About bone cancer surgery

Surgery is the main treatment for most types of primary bone cancer. The aim is to remove all of the cancer from the bone, while trying to keep as much function as possible.

Usually an operation called a wide local excision is done. This means the surgeon removes the cancer, and an area (margin) of healthy, cancer-free tissue around it.

Primary bone cancers are rare, so surgery is done by a surgeon who specialises in treating them. Most bone cancers affect the arms and legs (limbs) or pelvis.

Surgery to these areas is done by a bone surgeon (orthopaedic surgeon). If the cancer is in the bones of the face, skull or chest, there are surgeons who specialise in those areas. The surgeon is part of a multidisciplinary team (MDT) and based in a specialist sarcoma unit.

Types of surgery for bone cancer

It is hard to give general information about surgery, because the type of operation you have depends on where the cancer is in your body. Your surgeon will talk with you about which surgery they think is best for your situation.

Some types of surgery for primary bone cancer are minor. Some operations are major and may affect how that area of the body works, or how it looks.

In some cases, the surgeon can remove the affected area of bone without replacing it. They may do this if your movement will not be affected by removing the area of bone. Before surgery, you may be referred to a rehabilitation team. They will help you recover from the operation and get as much function as possible.

If the surgery is minor, you may not need the help of the rehabilitation team. Your surgeon and specialist nurse will talk with you about your operation and rehabilitation.

Surgery to the arms and legs (limbs)

It is usually possible to remove a primary bone cancer in an arm or leg without having to remove the whole limb. This is called limb-sparing surgery or limb-salvage surgery.

Chemotherapy is usually given before and after the operation. Sometimes radiotherapy may also be used.

Rarely, the best treatment option is to remove the affected limb (amputation). Sometimes the surgeons may suggest amputation if:

  • the cancer has spread from the bone into the surrounding blood vessels
  • your movement will be better after an amputation than after limb-sparing surgery
  • you get an infection in the bone after limb-sparing surgery that does not respond to treatment
  • the cancer comes back in the bone.

Limb-sparing surgery often takes longer to recover from than amputation. After talking to your cancer doctor, and close family or friends, you might choose to have an amputation instead of limb-sparing surgery.

Surgery to the pelvis

When possible, a primary bone cancer in the pelvis is treated with a wide local excision. This means the surgeon removes the cancer, and an area (margin) of healthy, cancer-free tissue around it.

To help reduce the risk of any cancer cells being left behind, chemotherapy may be used before the operation. Radiotherapy may also be given.

Sometimes, the pelvis needs to be reconstructed using bone taken from another area of the body (a bone graft).

Surgery to the jaw bone

Bone cancer in the jaw bone may be treated with surgery. The whole bone is usually removed and reconstructed using bone taken from another part of the body.

Radiotherapy may also be used if it is not possible to remove the whole bone.

Surgery to the spine or skull

If primary bone cancer affects the spine or skull, it may not be possible to remove the cancer safely. A combination of treatments might be used. These include:

Reconstructive surgery

The aim of reconstructive surgery is to make the area look and work as naturally as possible. The surgery you have will depend on where in your body the cancer is and how much tissue the surgeon needs to remove.

Your surgeon and specialist nurse will talk with you about the operation. They can answer any questions you have and give you an idea of how the area will look.

Surgery to remove bone cancer that has spread

Surgery is sometimes used to remove a primary bone cancer that has spread to other parts of the body or come back after treatment. An operation is only possible if the cancers are small and there are only a few of them.

It is mainly done when the cancer has spread to the lungs. Sometimes it may be used for cancer in other parts of the body.

If you need to have this operation, your cancer doctor will talk with you about it.

Sometimes chemotherapy is given first. This can help shrink the secondary cancers and help make an operation possible.