherapy is given as well as radiotherapy to help make the treatment more effective.

You may have radiotherapy before or after surgery. If it's given after surgery, the aim is to reduce the chance of the cancer cells regrowing.

Radiotherapy is usually given 5 days a week for 5 to 6 weeks. Radiotherapy given in small doses minimises any side effects. Each dose only takes a couple of minutes, but some preparation time is needed as you have to be treated in the same position each time.

A course of radiotherapy needs to be carefully planned. During your first visit you will need to lie under a large machine called a simulator. Your specialist will use this machine to calculate the correct dose and exact angles on your body for the radiation to target. This process ensures that the cancer receives the highest doses of radiation and the healthy tissue around it gets as little as possible.

Radiotherapy doesn't hurt but you do need to lie very still during the treatment. You can have radiotherapy as an outpatient. Some people are able to continue working throughout their treatment while others feel a little tired. Some people may have a skin reaction. Your treating team will discuss all these possibilities with you.

See Coping with radiotherapy section for more details.

Side effects of treatment

All treatments can have side effects. For example, chemotherapy may cause a drop in your blood cell count, increasing your risk of infection, anaemia and bleeding. Side effects are usually short term but there may be some long-term side effects. This may mean a change in the way a part of your body looks, feels or functions.

The type of side effects that you may have will depend on the type of treatment and where in your body the cancer is. Some people have very few side effects and others have more. Your medical team will discuss all possible side effects (long and short term) before your treatment begins.

Making decisions about treatment

It can be difficult to know which treatment is best for you. It's very important that you speak with a bone cancer specialist team before making your decision. Ask them to give you a clear plan of your treatment options and any possible long and short-term side effects. Some people prefer to seek several opinions before feeling confident to go ahead with the treatment.

You may have to attend many appointments. It often helps to take someone with you. They'll be able to listen, ask questions and remember what the doctor says. You can discuss your treatment options later. It may also help to take a list of questions.

Complementary and alternative treatments

It's common for people with cancer to seek out complementary and alternative treatments. Many people feel that it gives them a greater sense of control over their illness, that it's ‘natural' and low-risk, or that they just want to try everything that seems promising.

Complementary therapies include massage, meditation and other relaxation methods that are used along with medical treatments. Many people find using one or more types of complementary therapies very beneficial.

‘During my treatment I did a daily meditation to help keep my emotions under control. I also had weekly massages, which made me feel more relaxed.' (Jane, 59)

Alternative therapies are unproven and include some herbal and dietary remedies that are used instead of medical treatment. Some of these have been tested scientifically and found to be not effective or even harmful.

Some complementary therapies are useful in helping people to cope with the challenges of having cancer and cancer treatment. However, some alternative therapies are harmful, especially if:

  • you use them instead of medical treatment
  • you use herbs or other remedies that make your medical treatment less effective
  • you spend a lot of time and money on alternative remedies that simply don't work.

Be aware that a lot of unproven remedies are advertised on the Internet and elsewhere without any control or regulation. Before choosing an alternative remedy, discuss it with your doctor or a cancer nurse at the Cancer Council Helpline on 13 11 20.

For more information see:

Questions for your doctor

If you have bone cancer there are many questions that you may wish to ask your specialist. Getting the answers may help you make the best decision about which treatment to choose. Here are a few suggestions.

  • How will I know if I have bone cancer?
  • What has caused my bone cancer?
  • Is my family more at risk of bone cancer?
  • If I need to have a bone biopsy, will I have it at a specialist centre?
  • If I need to have treatment, where is the best centre for this type of cancer?
  • Is it possible to have surgery to try to cure my bone cancer?
  • If I can have surgery, which type will I need and why?
  • What are the risks and long-term side effects of each type of surgery?
  • Will I need to have any other type of treatment, such as radiotherapy or chemotherapy?
  • How effective is radiotherapy and chemotherapy for my type of bone cancer?
  • If my cancer has spread outside the bone, what treatment options are there for me?

Getting support

For more information contact the Cancer Council Helpline on 13 11 20. This is a confidential service staffed by cancer nurses. Information is available in languages other than English.

The cancer nurse can supply you with up-to-date information about your cancer and treatment. They can also link you with another person who has had your type of cancer through Cancer Connect. There's also Family Cancer Connect for your partner or carer. If you prefer you may also be linked in with a local cancer support group.

for