Types of treatment for bone cancer
This page tells you about the treatments used for cancers that started in the bones – primary bone cancer. If you have a cancer that has spread to the bone from somewhere else in your body, this is not the right section for you. You need to look at the list of specific cancers and choose the one where your cancer first started.
There is information below about
Types of treatment for bone cancer
When planning your treatment your doctor will take into account the type of bone cancer you have, the stage and your age and general health. The main types of treatment are surgery chemotherapy and radiotherapy.
The type of surgery you have depends on the size of your cancer, where it is in your body and whether it has grown into the surrounding tissue.
Limb salvage surgery means removing the bit of bone where the cancer is growing. If needed the surgeon replaces it with a metal replacement piece (a prosthesis), or with a bone graft. A graft is a piece of healthy bone from somewhere else in your body.
If the cancer has spread into the tissue around the bone, the surgeon may need to remove the affected limb. If the surgeon only removes the tumour, the risk of the cancer coming back may be too high.
You may have chemotherapy to shrink the tumour and make it easier to remove. You may also have it after surgery, to try and kill off any cancer cells that escaped before your tumour was removed.
Radiotherapy can be part of treatment for some types of sarcoma. It can shrink a tumour and make it easier to remove. Or you may have it after surgery to kill off any cancer cells that may have been left behind.
You can view and print the quick guides for all the pages in the Treating bone cancer section.
As with many types of cancer, the earlier your cancer is diagnosed, the easier it is to get it under control and possibly cure it. Some bone cancers are treated with a combination of surgery and chemotherapy, these include
For these types of bone cancer, doctors often give chemotherapy before surgery to help shrink the tumour and make it easier to remove.
Ewing's sarcoma responds well to radiotherapy and this may be used
- To shrink a tumour after chemotherapy
- Before or after surgery to help lower the risk of the cancer coming back
You may have radiotherapy as your main treatment instead of surgery if the tumour is difficult to remove surgically. For example, Ewing's sarcoma sometimes develops in the pelvis and it may then be very difficult to remove.
Doctors most often treat chondrosarcomas with surgery. Doctors do not routinely use chemotherapy or radiotherapy to treat this type of bone cancer as these treatments don't work very well. In some situations, your doctor may suggest radiotherapy, either after surgery or to help relieve symptoms.
Chordoma is usually treated with surgery followed by radiotherapy.
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. Your surgeon may suggest
- Removing the bone affected by the cancer
- Limb sparing surgery
- Removal of an arm or leg (amputation)
- Surgery to remove cancer that has spread
The surgeon removes part or all of the bone affected by the cancer. This is called resection. You may have this type of surgery for cancer in bones such as a rib or fibula (calf bone). The bone is removed along with a surrounding area of healthy tissue. The bone does not need replacing and there is no loss of function. If the cancer is in a structurally important bone in an arm or leg, the surgeon replaces the removed bone. This type of surgery is called limb salvage surgery.
This means surgery to an arm or leg to take out the bit of the bone where the cancer is growing. It is also sometimes called limb salvage surgery. The surgeon replaces the piece of bone containing the cancer with a piece of metal (a prosthesis) or with a bone graft. A graft is a piece of healthy bone from somewhere else in your body. Bone can also be taken from another person. Using bone from another person is called a bone allograft. This type of surgery is very skilled and complicated. It has to be done by specialist surgeons working in specialist centres. You may have to travel to a major treatment centre, rather than go to your local hospital.
It can be devastating news to be told you must lose an arm or leg. But you may need the operation to try to cure the cancer. Amputation may be needed if the bone tumour has spread into the tissues surrounding the bone, and is affecting the blood vessels or nerves. It may be that if your surgeon only removes the tumour, there may be a very high risk of the cancer coming back. Or the tumour may be in a place where the function of the limb would not be very good after limb sparing surgery.
After the surgery, a specialist in false limbs (prosthetic limbs) will fit you with a prosthesis made specially for you. The limb specialist and the specialist physiotherapists will make sure you have all the help you need to learn to cope with your prosthesis.
Primary bone cancer that has spread can sometimes be removed with surgery. This is called metastasectomy and is most often done with lung secondaries. It can also be used for bone secondaries. This type of surgery is not always possible. It depends on how many secondary cancers there are and their size and shape. Successful removal of lung cancer secondaries is more common after osteosarcoma than other types of primary bone cancer.
Chemotherapy works very well for some types of bone cancers, particularly Ewing's sarcomas and osteosarcomas, but not for all patients. Unfortunately we can't tell how the cancer will respond until you've tried the treatment.
Chemotherapy can help cure your bone cancer. It can be very intensive treatment. There is information about chemotherapy for bone cancer and the specific drugs used in this section.
Chemotherapy is usually used with surgery to treat bone cancer. For Ewing's sarcoma, osteosarcoma and spindle cell sarcomas, you usually have the treatment before and after surgery. The treatment before surgery helps to shrink the cancer and make it easier to remove. It may sometimes make it possible to do limb sparing surgery instead of an amputation. After your chemo treatment, you will have to wait for your blood count to come back to normal before you have your surgery.
The chemotherapy after surgery is to try to kill off any cancer cells that escaped before your tumour was removed. This lowers the risk of the cancer coming back in the future.
Radiotherapy can be an important part of treatment for Ewing's sarcoma. It can shrink a tumour and make it easier to remove. After surgery, you usually have radiotherapy to try to kill off any cancer cells that may have been left behind. This lowers the risk of the Ewing's sarcoma coming back in the future. If surgery to remove the tumour would be too difficult, radiotherapy and chemotherapy treatment may be used instead.
Radiotherapy is sometimes used after surgery for chordomas.
Doctors occasionally use radiotherapy after surgery for osteosarcomas if there is a risk of cancer cells remaining in the area after the surgery, but it is not a routine treatment.
For osteosarcoma, Ewing’s sarcoma and chordoma radiotherapy may be used to relieve symptoms or treat advanced bone cancers. It can be very good at shrinking cancers in the bones and so relieving pain and other symptoms caused by pressure from the cancer.
Radiotherapy is rarely used to treat chondrosarcoma because it does not usually work very well for this type of bone tumour.
NHS guidelines emphasise that everyone with a bone cancer should be under the care of a multi disciplinary team (MDT). This is a team of health professionals who work together to decide on the best way forward for each patient. The MDT includes
- Specialist bone cancer surgeons
- Cancer specialists
- A specialist nurse
- A physiotherapist
- A prosthetist (false limb specialist)
- Psychologist or counsellor
- Social worker
If you are concerned that a multi disciplinary team is not looking after you, do ask about it. It may be that you have only seen one specialist, but the MDT team have still got together with your test results and case notes to discuss the best treatment options for you.
Some rare cancer types, such as Ewing's sarcoma, have national multi disciplinary 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.
As with many cancers, the treatment options are surgery, chemotherapy and radiotherapy. Surgery and chemotherapy are the most common treatments for primary bone cancer. Radiotherapy is an important part of treatment for Ewing's sarcoma. Your doctor will plan your treatment taking into account
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