Surgery for bone cancer

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 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.

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.

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.

If it is possible to remove all the cancer safely, a combination of treatments might be used. These include surgery, chemotherapy and radiotherapy.

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.

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