Treatment options for bone cancer
The main treatments for cancer that starts in your bone (primary bone cancer) include:
- surgery
- chemotherapy
- radiotherapy
Some people may have a 
for primary bone cancers. Or you may have treatment as part of a .
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 or metastatic bone cancer.
Deciding on treatment
Your treatment will depend on:
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the type of bone cancer you have
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your age
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where your cancer is
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how far the cancer has grown or spread (the stage)
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how abnormal the cells look under a microscope (the grade)
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your general health and level of fitness
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your preferences for treatment
You will discuss your treatment, its benefits and the possible side effects with your doctor.
Your treatment team
An expert team of doctors and other professionals who specialise in bone sarcoma discuss the best treatment and care for you. They are called a multidisciplinary team (MDT). They are also called the bone sarcoma MDT. The MDT are based at specialist sarcoma centres.
The MDT includes:
- specialist bone cancer surgeons
- cancer doctors who treat cancer with drugs are called medical oncologists
- cancer doctor who treats with radiotherapy is called a clinical oncologists
- pathologist - a specialist looking at cells under a microscope
- a doctor specialising in diagnosing disease through imaging such as x-rays and MRI scans. These are called radiologists
- a specialist cancer nurse - also called a clinical nurse specialist or your keyworker
- a
physiotherapist - an
occupational therapist - a false limb specialist (prosthetist)
psychologist or counsellor - social workers
- symptom control specialists called palliative care doctors and nurses
Your specialist sarcoma centre might be at a hospital a bit further away than your local hospital. There are sarcoma centres around the UK. You can read more about where these are on the Sarcoma UK website.
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 some bone cancers.
Some people with osteosarcoma will have a targeted drug.
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:
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a resection - removing the bone affected by the cancer
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limb sparing surgery - removing the bone containing cancer and replacing it with a metal implant (prosthesis) or bone
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amputation - removing a limb
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a metastasectomy - removing cancer that has spread
Chemotherapy
Chemotherapy is part of . Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. It works well for some types of bone cancers such as Ewing sarcoma and osteosarcoma. You usually have chemotherapy before and after surgery.
Before surgery, chemotherapy treatment can shrink the cancer and make it easier to remove. After surgery, chemotherapy can kill off any cancer cells that may have 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. This is called advanced or metastatic bone cancer.
Radiotherapy
Radiotherapy uses high energy waves similar to x-rays to kill cancer cells. Radiotherapy is not a standard treatment for all types of bone cancer. But it can be an important part of treatment for some bone cancers such as Ewing sarcoma.
For Ewing sarcoma you can have radiotherapy before or after surgery. This depends on where the cancer is. If surgery to remove the cancer is not possible or appropriate, you might have radiotherapy and chemotherapy instead of surgery.
You might have radiotherapy for osteosarcoma or chordoma if surgery is not possible. Or you might have it when all of the cancer couldn't be removed with surgery.
You might have radiotherapy to relieve the symptoms or treat all types of advanced primary bone cancer.
Targeted cancer drugs
Targeted cancer drugs work by ‘targeting’ those differences that help a cancer cell to survive and grow.
Mifamurtide is a type of targeted cancer drug. You might have this is you are a child or young person with osteosarcoma. It works by stimulating the to kill the cancer cells. It makes the immune system produce certain types of white blood cells called monocytes and macrophages.
Imatinib and sunitinib are both targeted cancer drugs. You might have one of these if you have a type of bone cancer called a chordoma.
Other types of bone sarcoma might have other targeted treatments. These include:
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pazopanib
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cabozantinib
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regorafenib
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lenvatinib
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denosumab
Treatment by type of bone cancer
You usually have chemotherapy before surgery to treat the cancer and any cells that may be elsewhere in the body. You then have surgery. After surgery you have more chemotherapy.
Children and young adults between the ages of 2 and 30 might have a targeted cancer drug called mifamurtide (Mepact). You have this alongside chemotherapy after surgery if you have a high grade (glossary) osteosarcoma.
You usually have chemotherapy before surgery. And you are likely to have more chemotherapy after surgery. The timing of treatments can change depending on your cancer.
It might be difficult to remove all of your cancer. For example, if the cancer is in your or . Then you have radiotherapy as your main treatment instead of surgery.
Ewing sarcoma responds well to radiotherapy and you may also have it:
- before or after surgery to help lower the risk of the cancer coming back
- to shrink the cancer alongside chemotherapy
Surgery is the main treatment for chondrosarcoma. Your treatment depends on your type of chondrosarcoma.
For mesenchymal chondrosarcoma you usually have chemotherapy before or after surgery.
Doctors are less clear about the best way to use chemotherapy for dedifferentated chondrosarcoma. You might have it:
- before surgery
- after surgery
- before and after surgery
You may have radiotherapy for this chondrosarcoma:
- if you are unable to have an operation to remove the cancer
- if the cancer that was removed had cancer cells that were close or in the margin of healthy tissue surrounding the cancer
- to control symptoms
You usually have surgery. You might also have radiotherapy after surgery.
If you can't have surgery, you might have radiotherapy as your main treatment. The aim is to shrink and control the cancer and relieve any symptoms.
Some people might have a targeted treatment. You can have this if:
- your chordoma is locally advanced
- your surgeon cannot remove the cancer
- your cancer has spread to other parts of the body
Other types of bone cancer include:
- fibrosarcoma of the bone
- leiomyosarcoma of the bone
- undifferentiated pleomorphic sarcoma of the bone (UPS)
- malignant giant cell tumour of the bone
Treatment for these types is similar to osteosarcoma. You are likely to have chemotherapy before surgery to help shrink the cancer and make it easier to remove. You usually have more chemotherapy after surgery.
You may have radiotherapy if you are unable to have surgery.
Adamantinoma is another type of bone cancer. It’s usually slow growing and you might only need surgery to remove it. But if the cancer is fast growing, you might also have chemotherapy.
When cancer spreads it is called secondary cancer. Secondary cancers are also called metastases.
You might have surgery to remove secondary cancer that comes back later in your lungs. Or you might have surgery if you have secondary lung cancer when you are diagnosed. If the cancer is too widespread in the lung, surgery may not be possible.
Surgery to remove secondary cancer is called a metastasectomy. It is more common to have this surgery for osteosarcoma that has spread to the lungs than for other types of bone cancer.
For Ewing sarcoma you might have lung radiotherapy if you have secondaries in the lung.
Advanced bone cancer means that cancer has spread from where it has started in the bone. It is also called metastatic bone cancer.
Unfortunately it can be harder to cure advanced cancer. This depends on what type of bone cancer you have, and how far and where it has spread. Your doctor will tell you more about your outlook (prognosis). Treatment might control it, help symptoms, and improve your for some time. Doctors call this palliative treatment.
How you might feel
Finding out that you can’t be cured is distressing and can be a shock. It’s common to feel uncertain and anxious. It's normal to not be able to think about anything else.
Lots of information and support is available to you, your family and friends. Some people find it helpful to find out more about their cancer and the treatments they might have. Many people find that knowing more about their situation can make it easier to cope.
Talk to your doctor or specialist nurse to understand:
- what your diagnosis means
- what is likely to happen
- what treatment is available
- how treatment can help you
- what the side effects of the treatment are
Deciding about advanced cancer treatment
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.
Your doctors considers the following to help decide on treatment for advanced cancer:
- the size of the cancer (stage)
- where your cancer is in the body
- the treatment you have already had
- your general health and level of fitness
Clinical trials
Doctors are always trying to improve treatments and reduce side effects. Your doctor might ask you to participate in a clinical trial as part of your treatment. This might be to test a new treatment or to look at different combinations of existing treatments.
Your doctor will tell you if there are any trials that you can enter.
Your choices
Your doctor might offer you a choice of treatments. Discuss each treatment with them and ask how they can control any side effects. This helps you make the right decision for you. You also need to think about the other factors involved in each treatment, such as:
- whether you need extra appointments
- if you need more tests
- the distance you need to travel to and from hospital
You might have to make further choices as your situation changes. It helps to find out as much as possible each time. You can stop a treatment whenever you want to if you find it too much to cope with.
Second opinion
Some people might want to get a second opinion before starting treatment. You can ask your specialist or GP to refer you to a doctor or surgeon specialising in bone cancer. It can be better to arrange a second opinion through your specialist because they can send all your notes and test results with you.
Having a second opinion doesn't usually mean that the new doctor takes over your treatment and care. They discuss with you and your current doctor which they feel is the best treatment for you.
It can take time to arrange a second opinion, which might mean that your treatment is delayed for a while. Remember also that several specialists will be involved in your care as part of your multi disciplinary team. Between them, they discuss the best way to treat your cancer.
Support for you
You can call the Cancer Research UK information nurses on freephone 0808 800 4040. Lines are open 9am to 5pm, Monday to Friday. You can talk through your treatment options for bone cancer.
