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Decisions about your treatment

Find out about how your doctor decides which treatment you need and the types of treatment you might have.

This page is about cancer that starts in your bone (primary bone cancer).

If your cancer has spread into bone from another part of the body, it is called secondary bone cancer.

Your treatment team

A team of doctors and other professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT).

The MDT includes:

  • specialist bone cancer surgeons
  • cancer specialists (oncologists)
  • a specialist nurse
  • a physiotherapist
  • a prosthetist (false limb specialist)
  • psychologist or counsellor
  • social worker

Some rare cancer types, such as Ewing's sarcoma, have national multidisciplinary teams. They provide national expert advice to doctors treating people with these tumours. To discuss individual patients the team meets online, using web technology to speak and see each other. They can look at scans and test results and come up with a treatment plan that is appropriate for each patient. 

Deciding on treatment

Your treatment will depend on:

  • where your cancer is
  • how far it has grown or spread (the stage)
  • the type of cancer
  • how abnormal the cells look under a microscope (the grade)
  • your general health and level of fitness

Your doctor will discuss your treatment, its benefits and the possible side effects with you.

Treatment overview

The main treatments are:

  • surgery
  • chemotherapy
  • radiotherapy

Surgery and chemotherapy are the most common treatments for primary bone cancer. Radiotherapy is an important treatment for Ewing's sarcoma.

Surgery

The type of surgery you have will depend on the size of the cancer, where it is in your body and whether it has grown into the tissues surrounding the bone. 

Types of surgery include:

  • removing the bone affected by the cancer - this is called a resection
  • removing the bit of bone containing cancer and replacing it with a piece of metal (prosthesis) - this is called limb sparing surgery
  • removing an arm or leg - this is called amputation
  • removing cancer that has spread - this is called a metastasectomy

Chemotherapy

Chemotherapy can work very well for some types of bone cancers - particularly Ewing's sarcoma and osteosarcoma. You usually have chemotherapy before and after surgery.

Before surgery, treatment can shrink the cancer and make it easier to remove. After surgery, chemotherapy can kill off any cancer cells that escaped before your operation. This lowers the risk of the cancer coming back in the future.

You might also have chemotherapy to control bone cancer that has spread or come back after treatment (advanced bone cancer). 

Radiotherapy

You don't routinely have radiotherapy for all types of bone cancer. But it can be an important part of treatment for Ewing's sarcoma.

For Ewing's sarcoma, you might have radiotherapy to shrink the tumour before surgery. After surgery, you can have radiotherapy to try to kill off any cancer cells that may have been left behind. If surgery to remove the tumour would be too difficult, you might have radiotherapy and chemotherapy instead of surgery.

You sometimes have radiotherapy after surgery for chordomas. And occasionally you have it after surgery for osteosarcoma. 

You might have radiotherapy to relieve the symptoms or treat all types of advanced primary bone cancer. 

Treatment by type of bone cancer

You are likely to have chemotherapy before surgery to help shrink the tumour and make it easier to remove. You usually have more chemotherapy after sugery.

Children and young adults who have a high grade osteosarcoma might have a biological therapy called mifamurtide (Mepact). This is given alongside chemotherapy and after surgery.

You are likely to have chemotherapy before surgery, if the surgeon is able to remove your cancer with surgery. And then you usually have more chemotherapy after sugery.

Ewing's sarcoma responds well to radiotherapy and you may have this:

  • as your main treatment instead of surgery, if it is difficult for the surgeon to remove all of your cancer - for example if your cancer is in your pelvis
  • before or after surgery to help lower the risk of the cancer coming back
  • to shrink a tumour after chemotherapy

Spindle cell sarcomas include fibrosarcoma and malignant fibrous histiocytoma.

You are likely to have chemotherapy before surgery to help shrink the tumour and make it easier to remove. You usually have more chemotherapy after sugery.

You are likely to have surgery for your chondrosarcoma. You don't routinely have chemotherapy or radiotherapy for this type of bone cancer. These treatments don't tend to work as well with chondrosarcomas. 

In some situations, your doctor may suggest radiotherapy, either after surgery or to help relieve symptoms.

You usually have surgery followed by radiotherapy.

If you can't have surgery, you might have radiotherapy to shrink the tumour and relieve any symptoms.

When cancer spreads it is called secondary cancer. You might have surgery to remove secondary cancer that comes back later in the lungs. Or, you might have surgery if you have secondary lung cancer when you are diagnosed. If the cancer is too widespread, surgery may not be possible.

Surgery to remove secondary cancer is called a metastasectomy. You most often have this for secondary cancer in the lungs. It is more common to have this surgery for osteosarcoma than for other types of bone cancer.

Deciding about treatment can be difficult when you have advanced cancer. Treatments such as chemotherapy or radiotherapy can help to reduce symptoms and might make you feel better. But they also have side effects that can make you feel unwell for a while.

Your doctor or specialist nurse can talk to you about the benefits and possible side effects. You can ask them questions. You might also find it helps to talk things over with a close relative, a friend or a counsellor at the hospital.

Treatment depends on:

  • the size of the cancer and where it is in the body
  • the treatment you have already had
  • your general health

Clinical trials to improve treatment

Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to improve treatment by:

  • making existing treatments better
  • developing new treatments

Support for you

You can call the Cancer Research UK nurses on freefone 0808 800 4040. Lines are open 9am to 5pm, Monday to Friday. You can talk through your treatment options for bone cancer.
Last reviewed: 
07 Jan 2015
  • Bone Sarcomas: ESMO Clinical Practice Guidelines

    The ESMO/European Sarcoma Network Working Group 

    Annals of Oncology, 2014. Volume 25, Supplement 3

  • Cancer and its management (6th edition)
    J Tobias and D Hochhauser
    Blackwell, 2010

  • UK Guidelines for the Management of Bone Sarcomas

    Grimer and others

    Sarcoma, 2010

Information and help

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