Treatment for bone cancer

Saturday 1 August, 2015

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On this page: Surgery | Chemotherapy | Radiotherapy | Question checklist


Your doctor will recommend the best treatment for you, depending on:

  • the type of primary bone cancer
  • whether or not the cancer has spread (its stage)
  • your age, fitness and general health
  • your preferences.

Treatment for primary bone cancer usually includes surgery, chemotherapy and radiotherapy or a combination of these treatments.

Understanding the available treatments and possible side effects can help you weigh up the pros and cons of different treatments. You may want to get a second opinion from another specialist to confirm or clarify the doctor’s recommendations 

Specialist treatment centres

Although bone cancer is rare and treatment is often complex, there are specialist centres throughout Australia that have expert teams who manage this cancer on a regular basis.

Surgery

There are different types of operations depending on the location of the cancer.

Surgery to remove the cancer but spare the limb (limb-sparing surgery)  

Limb-sparing surgery is done in about nine out of 10 people. You will have a general anaesthetic and the surgeon will remove the affected part of the bone where the cancer is growing. Often the surgeon takes out some surrounding bone and muscle to be sure they are removing as much of the cancer as possible, and to reduce the chance of the cancer coming back. This is called a wide local excision.

The surgeon replaces the bone that is removed with an implant (prosthesis) or a bone graft. A graft involves using a piece of healthy bone from another part of the body or a bone transplant from a ‘bone bank’. A bone bank is a facility that collects tissue for research and use during surgery.

After surgery, the remaining soft tissue and skin will heal. There will be some changes in the way the remaining limb looks, feels or works. A physiotherapist can plan an exercise program to help you regain strength and function in your limb.

Surgery to remove the limb (amputation)

Sometimes it is not possible to remove all of the cancer without affecting the arm or leg too much. For about one out of 10 people, the only effective treatment is to remove the limb. This procedure is becoming less common as limb-sparing surgery has improved in the past few decades.

After surgery, any remaining tissue (called the stump) will be swollen and painful. You will be given medication to manage the pain. After the area has healed, you will be measured for a replacement limb (prosthesis). A physiotherapist will teach you exercises and techniques to regain movement using a prosthetic arm or leg.

Surgery for bone cancer in other parts of the body

Other types of surgery are used for bone cancers that don’t affect the limbs.

Pelvis

When possible, the cancer is removed along with some healthy tissue around it. This is called a wide local excision. Some people may need to have bone grafts to rebuild the bone.

Jaw or cheek bone (mandible or maxilla)

The surgeon will remove the affected bone. Once healed, bones from other parts of the body may be used to replace the bone that was removed. As the face is a delicate area, it can be difficult to remove the cancer surgically and other treatment may be required.

Spine or skull

If surgery isn’t possible, a combination of treatments may be used. This may include radiotherapy, cryotherapy (freezing method) or curettage (scooping out the cancer). If you need one of these specialised types of treatment, your doctor will discuss the details with you.

Most people need emotional support before and after surgery, particularly if they have an amputation or a lot of bone is removed. A counsellor or psychologist can talk to you about how you are feeling and help you adjust to the changes. 

See more information on surgery.

Chemotherapy

Chemotherapy drugs are given to damage or destroy cancer cells. For certain types of bone cancer, such as high-grade osteosarcoma, chemotherapy is given in combination with surgery:

  • before surgery, to shrink the size of the tumour and make it easier to remove
  • after surgery, to kill any cancer cells left behind
  • to help stop the growth of, or control the symptoms of, an advanced cancer (this is known as palliative treatment).

Drugs are usually injected into a vein over several hours. The number and length of chemotherapy cycles you have depends on the type of bone cancer.

The side effects of chemotherapy will depend on the drugs you receive and where the cancer is in your body. Some people have few side effects and others have more. Most side effects can be managed with medication or other techniques.

See more information on chemotherapy

Radiotherapy

Radiotherapy uses high-energy rays to damage or destroy cancer cells. If it is used, it may be given before or after surgery. Talk to your specialist if radiotherapy is recommended for you.

Treatment is usually given in the hospital radiotherapy department, every weekday, with a rest over the weekend. How long your treatment takes will depend on the type and size of the cancer, but it may take a few weeks.

Side effects will depend on the area being treated and the strength of the dose you have.

See more information on radiotherapy.

Question checklist

You may find this checklist helpful when thinking about the questions you want to ask your doctor about primary bone cancer and treatment. If your doctor gives you answers that you don’t understand, ask for clarification.

  • What type of primary bone cancer do I have?
  • How far has the cancer spread? How fast is it growing?
  • What treatment do you recommend and why?
  • How long will treatment take? Will I have to stay in hospital?
  • If I have surgery, what are the side effects? Do I need an amputation?
  • Are the latest tests and treatments for this type of cancer available in this hospital?
  • Are there any clinical trials or research studies I could join?
  • If my cancer has spread outside the bone, what treatment options are available for me?
  • How often will I need check-ups? Which specialists will I see?
  • If the cancer comes back, how will I know?
Where to get help and information

Call Cancer Council 13 11 20 for more information about primary bone cancer.

Trained health professionals can listen to your concerns, provide additional information, and put you in touch with local services.


Reviewed by: Prof Peter Choong, Director of Orthopaedics, St Vincent’s Hospital, and Chair of the Bone and Soft Tissue Sarcoma Service, Peter MacCallum Cancer Centre, VIC; Dr Jayesh Desai, Medical Oncologist, Royal Melbourne Hospital, Walter and Eliza Hall Institute and Peter MacCallum Cancer Centre, VIC; Sandeep Gupta, Musculoskeletal-Amputee Physiotherapist, Royal Prince Alfred Hospital, NSW; Fiona Hammond, Nurse Coordinator, Bone and Soft Tissue Service, Peter MacCallum Cancer Centre, VIC; Meghann Lang, Nurse Care Coordinator, Adolescents and Young Adults & Sarcoma, The Canberra Hospital, ACT.
Updated: 01 Aug, 2015