Surgery for bone cancer
Surgery is one of the main treatments for primary bone cancer. Surgery involves removing all or part of the cancer with an operation.
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Surgery is usually the main treatment for most types of primary bone cancer. When surgery is not possible, your cancer doctor will talk to you about other treatments.
Primary bone cancers are rare, so surgery is done by a specialist surgeon as part of a bone sarcoma multidisciplinary team (MDT). They are based in a specialist sarcoma unit.
The type of operation depends on where the cancer is in the body.
Some operations for primary bone cancer are minor. Other may involve major surgery and could affect how that area of the body works or looks.
Sometimes reconstructive surgery is also needed so the area affected can work or move as well as possible. In some cases, the surgeon can remove the affected area of bone without replacing it.
The aim of most sarcoma surgery is to remove (excise) all of the cancer from the bone. Surgery may affect the way the body part moves or works, but surgeons will try to keep as much movement as possible. Usually, they do an operation called a wide local excision. This means the surgeon removes the cancer, along with an area (margin) of healthy, cancer-free tissue around it.
After the operation, the pathologist looks at the tissue from the margin under a microscope. If there are cancer cells in the margin, you may need another operation to remove more tissue. Making sure the margins are clear reduces the risk of the cancer coming back.
Most bone cancers affect the arms and legs (limbs) or pelvis. Surgery to these areas is done by a bone surgeon called an orthopaedic surgeon. If the cancer is in the bones of the face, skull or chest, a surgeon who specialises in those areas will do the surgery.
Your surgeon will talk with you about which operation they think is best for you.
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 or limb-salvage surgery. You will usually have chemotherapy before and after the operation. Sometimes radiotherapy may also be used.
Rarely, the most affective treatment option is to remove the affected limb. This is called an amputation. This is to make sure all the cancer has been removed. It may also be done if the surgeon thinks that limb sparing surgery may cause problems with movement of the limb.
Bone cancer in the pelvis
When possible, a wide local excision is used to remove primary bone cancer in the pelvis. Depending on the type of bone cancer, chemotherapy may be used before the operation. This is to help shrink the cancer before having the surgery. For some types of bone cancer, chemotherapy is sometimes used after surgery.
Radiotherapy may also be given before or after surgery.
Sometimes, the pelvis is reconstructed using bone taken from another area of the body. This is called a bone graft.
If lymph nodes in the pelvis are removed, this can increase the risk of lymphoedema in your legs. Lymphoedema is swelling near to where the lymph nodes were removed. Your doctor and nurse will explain more about this.
Bone cancer in the jawbone
The whole bone is usually removed and then reconstructed using bone taken from another part of the body. If it is not possible to remove the whole bone, radiotherapy may also be used.
Depending on the size and position of the bone cancer, the surgeon may need to remove a large area of bone.
This means you may have surgery to reconstruct the area at the same time as your operation. It may be possible to replace the bone that is removed with a metal implant. This is called an endoprosthetic replacement (EPR).
If a metal implant or a bone graft is needed, surgery is done by a plastic surgeon and an orthopaedic (bone) surgeon.
The aim of reconstructive surgery is to make the area look and work as naturally as possible. The surgery you have depends on:
- where in your body the cancer is
- how much bone and tissue the surgeon needs to remove.
Rehabilitation can take time. You will have support with your recovery and go to the hospital gym for physiotherapy. This will help you recover and reduce the risk of problems after surgery.
Your surgeon and specialist nurse will talk to you about the operation. They can answer any questions you have and give you an idea of how the area will look after surgery. They may be able to show you photographs of others who have had the same surgery.
Surgery is sometimes used to remove a primary bone cancer that has:
- spread to other parts of the body (secondary cancer)
- come back after treatment (recurrence).
It is mainly done when the cancer has spread to the lungs. An operation may only be possible if the secondary cancers are small and there are only a few of them.
Sometimes surgery is 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.
Chemotherapy may be given first. This can help shrink the secondary cancers and help make an operation possible.
Before surgery your surgeon and specialist nurse will tell you about the side effects and possible risks. It is important you understand what your operation may involve.
Before surgery, you may be given advice on:
- stopping smoking to help you recover and reduce your risk of problems after surgery.
- exercises to help you get back to your usual activities after surgery, or to get fitter - for example, if you will use crutches or a walking frame after surgery, they might suggest upper body strength exercises.
- eating healthily or taking supplement drinks.
Depending on the type of surgery you have, may be referred to a rehabilitation team. They will help you recover from the operation, and make sure the area being operated on moves and works as well as possible.
Below is a sample of the sources used in our information about primary bone cancer. If you would like more information about the sources we use, please contact us at firstname.lastname@example.org
European Society for Medical Oncology, ESMO. 2021. Bone sarcomas: ESMOeEURACANeGENTURISeERN PaedCan Clinical Practice Guideline for diagnosis, treatment and follow-up. Annals of Oncology. S. J. Strauss1 et al. Available at: https://www.esmo.org/guidelines/guidelines-by-topic/sarcoma-and-gist/bone-sarcomas (accessed July 2023)
UK guidelines for the management of bone sarcomas, Clinical Sarcoma Research (2016) 6:7. Gerrand C et al on behalf of the British Sarcoma Group. Available at: UK guidelines for the management of bone sarcomas - PMC (nih.gov)(accessed July 2023)
British Medical Journal, BMJ Best Practice. Osteosarcoma. Last updated May 2022. Last reviewed 27 Jun 2023. Available at: Osteosarcoma - Symptoms, diagnosis and treatment | BMJ Best Practice (accessed July 2023)
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