Having treatment for bone cancer

The three main types of treatment for bone cancer are chemotherapy|, surgery| and radiotherapy|. Most people have a combination of treatments.

Your doctors will plan your treatment based on:

• the type of bone cancer you have
• where the cancer is
• the stage of the cancer (this means how fast-growing the cancer is and whether it has spread outside the bone).

If you have any questions about your treatment, ask your doctor or nurse. They'll be happy to help you understand what's involved.

 In this information we sometimes use the term ‘bone tumour’. This means the same as bone cancer.

Chemotherapy (chemo) Back to top

This is when you’re given anti-cancer drugs to destroy the cancer cells. It’s an important treatment for bone tumours. It helps shrink the tumour before surgery or radiotherapy, and it kills cells that have spread outside the bone. After your surgery or radiotherapy you’ll usually have more chemo.

Chemo for bone cancer is given into a vein, usually through a central line, a port or a PICC line. 

You’ll have chemo over a few days and then you’ll have a few weeks off so that your body can recover from any side effects. The days you have the chemo and the rest period afterwards is called a cycle. Most people have several cycles of chemo.

You'll probably need to stay in hospital for some of the time during chemo, but it’s often possible to have part of your treatment as an outpatient.

If you want more info about how chemo is given and the drugs used, see our chemo section|.

The type of chemo you have depends on whether the tumour is a Ewing sarcoma or an osteosarcoma.

Chemotherapy for Ewing sarcoma

For Ewing sarcoma the drugs most often used first are vincristine, ifosfamide, doxorubicin and etoposide. Giving these drugs together is called VIDE.  

You’ll have six cycles of VIDE in total, and after the third or fourth cycle you’ll have stem cells collected (harvested). Stem cells are very early blood cells. Once they’re collected, they’re stored in case you need them later for a stem cell transplant.

After your chemo you’ll have surgery, or, if the tumour can’t be removed with an operation, you’ll have radiotherapy.  Some people have both surgery and radiotherapy.  The team looking after you will decide on the best combination for you, based on where your tumour is, how easy or difficult it is to remove with an operation, and how far your cancer has spread.

If you have surgery, you’ll have more chemo afterwards to help stop the tumour coming back or spreading to other parts of the body. At the moment many people having treatment for Ewing sarcoma are part of a clinical trial called the Euro-Ewing 99 trial. The trial is comparing different combinations of treatment that can be given after surgery to find which one works best.

The chemo drugs you're given with this trial are either vincristine, actinomycin D and ifosfamide (called VAI), or vincristine, actinomycin D and cyclophosphamide (called VAC). 

In the Euro-Ewing 99 trial some people have eight cycles of chemo, and some people have one cycle of VAI chemo followed by a very high-dose type of chemotherapy and a stem cell transplant.

You’ll be given lots of information at the hospital about what the trial involves and you can ask as many questions as you like to help you understand what’s involved.

If you’re not taking part in this trial, your doctor will decide what treatment you have.

Chemotherapy for osteosarcoma

Osteosarcoma is usually treated with three chemo drugs called methotrexate, doxorubicin (Adriamycin) and cisplatin. Giving these drugs together is called MAP.   

You have six cycles of chemo in total. Each cycle takes about five weeks. After the first two cycles you’ll have surgery to remove the cancer.

If the cancer has spread, you may also need to have surgery on another part of your body. For example, if osteosarcoma spreads outside of the main tumour, it usually spreads to the lungs. If the cancer has spread to your lungs, you’ll probably have a second operation to remove the cancer in your lungs. If you have bone cancer that's spread, your doctors will talk to you about what will happen.

After surgery you’ll have four more cycles of MAP chemo. You may also be given a new treatment called mifamurtide (Mepact), which helps your body kill tumour cells. It’s given as a drip into a vein twice a week for 12 weeks, then once a week for 24 weeks. Your doctor will tell you if you can have this drug as well as your chemo.

Side effects

Different chemo drugs cause different side effects. Some people have just a few side effects and others have more. It's hard to know how it's going to be for you, as everyone’s different. Most side effects are short-term (temporary) and gradually disappear once treatment stops. 

The most common are hair loss, tiredness, sickness and being more at risk of getting an infection.  

The most common side effect of mifamurtide is having a high temperature or feeling cold and shivery for a few hours after it’s given.

Surgery Back to top

Your surgeon will aim to remove all of the cancer, and at the same time try to reduce the long-term effects for you as much as possible.

The surgery you have will depend on the type of bone cancer you have and where it is.

You can find out more about what happens before an operation and after an operation in our surgery| section.

Limb-sparing surgery Back to top

Most people with bone cancer have a type of operation called limb-sparing surgery. This means the surgeon removes the cancer without having to remove the arm or leg it’s in. You’ll have all of the tumour taken away from your limb, including any bone and muscle affected by the tumour. The surgeon then replaces the bit of bone they’ve taken away. They do this with a specially designed metal implant called an endoprosthesis (often shortened to prosthesis). Or sometimes they replace it using bone from another part of your body, which is called a bone graft. If your cancer affects a bone in or near a joint, your joint can be replaced with an artificial one.

Before the operation

If you've had chemo, you'll need two or three weeks to recover from the treatment before you can have your op. Doctors will check that your blood count has returned to normal. They'll also make sure that you're well enough to have the operation. If you’ve lost weight or been off your food, you might need to build yourself up a bit before the op. The hospital dietitian can help you do this. You’ll probably see a physiotherapist, who’ll give you exercises to strengthen your muscles. 

If you want to have a look at the endoprosthesis that will be put in during your surgery, your keyworker or surgeon can usually arrange this.

After the operation

You’ll have a bandage or splint on your limb to keep it still and let it heal.

You’ll probably have a tube, called a drain, coming out of your wound. This stops fluid building up in your wound. A nurse will take it out after about 3-4 days.

You won’t feel like eating or drinking much for a few hours after your op, so you’ll be given fluids into a vein. This is called a drip.

You’ll probably feel a bit sore to begin with, but you’ll be given strong painkillers to help. It’s important to tell the nurses if you need extra pain relief. The pain usually starts to get better within 2-3 days. As time goes on you'll need fewer painkillers and will start to feel a lot more comfortable.

Once you’re home you’ll probably feel a bit better and stronger every day. But if you do have any problems it’s important to get them treated right away, as a delay could mean they get much more serious.

If your new joint starts to stiffen up you may need some more physiotherapy, so tell your doctor so they can arrange this for you if necessary.

If you notice any new redness, soreness or swelling in the limb that’s been operated on, it’s especially important to get in touch with your doctor right away. You might have an infection that needs treatment, so you’ll need to see the surgeon who did your operation without delay.

There's more information about the long-term effects of limb-sparing surgery in our section on living with and after bone cancer|.

Amputation Back to top

For bone tumours affecting an arm or leg, sometimes the only way to get rid of the cancer is to remove the affected limb. This is called an amputation. It’s only done if there is no alternative. This is usually because the cancer has spread from the bone and has grown around nearby blood vessels. These need to be removed along with the cancer.

An amputation may also need to be done if there’s an infection in the bone that doesn’t go away with treatment, or if the cancer comes back in the bone. Every person and every tumour is different, so you might meet other people with the same type of tumour, who are having slightly different surgery. Your specialist will talk to you about your operation and make sure you understand what's involved.

Before the operation

Your doctor will talk things through with you so that you fully understand what’s involved. Losing a limb can feel very scary and you might want to talk to a specialist nurse or a counsellor about your feelings. It might also help to talk to someone who has had an amputation - your nurse or doctor can arrange this. It's really important to get support at this tough time.

After the operation

You’ll have bandages or a plaster cast on the area that’s been operated on. There’ll be a tube (called a drain) coming from the wound to remove any excess fluid that builds up. The drain is usually taken out by a nurse on the ward after 3-4 days. You’ll also have a drip to give you fluid into a vein in your arm until you feel like eating and drinking again.

You’ll probably feel a bit sore after your op, especially for the first 2-4 days, but you'll be given strong painkillers to help with this. It’s important to tell the nurses if you need extra pain relief. You may have pain that feels as if it’s coming from the part of the limb that’s been removed. This is known as ‘phantom pain’. Let your doctor or nurse know if you have this - there are medicines that can help ease it or take it away. It usually gets better and goes away in time.

A physiotherapist will visit you a day or so after your operation. They’ll show you exercises to keep your muscles strong and flexible.

If you’ve had an arm removed, you’ll be able to get up and move around once you’ve recovered from the anaesthetic and don’t feel too sore. If you’ve had a leg removed, the physiotherapist will show you how to move around in bed and get from your bed to a chair. You'll probably be moving around with crutches or in a wheelchair within a few days.

Once you’re up and around you’ll go to the hospital gym for physiotherapy. This is a big part of your recovery. Your physiotherapist will give you more exercises to do as your wound heals and you get stronger.

It’ll take a few months for your limb to heal to its final shape after the operation, so you won’t be fitted with your permanent prosthesis until this happens. In the meantime, you’ll be given a temporary prosthesis and you’ll start learning how to use it in physiotherapy.

You'll be able to go home about two weeks after your operation.

There's more information about the long-term effects of amputation in our section on living with and after bone cancer|.

Radiotherapy Back to top

Radiotherapy treats cancer by using high-energy x-rays to destroy cancer cells. There’s more information about it in the radiotherapy| section.

Radiotherapy is mainly used to treat Ewing sarcoma. Some people with Ewing sarcoma have radiotherapy after having chemo, or before or after having surgery.

If you have osteosarcoma you’re less likely to have radiotherapy treatment. But you might have it if an operation to remove the cancer isn’t possible. Occasionally people with osteosarcoma have radiotherapy after surgery to remove their cancer.

Radiotherapy is generally given every weekday (Monday-Friday) for five weeks. Each treatment takes a few minutes. We have more info about planning radiotherapy and how radiotherapy is given.

Side effects

Radiotherapy isn't painful, but it can cause other side effects. After a few treatments you may begin to feel tired, and your skin may go red or get darker and feel sore or itchy around the area that’s being treated. This gets better once your radiotherapy treatment is over.

Other side effects depend on which part of your body is being treated. Having radiotherapy around a joint can make it feel stiff, but physiotherapy can help. There’s more information about side effects in the radiotherapy| section.