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, you can talk to Macmillan.
The 3 main treatments for bone cancer are chemotherapy, surgery and 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 (this means whether it has spread outside the bone)
- how fast-growing the cancer is
If you have any questions about your treatment, ask your doctor or nurse. They'll be happy to help you understand what's involved.
You may be offered the opportunity to take part in a clinical research trial. These trials help doctors find new and better treatments for people with bone cancer. If your doctor thinks you are suitable for a clinical trial, they'll discuss this with you.
In this information we sometimes use the term ‘bone tumour’. This means the same as bone cancer.
Chemotherapy is when you’re given anti-cancer drugs to destroy the cancer cells. It’s an important treatment for bone tumours. It helps shrink the tumour before surgery or radiotherapy, and it can kill cells that have spread outside the bone. After your surgery or radiotherapy, you’ll usually have more chemotherapy.
Chemotherapy for bone cancer is given into a vein, usually through a central line, a port or a PICC line.
You’ll have chemotherapy over a few days and then you’ll have some time off to give your body a chance to recover from any side effects. The days you have the chemotherapy and the rest period afterwards is called a cycle. Most people have several cycles of chemotherapy. You'll probably need to stay in hospital for some of the time during chemotherapy.
The type of chemotherapy you have depends on whether the tumour is an Ewing sarcoma or an osteosarcoma.
Chemotherapy for Ewing sarcoma
For Ewing sarcoma, the drugs most often used first are vincristine, ifosfamide, doxorubicin and etoposide. Giving these drugs together is called VIDE. You’ll usually have 6 cycles of VIDE.
After your chemotherapy you may have surgery, or, if the tumour can’t be removed with an operation, you’ll have radiotherapy. Some people have both surgery and radiotherapy. The team looking after you will decide on the best combination for you.
If you have surgery, you’ll have more chemotherapy afterwards to help stop the tumour coming back or spreading to other parts of the body.
At the moment, there is a clinical trial called Euro-Ewing 2012 that is comparing different combinations of chemotherapy treatments before and after surgery for people with Ewing sarcomas. You can talk to your specialist doctor about whether you could take part in this trial.
Chemotherapy for osteosarcoma
Osteosarcoma is usually treated with 3 chemotherapy drugs called methotrexate, doxorubicin (Adriamycin) and cisplatin. Giving these drugs together 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’ll 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. If the cancer has spread to your lungs, you may need a second operation to remove the cancer in your lungs. If you have bone cancer that's spread, your doctors will talk to you about what will happen next.
After surgery, you’ll have 4 more cycles of MAP chemotherapy. You may also be given a new treatment called mifamurtide (Mepact), which helps your body kill tumour cells. Your doctor will tell you if you can have this drug as well as your chemotherapy.
Different chemotherapy drugs cause different side effects. Some people have just a few side effects and others have more. It's hard to know how it's going to be for you. Most side effects are temporary and gradually disappear once treatment stops.
The most common are a sore mouth, hair loss, tiredness, sickness and being more at risk of getting an infection.
The most common side effect of mifamurtide is having a high temperature or feeling cold and shivery for a few hours after it’s given.
The surgery you have will depend on the type of bone cancer you have and where it is in the body.
Your surgeon will aim to remove all of the cancer, while trying to keep as much function in the limb as possible.
Most people with bone cancer have an operation called limb-sparing surgery. This means the surgeon removes the cancer without having to remove the arm or leg it’s in. You’ll have all the tumour taken away from your limb, including any bone and muscle affected by the tumour.
It’s usually possible to remove the affected part of the bone and replace it with a custom-made 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. In some cases, the surgeon can remove the affected bone without replacing it with anything and without it affecting the way you move.
Before the operation
If you've had chemotherapy, you'll need 2 or 3 weeks to recover before you can have your operation. Doctors will make sure that you're well enough to have the operation. If you’ve lost weight or been off your food, you might need to build yourself up a bit before the operation. The hospital dietitian can help you do this. You’ll probably see a physiotherapist, who’ll give you exercises to strengthen your muscles.
You may like to see the replacement part or endoprosthesis (often just called a prosthesis) that will be put in during your operation. If you would like to see it, your surgeon or key worker can usually arrange this.
After the operation
You’ll have a bandage or splint on your limb to keep it supported and let it heal.
You’ll probably have a tube, called a drain, coming out of your wound. This stops fluid building up in your wound. A nurse will take it out after about 3 to 4 days.
You won’t feel like eating or drinking much for a few hours after your operation, so you’ll be given fluids into a vein. This is called a drip.
You’ll probably feel a bit sore to begin with, but you’ll be given 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 or 3 days. As time goes on, you'll need fewer painkillers and will start to feel a lot more comfortable.
Once you’re home, you should start to feel a bit better and stronger every day. But if you do have any problems, it’s important to tell your doctor or nurse right away, so they can deal with them quickly.
After your operation, you will need to do lots of physiotherapy to help you make the best possible recovery. This can feel like hard work but is really important. Your physiotherapist will tell you what exercises to do, and help you to do them regularly.
If you notice any new redness, pain or swelling in the limb that’s been operated on, it’s very important to get in touch with your doctor right away. You might have an infection that needs treatment, so you’ll need to see the surgeon who did your operation without delay.
There's more information about the long-term effects of limb-sparing surgery in our section on living with and after bone cancer.
Sometimes the only way to get rid of the bone cancer affecting an arm or a leg is to remove the limb. This is called an amputation. It’s only done if there is no alternative. This is usually needed if the cancer has spread from the bone and has grown around nearby blood vessels. These need to be removed along with the cancer.
Some people choose to have an amputation rather than limb-sparing surgery. You should be given a chance to discuss the advantages and disadvantages of both types of surgery with your team.
An amputation may also need to be done if there’s an infection in the bone that doesn’t go away with treatment, or if the cancer comes back in the bone. Every person and every tumour is different, so you might meet other people with the same type of tumour, who are having slightly different surgery. Your specialist will talk to you about your operation and make sure you understand what's involved.
Before the operation
Your doctor will talk things through with you so that you fully understand what’s involved. Losing a limb can feel very scary and it might help to talk to your specialist nurse, key worker or a counsellor about your feelings. It might also help to talk to someone who’s had an amputation – your nurse or doctor can arrange this. It's really important to get support at this tough time.
After the operation
You’ll have bandages or a plaster cast on the area that’s been operated on. There’ll be a tube, called a drain, coming from the wound. This stops fluid building up. A nurse will usually take it out after 3 or 4 days. You’ll also have a drip to give you fluid into a vein in your arm until you feel like eating and drinking again.
You’ll probably feel a bit sore after your op, especially for the first 2 or 4 days, but you'll be given strong painkillers to help with this. It’s important to tell the nurses if you need extra pain relief. As time goes on, you’ll need fewer painkillers and will start to feel a lot more comfortable. You may have pain that feels like it’s coming from the part of the limb that’s been removed. This is known as ‘phantom pain’. Let your doctor or nurse know if you have this. There are medicines that can help ease it or take it away. It usually gets better and goes away in time.
A physiotherapist will visit you a day or so after your operation. They’ll show you exercises to keep your muscles strong and flexible.
If you’ve had an arm removed, you’ll be able to get up and move around once you’ve recovered from the anaesthetic and don’t feel too sore. If you’ve had a leg removed, the physiotherapist will show you how to move around in bed and get from your bed to a chair. You'll probably be moving around with crutches or in a wheelchair within a few days.
Once you’re up and about, you’ll 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’ll take a few months for your limb to heal to its final shape after the operation, so you won’t be fitted with your permanent prosthesis until this happens. In the meantime, you’ll be given a temporary prosthesis and learn how to use it in physiotherapy.
You should be able to go home about 2 weeks after your operation.
There's more information about the long-term effects of amputation in our section on living with and after bone cancer.
Radiotherapy treats cancer by using high-energy X-rays to destroy cancer cells.
Radiotherapy is mainly used to treat Ewing sarcoma. You may have radiotherapy after your chemotherapy, or before or after having surgery.
If you have osteosarcoma, you’re less likely to have radiotherapy treatment. But you might have it if an operation to remove the cancer isn’t possible. Occasionally, people with osteosarcoma have radiotherapy after surgery to remove their cancer.
Radiotherapy is generally given every weekday (Monday to Friday) for 5 weeks. Each treatment takes a few minutes.
Radiotherapy isn't painful, but it can cause other side effects. After a few treatments you may begin to feel tired, and your skin may go red or get darker and feel sore or itchy around the area that’s being treated. This gets better once your radiotherapy treatment is over.
Other side effects depend on which part of your body is being treated. Having radiotherapy around a joint can make it feel stiff, but physiotherapy can help.
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If you're looking for information about bone cancer in people of all ages, read our general bone cancer section.