Bone cancer - Treatment

Treatment-Bone cancer




Treatment for bone cancer depends on the type of bone cancer you have, how far it has spread and your general health. The main treatments are surgery, chemotherapy and radiotherapy.

Your treatment plan

Your treatment should be managed by a specialist centre with experience in treating bone cancer, where you'll be cared for by a team of different healthcare professionals known as a multi-disciplinary team (MDT).
Members of the MDT will include an orthopaedic surgeon (a surgeon who specialises in bone and joint surgery), a clinical oncologist (a specialist in the non-surgical treatment of cancer) and a specialist cancer nurse, among others.
Your MDT will recommend what they think is the best treatment for you, but the final decision will be yours.
Your recommended treatment plan may include a combination of:
  • surgery to remove the section of cancerous bone – it's often possible to reconstruct or replace the bone that's been removed, although amputation is occasionally necessary
  • chemotherapy – treatment with powerful cancer-killing medication
  • radiotherapy – where radiation is used to destroy cancerous cells
In some cases, a medication called mifamurtide may be recommended as well.

Surgery

Surgery to remove the cancerous area of bone is an important part of treatment for bone cancer, although it's often combined with the other treatments mentioned below.
It's usually possible to avoid removing an affected body part completely (known as limb-sparing surgery), although up to 1 in every 10 people may need to have a limb permanently removed (amputation).

Limb-sparing surgery

Limb-sparing surgery is usually possible when the cancer has not spread beyond the bone, and the bone can be reconstructed.
The most common type of limb-sparing surgery involves removing the section of affected bone and some of the surrounding tissue (in case any cancerous cells have spread into the tissue).
The removed section of bone may then be replaced with a metal implant called a prosthesis or a piece of bone from elsewhere in your body (bone graft).
If the cancer is near a joint, such as the knee, it may be possible to remove the joint and replace it with an artificial one. Read more about knee joint replacement and hip joint replacement.

Amputation

Amputation may be necessary if limb-sparing surgery is not possible or has not worked well. For example, it may be necessary if:
  • the cancer has spread beyond the bone into major blood vessels or nerves
  • you developed an infection after limb-sparing surgery and the prosthesis or bone graft had to be removed 
  • the cancer has developed in a part of the body where limb-sparing surgery is not technically possible, such as the ankle
Your care team will understand the shock and fear that you, or your child, may be feeling if an amputation is needed and should be able to provide you with counselling and other support. In some cases, your care team may be able to introduce you to someone who has already had an amputation.
After an amputation, most people use an artificial limb to replace the removed limb. These limbs are now very advanced and convenient to use. For example, people with an artificial leg are often able to walk, run and play sport, and have an excellent quality of life.

Recovering from surgery

After limb-sparing surgery or an amputation, you'll need help to return to normal life. This is known as rehabilitation.
Rehabilitation will usually involve physiotherapy sessions, where you carry out exercises to help regain proper function in the treated body part, and occupational therapy, where you're taught skills to help you cope with day-to-day activities.
After an amputation, you may be referred to a local limb centre for advice, support and rehabilitation treatment. Read more about living with an amputation.

Chemotherapy

There are 4 ways chemotherapy can be used to treat bone cancer:
  • before surgery – to shrink the tumour and make surgery easier
  • in combination with radiotherapy before surgery (chemoradiation) – this approach works particularly well in the treatment of Ewing sarcoma
  • after surgery, to prevent the cancer returning
  • to control symptoms in cases where a cure is not possible (known as palliative chemotherapy)
Chemotherapy for bone cancer involves taking a combination of different medications that are usually delivered via a drip into your vein, or into a line inserted into a bigger blood vessel.
The treatment is usually given in cycles. A cycle involves taking the chemotherapy medication for several days, then having a break for a few weeks to allow your body to recover from the effects of the treatment. The number of cycles you need will depend on the type and grade of your bone cancer.

Side effects

Chemotherapy can damage healthy cells as well as cancerous cells, which means it often causes a number of side effects.
Common side effects of chemotherapy include:
Most side effects associated with chemotherapy should resolve once your treatment has finished. However, there is a risk you will be permanently infertile. Your care team will provide more detailed information about the specific risk to your fertility.
Read more about the side effects of chemotherapy.

Radiotherapy

As with chemotherapy, radiotherapy can be used before and after surgery to treat bone cancer, or used to control the symptoms and slow the spread of cancer when a cure is not possible.
Radiotherapy for bone cancer involves beams of radiation being directed at the cancerous section of bone by an external machine.
This is normally given in daily sessions, 5 days a week, with each session lasting a few minutes. The whole course of treatment will usually last a few weeks.

Side effects

The radiation you're exposed to during radiotherapy will mostly be focused on the cancerous cells, but healthy cells nearby can also be damaged. This can lead to side effects such as:
  • reddening and irritation of the skin (this can feel much like sunburn)
  • joint pain in the part of the body that is being treated
  • feeling sick
  • hair loss in the body part being treated
  • tiredness
These side effects will pass once the radiotherapy has been completed, although feelings of tiredness may persist for several weeks.
Read more about the side effects of radiotherapy.

Mifamurtide

For people with a type of bone cancer called osteosarcoma, a medication called mifamurtide may be used alongside the treatments described above.
Mifamurtide is an immune macrophage stimulant. This means it works by encouraging the immune system to produce specialised cells that kill cancerous cells.
It's normally recommended for young people with high-grade osteosarcomas and is given after surgery, in combination with chemotherapy, to help prevent the cancer returning.  
Mifamurtide is slowly pumped into one of your veins over the course of an hour (known as infusion). The recommended course of treatment is usually twice a week for 12 weeks, and then once a week for a further 24 weeks.

Side effects

Mifamurtide can cause a wide range of side effects. These can include:
  • nausea and vomiting 
  • diarrhoea or constipation
  • headache 
  • dizziness
  • loss of appetite
  • tiredness and weakness
It's unclear whether it's safe to take mifamurtide during pregnancy, so as a precaution it's important to use an effective method of contraception if you're a sexually active woman. You will need to tell your MDT as soon as possible if you think you're pregnant, and you should avoid breastfeeding while taking mifamurtide.

Follow-up

Once your treatment has finished, you'll need to attend regular follow-up appointments to check the cancer hasn't returned.
You'll be asked to attend frequent appointments in the first 2 years after treatment has finished – possibly every 3 months. These will become less frequent as the years go on.
Contact your specialist or GP if you develop symptoms of bone cancer again and think the cancer may have come back.
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