Treatment for bone cancer

The information on this page is about Ewing sarcoma and osteosarcoma.

The three main treatments for these bone cancers are:

  • chemotherapy (chemo)
  • surgery
  • radiotherapy.

Most people have a combination of these. Your doctors will plan your treatment based on:

  • the type of bone cancer you have
  • where the cancer is
  • the stage of the cancer (whether it has spread outside the bone)
  • how fast the cancer has grown.

You may have the option of taking part in a clinical trial. If your doctor thinks there is a trial suitable for you, they will discuss this with you. You will be able to talk to your specialist and family about it before you decide what to do. It will be your decision whether or not to take part in a trial.

Treatment for bone cancer

The information on this page is about Ewing sarcoma and osteosarcoma. If you have a different type of bone cancer and want to know more, please contact us.

The three main treatments for bone cancer are:

  • chemotherapy (chemo)
  • surgery
  • radiotherapy.

We have more information about these different types of treatment, written for people of all ages.

Most people have a combination of these 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 (whether it has spread outside the bone)
  • how fast the cancer has grown.

If you have any questions about your treatment, ask your doctor or nurse. They will help you understand what it involves.

You may have the chance to take part in a clinical trial. If your doctor thinks there is a trial that is suitable for you, they will discuss this with you. You will be able to talk about it with your specialist and family before you decide what to do. It will be your decision whether or not to take part in a trial.

Watch: Coping with bone cancer as a young adult | Shelbee's story

Watch: Coping with bone cancer as a young adult | Shelbee's story


Chemotherapy (chemo)

Chemotherapy is when you have anti-cancer drugs to destroy cancer cells. It is an important treatment for bone cancers. It helps shrink the cancer before surgery or radiotherapy. It can also kill cells that have spread outside the bone. After surgery or radiotherapy, you will usually have more chemotherapy.

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

You have chemotherapy over a few days. Then you have some time off to let your body recover from any side effects. The days you have the chemotherapy and the rest period afterwards are called a cycle. Most people have several cycles of chemotherapy. You probably need to stay in hospital for some of the time you are having chemotherapy.

We have more information about how you have chemotherapy. We also have more information on chemotherapy drugs written for people of all ages.

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

Chemotherapy

This video provides a brief overview of chemotherapy treatment, how it can be given, how it works and possible side effects.

About our cancer information videos

Chemotherapy

This video provides a brief overview of chemotherapy treatment, how it can be given, how it works and possible side effects.

About our cancer information videos


Chemotherapy for Ewing sarcoma

For Ewing sarcoma, the most common drugs are:

  • vincristine
  • ifosfamide
  • doxorubicin
  • etoposide.

Your doctor can tell you more about the drugs you will have.

After chemotherapy, you may have surgery. Or if doctors cannot remove the tumour with an operation, you will have radiotherapy. Some people have both surgery and radiotherapy. The team looking after you will decide on the best combination for you.

After surgery or radiotherapy, you will have more chemotherapy to help stop the cancer returning or spreading around the body.


Chemotherapy for osteosarcoma

Osteosarcoma is usually treated with three chemotherapy drugs:

  • methotrexate
  • doxorubicin (Adriamycin®)
  • cisplatin.

When doctors give these drugs together, it is called MAP.

You will usually have 6 cycles of chemotherapy in total. Each cycle takes about 5 weeks. After the first 2 cycles, you may 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. You may need a second operation to remove the cancer in your lungs. If you have bone cancer that has spread, your doctors will talk to you about what happens next.

After surgery you will have 4 more cycles of MAP chemotherapy. You may also have a targeted therapy called mifamurtide (Mepact®). This helps your body’s immune system kill tumour cells. The most common side effect of mifamurtide is having a high temperature or feeling cold and shivery. This may last for a few hours after you have mifamurtide. Your doctor will tell you if you can have this drug as well as chemotherapy.


Side effects of chemotherapy

Different chemotherapy drugs cause different side effects. Some people have just a few side effects and others have more. It is hard to know how it is going to affect you. Your doctor or nurse can tell you more about what to expect. Most side effects are temporary and will stop when treatment finishes.

The most common side effects are:

  • a sore mouth
  • hair loss
  • tiredness
  • sickness
  • being more at risk of getting an infection.


Surgery

The type of surgery you have depends on the type of bone cancer and where it is in the body.

Your surgeon will aim to remove all of the cancer. But they will also try to keep the body part working as well as possible.


Limb-sparing and non-amputation surgery

Most people with bone cancer in an arm or leg have an operation called limb-sparing surgery. This means the surgeon removes the cancer without removing the arm or leg.

In limb sparing and non-amputation surgery, the surgeon will remove all the cancer. This includes any affected bone and muscle.

Surgeons can usually remove the affected part of the bone. If needed, they replace it with:

  • a custom-made metal fitting (endoprosthesis or prosthesis)
  • a bone from another part of the body (bone graft).

The cancer may be affecting a bone that is in or near a joint. In this case, surgeons can often replace the whole joint with an artificial one.

Sometimes, removing the cancer will not affect the way you move, so you will not need any replacement joints. For example, this can happen with a cancer in the rib.

Before the operation

You may need 1 to 3 weeks to recover from chemotherapy before you can have your operation. This will depend on the chemotherapy drugs you have had. Your doctor will make sure that you are well enough to have the operation. You may have not felt like eating, or you may have lost weight. If this has happened, you may need to build yourself up before the operation. The hospital dietitian can help you do this. You will probably see a physiotherapist, who will give you exercises to strengthen your muscles.

You may want to know more about the replacement part or prosthesis that surgeons put in during your operation. Your surgeon or key worker can answer any questions. They can also show you pictures of the prosthesis they plan to use.

After the operation

You will have a bandage or splint on your limb, to support it and let it heal.

You may have a tube (a drain) coming out of your wound. This stops fluid collecting in your wound. A nurse will take it out after about 2 to 4 days.

You may not feel like eating or drinking much after your operation. If this happens, a drip will give you fluids directly into a vein.

You may feel a bit sore to begin with, but you will have 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 to 3 days. As time passes, you will need fewer painkillers and will start to feel more comfortable.

Once you are home, you should start to feel better and stronger every day. But if you have any problems, it is important to tell your doctor or nurse right away. This means they can deal with any problems quickly.

After your operation, you will need to do exercises to help you recover. This can be hard work, but it is important. Your physiotherapist will show you these exercises and will help you do them regularly.

Tell your doctor straight away if you notice new redness, pain or swelling in the limb that’s been operated on. This means you might have an infection that needs treatment. You will need to see the surgeon who did your operation as quickly as possible.

We have more information about the long-term effects of limb-sparing surgery in our section on living with and after bone cancer.


Amputation

Sometimes, the only way to get rid of the bone cancer is to remove the affected arm or leg. This is called an amputation, and will only happen if there is no other choice. You may need an amputation if the cancer has spread from the bone and grown around nearby blood vessels. The surgeon will remove these with the cancer.

Some people choose to have an amputation rather than limb-sparing surgery. You can discuss the benefits and disadvantages of both types of surgery with your team.

You may need an amputation if there is an infection in the bone that does not go away. Or you may need one if the cancer comes back in the bone. Every person and every cancer is different. You might meet other people with the same type of cancer having different surgery. Your specialist will talk to you about your operation and make sure you understand what it involves.

Before the operation

Your doctor will talk to you about the operation, so you understand what it involves. The thought of losing a limb can be frightening. It might help to talk to your specialist nurse, your keyworker or a counsellor about your feelings. You may be able to talk to someone who has had an amputation. Your nurse or doctor can often arrange this. It is important to get support during this time.

After the operation

You will have bandages on the area that has been operated on. There will be a tube (a drain) coming from the wound. This stops fluid building up. A nurse will usually take it out after 2 to 4 days. You will also have a drip put into a vein in your arm to give you fluids. You will have this until you feel like eating and drinking again.

You will probably feel sore after your operation, especially for the first 2 to 4 days. But you will have strong painkillers to help with this. It is important to tell the nurses if you need extra painkillers. As time passes, you will need fewer painkillers and will start to feel more comfortable.

You may have pain that feels like it is coming from the part of the limb that was removed. This is known as phantom pain. Let your doctor or nurse know if you have this. There are medicines that can help ease or take it away. It usually gets better and stops in time.

A physiotherapist will show you exercises to keep your muscles strong and flexible.

If you have an arm removed, you will be able to get up and move around once you have recovered from the anaesthetic. If you have a leg removed, the physiotherapist will show you how to move around in bed. They will also show you how to get from your bed to a chair. You will probably be moving around with crutches or in a wheelchair within a few days.

Once you are ready, you will 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 will take a few months for your limb to heal to its final shape after the operation. Doctors will not fit your permanent prosthesis until this happens. In the meantime, you will have a temporary prosthesis. You will learn how to use it in physiotherapy.

You should be able to go home about 5 days after your operation.

We have more information about the long-term effects of amputation in our section on living with and after bone cancer.


Radiotherapy

Radiotherapy treats cancer by using high-energy x-rays to destroy cancer cells.

You may have radiotherapy to treat Ewing sarcoma. You may have radiotherapy after you have had chemotherapy. Radiotherapy can be given before, after or instead of surgery.

If you have osteosarcoma, you are less likely to have radiotherapy. But you might have radiotherapy if it is not possible to remove the cancer with an operation. Sometimes, people with osteosarcoma have radiotherapy after surgery.

You usually have radiotherapy every weekday (Monday to Friday), for 5 weeks. Each treatment takes a few minutes.

We have more info about planning radiotherapy and how you have radiotherapy.

Watch our video about external beam radiotherapy

Consultant Clinical Oncologist Vincent Khoo describes external beam radiotherapy, how it works, and what it involves.

Information about our videos

Watch our video about external beam radiotherapy

Consultant Clinical Oncologist Vincent Khoo describes external beam radiotherapy, how it works, and what it involves.

Information about our videos


Side effects of radiotherapy

Radiotherapy is not painful, but it can cause some side effects. After a few treatments, you may begin to feel tired. Your skin may go red or get darker. It could also feel sore or itchy around the area being treated. This gets better once your radiotherapy treatment is over.

Other side effects depend on the part of your body being treated. Having radiotherapy around a joint can make it feel stiff. But physiotherapy can help with this. Your doctor can talk to you about possible side effects before you start treatment.

We have more information about the side effects of radiotherapy.

Back to Bone cancer

The bones

Knowing what your bones do might help you understand what bone cancer is.