The treatment of bone cancers is complex and requires specialist care. It will depend 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, general health and preferences.

The aim of treatment for primary bone cancer is to control the cancer and maintain the use of the affected area of the body. Many people who are treated for bone cancer go into remission. 

Preparing for treatment

There are some key points to consider before treatment for primary bone cancer, including:

• Some types of chemotherapy and radiotherapy can affect your heart and kidneys.
• Treatment may affect your ability to conceive a child. If you are interested in having children in the future, discuss this with your doctor before treatment starts.
• 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.

You may be referred to a specialist treatment centre, which are located in major cities throughout Australia. These centres have expert multidisciplinary teams (MDTs) who regularly manage this cancer, including surgeons, medical oncologists, allied health professionals and many others. To find a specialist treatment centre visit the Australia and New Zealand Sarcoma Association.  

Specialist sarcoma treatment centres

You can find specialised sarcoma treatment centres at certain hospitals and cancer centres in major citites throughout Australia. 

These specialist centres have multidisciplinary teams (MDTs) who regularly manage this cancer. The team will include surgeons, medical oncologists, radiation oncologists, pathologists, radiologists and clinical nurse consultants. It will also include allied health professionals such as physiotherapists, occupational therapists and social workers. Some centres also have oncologists with experience in treating children and young people with bone cancer. 

To find a specialised sarcoma team in your state or territory, visit sarcoma.org.au. You might have to travel for treatment. 

Surgery

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

Limb-sparing surgery

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 as well as some surrounding normal-looking bone and muscle. This is called a wide local excision and it aims to reduce the chance of the cancer coming back.

A pathologist will then check the tissue to see whether the edges are clear of cancer cells. The bone that is removed is replaced with a metal implant (prosthesis) or a bone graft, which involves using a piece of healthy bone from another part of your body or from a 'bone bank', which is a facility that collects tissue for research and surgery. In some cases, it may be possible to treat the removed bone with radiation therapy to destroy the cancer cells, then use the treated bone to reconstruct the limb.

After surgery, you will be given medicine to manage any pain and reduce the chance of getting an infection in the bone or prosthesis. There will be some changes in the way the limb looks, feels or works. 

Surgery to remove the limb (amputation)

Sometimes it is not possible to remove all of the cancer without affecting the arm or leg, and the limb has to be removed (amputated). For about one in 10 people, this is the only effective treatment, however this procedure has become less common as limb-sparing surgery has improved.

After surgery, you will be given medicine to manage the pain and taught how to care for the part that remains (residual limb). After the area has healed, you may be fitted for an artificial limb (prosthesis). If you have a leg removed and receive a prosthesis, a physiotherapist will teach you exercises and techniques to improve walking and other movement.

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

Pelvis

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.

Spine or skull

If surgery isn't possible, a combination of treatments may be used. This may include radiation therapy, cryotherapy (freezing method) or curettage (scooping out the cancer).

Chemotherapy

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 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
• as palliative treatment, to help stop the growth or control the symptoms of an advanced cancer.

Chemotherapy drugs are usually injected into a vein. Most people have chemotherapy as a day patient, but some types of drugs require a hospital stay.

The side effects of chemotherapy will depend on the drugs you receive and where the cancer is located in your body, however commonly they include tiredness, nausea, vomiting and diarrhoea, appetite loss, hair loss, mouth ulcers, constipation, numbness or tingling in the hands and feet, effects on hearing and increased risk of infection.

Radiation therapy

Radiation therapy uses targeted radiation (usually in the form of x-ray beams) to kill or damage cancer cells. It may be used for Ewing sarcoma:

• after surgery or chemotherapy, to kill any remaining cancer cells
• as an alternative treatment to surgery if a wide local excision is not possible
• as palliative treatment, to help stop the growth of an advanced cancer or control the symptoms

Radiation therapy is usually given every weekday, with a rest over the weekend, for several weeks. Side effects will depend on the area being treated and the strength of the dose you have, and commonly include fatigue (tiredness), skin redness or soreness, and hair loss within the treatment area. 

Follow-up appointments

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. Appointments will become less frequent if you have no further problems.

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.