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Overview
Primary bone cancer is usually treated with a combination of surgery, chemotherapy and radiation therapy. Many people who are treated for primary bone cancer go into complete remission (when there is no sign of active cancer).
Treatment of bone cancer is complex. Having treatment at a specialised sarcoma centre can mean better recovery and longer survival. Most people can have surgery to remove the cancer but save their arm or leg. Occasionally the whole limb will need to be removed (amputated) but this is less common now.
If surgery isn’t possible, a combination of chemotherapy and radiation therapy may be used.
What’s on this page
The treatment of bone cancer is complex and requires specialist care. Research shows that having treatment at a specialist treatment centre (see below) means better recovery and longer survival. Treatment will depend on:
- the type of primary bone cancer
- the location and size of the tumour
- whether or not the cancer has spread
- your age, fitness and general health.
Primary bone cancer is usually treated by surgery, chemotherapy or radiation therapy, or a combination of those. The aim 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 complete remission (when there is no evidence of active cancer).
Preparing for treatment
Preparing for treatment
Ask about fertility
Treatment may affect your ability to conceive a child (fertility). Before treatment starts, you may be able to store sperm, eggs, embryos or ovarian tissue. For more information, see Fertility and cancer.
Avoiding fractures
If your doctor thinks you may be at risk of a bone fracture, they may recommend you wear a splint to support the bone or use crutches.
Checking heart and kidneys
Your doctor may recommend you have some tests to check how well your heart and kidneys are working, as some types of chemotherapy and radiation therapy may affect these organs.
Specialist sarcoma treatment centres
Specialist sarcoma treatment centres
You can find specialised sarcoma treatment centres at certain hospitals and cancer centres in major cities 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 the Australia and New Zealand Sarcoma Association. You might have to travel for treatment.
Surgery
The type of operation you have will depend on where the cancer is in the body.
Limb-sparing surgery
Limb-sparing surgery
Surgery to remove the cancer but save (salvage) the arm or leg (limb) can be done in most 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 with a layer of surrounding normal tissue. This is called a wide local excision, and it reduces the chance of the cancer coming back. A pathologist checks the tissue to see whether the edges are clear of cancer cells.
The bone that is removed is usually replaced with a metal implant or a bone graft. A graft uses 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 surgery. In some cases, the removed bone is treated with radiation therapy to destroy the cancer cells, then used to reconstruct the limb.
After surgery, you will be given medicine to manage pain and reduce the chance of getting an infection in the bone or metal implant. There are likely to be some changes in the way the limb looks, feels or works.
A physiotherapist can show you exercises to help you regain strength and improve how the limb works.
Surgery to remove the limb (amputation)
Surgery to remove the limb (amputation)
For about 1 in 10 people, the only way to remove the cancer completely is to remove the limb (amputation). This procedure is less common now because techniques used for limb-sparing surgery have improved. However, amputation may be needed in certain situations.
After surgery, you will be given medicine to manage the pain and taught how to care for the stump that remains (residual limb). After the area has healed, you may be fitted for an artificial limb (prosthesis).
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 control and use the prosthesis.
If you have a leg removed and receive a prosthesis, a physiotherapist will show you exercises and techniques to improve how you walk and move with your new limb. Some people choose to use a wheelchair instead of a prosthetic leg.
Surgery in other parts of the body
Surgery in other parts of the body
Pelvis
When possible, the cancer is removed along with some healthy tissue around it (wide local excision). Some people may need to have a bone graft or a metal implant to rebuild the bone.
Jaw or cheek bone (mandible or maxilla)
The surgeon will remove the affected bone. Bone from other parts of the body may be used to replace the affected bone. As the face is a delicate area, it may be difficult to remove the cancer with surgery, and some people may need to have chemotherapy or radiation therapy.
Spine or skull
If surgery isn’t possible, a combination of radiation therapy and chemotherapy may be used. If you need one of these treatments, your doctor will explain what will happen.
For more information, see Surgery.
Chemotherapy
This treatment uses drugs to destroy or slow the growth of cancer cells, while causing the least possible damage to healthy cells. It may be given for high-grade osteosarcoma and Ewing sarcoma:
- before surgery, to shrink the size of the tumour and make it easier to remove
- after surgery or radiation therapy, to kill any cancer cells possibly left behind
- as palliative treatment, to help stop the growth of an advanced cancer or control the symptoms.
Chemotherapy drugs are often injected into a vein. This may be as a day patient, or during a hospital stay. You will need scans (MRI, CT or PET–CT) during treatment to see how well the cancer is responding to the chemotherapy.
Side effects
These depend on the drugs that are given and where the cancer is in your body. Common side effects include fatigue (tiredness), nausea, vomiting, appetite loss, hair loss, constipation, diarrhoea, numbness or tingling in the hands and feet, effects on hearing and increased risk of infection. Talk to your treatment team about ways to manage side effects. If your red blood cell count drops too low, you may need a transfusion to build them up again.
For more information, see Chemotherapy.
Radiation therapy
This treatment uses targeted radiation to kill or damage cancer cells. The radiation is usually in the form of x-ray beams. Radiation therapy may be use for Ewing sarcoma:
- after surgery or chemotherapy, to kill any cancer cells possibly left behind
- 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. Your specialist will provide details about your specific treatment plan.
Side effects
These will depend on the area being treated and the strength of the dose you have. Common side effects include fatigue (tiredness), skin redness or soreness, and hair loss in the treatment area. Ask your treatment team for advice about dealing with any side effects.
For more information, see Radiation therapy.
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