The treatment of bone cancers is complex. For a better outcome, it is recommended you are referred before the biopsy to a specialist sarcoma service.
Your doctor will recommend the best treatment for you, depending on:
- the type of primary bone cancer
- the location and size of the tumour
- 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, with the aim of controlling the cancer and maintaining the use of the affected area of the body. Many people who are treated for bone cancer go into remission (when the symptoms of bone cancer decrease or disappear).
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
Diagnosis and treatment decisions can be very difficult. If your GP suspects that you have bone cancer, they'll refer you to one of the specialist centres throughout Australia that have expert multidisciplinary teams (MDTs) who manage this cancer on a regular basis. See australiansarcomagroup.org for a list of specialist sarcoma services.
The team will include a range of specialist doctors, nurses and allied health professionals who will be responsible for different aspects of your treatment.
Preparing for treatment
- Some types of chemotherapy and radiotherapy can affect your heart and kidneys. Your doctor may recommend you have some tests to check your heart and kidney functions.
- Treatment may affect your fertility (your ability to conceive a child). If you are interested in having children in the future, discuss this with your doctor before treatment starts. You may be able to store sperm, eggs or embryos. For more information, see Fertility and Cancer.
- If your doctor suspects you risk fracturing a bone because of the cancer, you may need to wear a splint to support the bone or use crutches.
There are different types of operations depending on the location of the cancer.
Surgery to remove the cancer but keep (spare) the limb 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. The surgeon will also take out some surrounding normal-looking bone and muscle to make sure they remove as much of the cancer as possible, and to reduce the chance of the cancer coming back. This is called a wide local excision. A pathologist will check the tissue to see whether the edges are clear of cancer cells.
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 your body or from a "bone bank". A bone bank is a facility that collects tissue for research and use during surgery. In some cases, it may be possible to treat the removed bone with radiotherapy to destroy the cancer cells, then use the sterilised bone to reconstruct your limb.
After surgery, the remaining soft tissue and skin will heal. You will be given medicines to help you manage any pain. 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.
Your doctor will talk to you about the risks of surgery. It is likely that you will be given antibiotics to reduce the risk of getting an infection in the bone or prosthesis.
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 in 10 people, the only effective treatment is to remove the limb. This procedure has become less common as limb-sparing surgery has improved.
After surgery, any remaining tissue (called the residual limb) will be swollen and painful. You will be given medicine to manage the pain and taught how to care for the residual limb. After the area has healed, you may be fitted for an artificial limb (prosthesis).
If you have a leg removed (amputated) and receive a prosthesis, a physiotherapist will teach you exercises and techniques to improve your function, such as walking. In some cases, using a prosthetic leg may be too difficult and you may prefer to use a wheelchair.
If you have an arm removed, an occupational therapist will teach you how to eat and dress yourself using one arm. If you receive a prosthetic arm, the occupational therapist will teach you exercises and techniques to better control and use the prosthesis.
Surgery in other parts of the body
When possible, the cancer is removed along with some healthy tissue around it (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 affected bone. As the face is a delicate area, it can be difficult to remove the cancer surgically and some people may need to have other treatments (see below).
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.
Chemotherapy uses drugs to destroy or slow the growth of cancer cells, while causing the least possible damage to healthy cells. For certain types of bone cancer, such as high-grade osteosarcoma and Ewing's sarcoma, chemotherapy may be given:
- before surgery, to shrink the size of the tumour and make it easier to remove
- after surgery or radiotherapy, to kill any cancer cells possibly left behind
- to help stop the growth or control the symptoms of an advanced cancer (palliative treatment).
Drugs are usually injected into a vein over several hours. Most people have several treatment cycles. The number and length of chemotherapy cycles you have depends on the type of bone cancer.
You may have additional imaging (MRI, CT or PET scans) during treatment to assess how well the disease is responding to the chemotherapy drugs.
The side effects of chemotherapy will depend on the drugs you receive and where the cancer is located in your body. Some people have few side effects; others have more. Common side effects include tiredness, nausea, vomiting and diarrhoea, appetite loss, hair loss, and increased risk of infection. Most can be managed with medicines or other techniques.
Radiotherapy uses high-energy x-rays to destroy cancer cells. It may be used for certain types of bone cancer, such as Ewing's sarcoma:
- before surgery, to shrink the size of the tumour
- after surgery or chemotherapy, to kill any remaining cancer cells
- to help control the cancer if it's not possible to remove the tumour surgically.
Clinical trials test new treatments to see if they're better than current methods. Accessing new treatments is an important consideration in your care. Talk to your doctor about the latest developments and whether you're a suitable candidate.
For more information on treatments and managing side effects, see Understanding Surgery, Understanding Chemotherapy and Understanding Radiotherapy.
Radiotherapy is usually given 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. Your specialist will provide details about your specific treatment plan.
Side effects will depend on the area being treated and the strength of the dose you have. Not everyone will experience side effects to the same degree. Common side effects include fatigue (tiredness), skin redness or soreness, and hair loss within the treatment area. Ask your treatment team for advice about dealing with any side effects.
The physical changes associated with treatment for bone cancer can affect your self-esteem and body image. It is natural to focus on the part of your body that has changed. Give yourself time to adapt to any changes in your appearance.
Limb-sparing surgery is a major operation that can leave a noticeable scar and tightness. If you have a limb amputated, it can take several months to feel comfortable with the prosthesis. You may restrict your interactions with other people because of anxiety about how you look or because you find it difficult to move around. Physiotherapy can help you regain flexibility and ease of movement.
Most people need emotional support before and after treatment, particularly if they have an amputation or a lot of bone is removed. Many people find it helps to talk things through with a counsellor, psychologist, friend or family member. Talk to your treating team or call Cancer Council 13 11 20 about support services available in your area.
For more information on coping with the emotional impact of bone cancer, see Emotions and Cancer.
After treatment, you will need check-ups every 3–12 months for several years to confirm that the cancer hasn't come back and to help you manage any treatment side effects. You will have a physical examination, and may have further imaging scans.
How often you will need to see your doctor will vary depending on the type of bone cancer you have. Appointments will become less frequent if you have no further problems.
Let your doctor know immediately of any health problems between appointments. Your doctor will advise you about things to look for and what to do if you think the bone cancer has come back.
If the cancer comes back
For some people bone cancer does come back after treatment, which is known as a recurrence. The risk that bone cancer will recur is greater within the first five years after treatment. If the cancer does recur, treatment is likely to include a mix of surgery, chemotherapy and radiotherapy.
In some cases of advanced bone cancer, treatment will focus on managing your symptoms and improving your quality of life without trying to cure the disease. Palliative treatment can relieve any pain and help to manage other symptoms.
- What type of bone cancer do I have?
- What treatment do you recommend and why?
- What is the prognosis?
- 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 bone cancer available in this hospital?
- Are there any clinical trials I could join? If the cancer has spread outside the bone, what treatment options are available for me?
- How often will I need check-ups after treatment?
- If the cancer comes back, how will I know?
Expert content reviewers:
Dr Richard Boyle, Orthopaedic Oncological and Reconstructive Surgeon, Royal Prince Alfred Hospital, North Shore Private Hospital and Chris O'Brien Lifehouse, NSW; Dr Jayesh Desai, Medical Oncologist, Peter MacCallum Cancer Centre, VIC; Sandeep Gupta, Head of Physiotherapy, Balmain Hospital, NSW; Prof Angela Hong, Radiation Oncologist, Chris O'Brien Lifehouse and University of Sydney, NSW; James Hyett, Consumer; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA.