Bone Cancer (primary)
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Bone Cancer (primary)
Treatment for primary bone cancer
The treatment of bone cancers is complex and requires specialist care. Treatment 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.
Treatment for primary bone cancer usually includes surgery, chemotherapy and radiation therapy, or a combination of these treatments. 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 remission (when the symptoms of bone cancer decrease or disappear).
Understanding your treatment options and possible side effects can help you weigh up the pros and cons of different treatments. You may want to get a second opinion from another specialist to confirm or clarify your first doctor’s recommendations.
Specialist treatment centres
Located in major cities throughout Australia, these centres have expert multidisciplinary teams (MDTs) who regularly manage this cancer. The team will include surgeons, medical oncologists, radiation oncologists, pathologists, radiologists and clinical nurse consultants, as well as allied health professionals such as physiotherapists, occupational therapists and social workers. Some centres also have oncologists with experience in treating young people with bone cancer.
To find a specialist treatment centre, visit sarcoma.org.au.
Preparing for treatment
Some types of chemotherapy and radiation therapy can affect your heart and kidneys. Your doctor may recommend you have some tests to check how well your heart and kidneys are working.
Treatment may affect your fertility (your ability to conceive a child). If you are interested in having children in the future, discuss this with your doctor before treatment starts. You may be able to store sperm, eggs or embryos.
Bones affected by cancer are weaker than normal bone. If your doctor suspects you are at risk of fracturing a bone because of the cancer, they may suggest you wear a splint to support the bone or use crutches.
There are different types of operations depending on the location of the cancer.
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. The surgeon will also take out some surrounding normal-looking bone and muscle to remove as much of the cancer as possible, and to reduce the chance of the cancer coming back. This is called a wide local excision. A pathologist will 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. A graft uses a piece of 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, 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.
The risks of surgery will be explained to you. 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. A physiotherapist can plan an exercise program to help you regain strength and function in your limb.
Surgery to remove the limb (amputation)
In some cases when it is not possible to remove all of the cancer without affecting the arm or leg too much, the limb is removed (amputation). For about one in 10 people, this is the only effective treatment. 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 (amputated) and receive a prosthesis, a physiotherapist will teach you exercises and techniques to improve walking and other movement. Some people find using a prosthetic leg too difficult and prefer to use a wheelchair.
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 (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 with surgery 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, chemotherapy, cryotherapy (freezing method) or curettage (scooping out the cancer). If you need one of these specialised types of treatment, your doctor will discuss the details with you.
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’s 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 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.
You may have additional imaging (MRI, CT or PET scans) during treatment to see how well the disease is responding to the chemotherapy.
The side effects of chemotherapy will depend on the drugs you receive and where the cancer is located in your body. Common side effects 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. Talk to your treatment team about ways to manage side effects. Some people may need to have blood transfusions to replace destroyed blood cells.
This treatment uses high-energy x-rays to destroy cancer cells. It may be used for Ewing’s sarcoma:
- before surgery, to shrink the size of the tumour
- after surgery or chemotherapy, to kill any remaining cancer cells
- to help control the cancer if it’s not possible to remove the tumour surgically
- to help control pain or other symptoms.
Radiation therapy is usually given every weekday, with a rest over the weekend. Your specialist will provide details about your specific treatment plan.
Side effects will depend on the area being treated and the strength of the dose you have. Not everyone experiences side effects to the same degree. Common side effects include fatigue (tiredness), skin redness or soreness, and hair loss within the treatment area. Ask your treatment team for advice about dealing with any side effects.
This information is reviewed by
This information was last reviewed June 2019 by the following expert content reviewers: Dr Richard Boyle, Orthopaedic Oncology Surgeon, Royal Prince Alfred Hospital and Chris O’Brien Lifehouse, NSW; Dr Sarat Chander, Radiation Oncologist, Peter MacCallum Cancer Centre, VIC; James Hyett, Consumer; Rebecca James, 13 11 20 Consultant, Cancer Council SA; Dr Warren Joubert, Senior Staff Specialist Medical Oncology, Division of Cancer Services, Princess Alexandra Hospital, QLD; Kristyn Schilling, Clinical Nurse Consultant – Cancer Outreach Program, St George Hospital, NSW; Prof Paul N Smith, Orthopaedic Surgeon, Orthopaedics ACT.