Surgery is a very important part of treatment and is used to remove a tumour from the bone.
There have been major improvements in surgical treatments for bone cancer. In the past, it was often necessary to remove (amputate) the limb if cancer was found. But now, it′s usually possible just to remove the affected part of the bone and replace it with a specially designed metal fitting (endoprosthesis), or with a bone from another part of the body (bone graft). If the cancer affects a bone in or near a joint, the whole joint can often be replaced with an artificial one.
These operations, called limb-sparing surgery, have made it possible for many people to avoid amputation. Intense rehabilitative therapy may be necessary after limb-sparing surgery to make the affected arm or leg to become fully functional. Unfortunately, it isn′t always possible to avoid an amputation. Sometimes an amputation may be needed to ensure the cancer has been completely removed. It may also be necessary if your mobility would be better after an amputation than with limb-sparing surgery.
The type of surgery you have will depend on a number of factors. Your surgeon will discuss the different types of surgery in detail with you before any decision is made about your treatment.
If a bone cancer spreads to the lungs it may still be possible to cure it with an operation to remove the part of the lung that′s affected. This operation is called a thoracotomy. It shouldn′t affect your breathing as it′s still possible to breathe properly if part of a lung, or even a whole lung, is removed.
When deciding whether this type of operation is possible, the surgeon will consider several factors including the type of primary bone cancer, the number of secondary cancers in the lungs, their size and where they are in the lungs. They will also take into account your age and general health, as this is a major operation. Sometimes a course of chemotherapy is given first. This can help shrink the secondary cancers and may make an operation possible.
Occasionally it′s not possible to remove a bone tumour using surgery. This is more likely to happen if the tumour is in a bone deep within the body such as the pelvis, or in a bone that can′t be easily removed without causing serious disability, such as a bone in the spine. In these situations other treatments such as chemotherapy or radiotherapy will be used instead.
Chemotherapy is an important part of the treatment for most osteosarcomas, spindle cell sarcomas and Ewing′s sarcomas.
Chemotherapy is usually given before you have surgery or radiotherapy. When given before surgery, it can shrink the tumour and make it easier to remove. It can also reduce symptoms such as pain and reduce the chances of the cancer spreading.
If you have an osteosarcoma or Ewing′s sarcoma, you will also have chemotherapy after surgery or radiotherapy. This is to destroy any remaining cancer cells that may have spread to other parts of the body. It′s given because tiny amounts of cancer may be present, especially in the lungs, that are too small to be detected by a scan.
A central line - Chemotherapy drugs are usually given by injection into a vein (intravenously). Sometimes, to make this easier and to avoid you having frequent injections, a fine plastic tube called a central line can be put into a vein in your chest. The line is put in under a general or local anaesthetic.
Peripherally Inserted Central Catheter Line (PICC line) - Instead of a central line, a tube may be put into a vein in the crook of your arm. This is known as a PICC line (peripherally inserted central catheter line).
An implantable port - A tube with an injectable port just under the skin can also be used. This is known as an implantable port.
Chemotherapy is usually given as a series of sessions of treatment. Each session usually lasts a few days and is followed by a rest period. The session of chemotherapy and the rest period is known as a cycle of treatment. A series of cycles makes up a course of treatment. The number of cycles you have will depend on the type of bone cancer you have and how well it is responding to the drugs.
Chemotherapy will usually mean spending a few days in hospital. Sometimes it may be given to you as an outpatient. In this situation it′s given continuously into a vein through a central line or PICC line. The dose is controlled by a small portable pump.
Radiation therapy uses high-powered beams of energy, to kill cancer cells. During radiation therapy, patients lie on a table while a linear accelerator moves around you and aims the energy beams at precise points on the body. At Dharamshila Narayana Superspeciality Hospital, we have the most advanced VMAT Radiation Technology to treat cancer patient.
Preoperative radiation therapy may be used to shrink a bone cancer to increase the likelihood that the surgical oncologist can remove the entire cancer with surgery. In this situation, radiation therapy may be combined with chemotherapy.
Radiation therapy may also be used in people with bone cancer that can′t be removed with surgery. It may also be used after surgery to kill any cancer cells that may be left behind. For people with advanced bone cancer, radiation therapy may help control signs and symptoms, such as pain.