Surgery is the main treatment for most bone cancers. Surgery includes the biopsy done to find the cancer and the surgery done to remove it. It is very important that the biopsy and surgical treatment be planned together. If possible, the same surgeon should do both the biopsy and the main surgery.
The goal of surgery is to remove all of the cancer. To try to be sure that no cancer cells are left behind, the surgeon will often remove the tumor plus some of the normal-looking tissue around it. This is called a wide-excision. After surgery, an expert will look at the tissue that was removed under the microscope to see if the outer edges (margins) have cancer cells. If so, it could mean that some cancer was left behind. When no cancer is seen at the edges of the tissue, the margins are said to be negative, clean, or clear. A wide-excision with clean margins gives the lowest chance that the cancer will grow back where it started.
Tumors in the arms or legs
There are 2 types of surgery for tumors in the arms or legs:
- Amputation removes the cancer and all or part of an arm or leg.
- Limb-salvage (also called limb-sparing) surgery removes the cancer without amputation.
While both surgeries have the same overall survival rates, it is important to know that there are pros and cons that go along with either type of surgery. And no matter which type of surgery is done, rehabilitation will be needed afterwards to help you use the limb again. This can be the hardest part of treatment. If possible, the patient should meet with a rehab specialist before surgery in order to learn what will be involved.
Amputation: Amputation may be the only option for some patients. If there is a large tumor that extends into the nerves and/or the blood vessels, it may not be possible to save the limb (arm or leg). Surgery is planned so that muscles and skin will form a cuff around the end of the arm or leg. This cuff will fit into the end of an artificial limb (called a prosthesis). With proper physical therapy a person is often walking again 3 to 6 months after leg amputation.
If the bone tumor is located in the upper arm, the tumor may be removed and then the lower arm attached again. This leaves the patient with an arm that works but is much shorter.
Limb-salvage surgery: This is a very complex surgery. The goal is to remove all of the cancer and still leave the patient with a working leg or arm. The surgeons who do it must have special skills and experience. The bone that is removed is replaced with a bone graft from donors or with a rod made of metal or other materials. This rod is called an endoprosthesis (meaning internal prosthesis).
Nine out of 10 patients with bone cancer in a limb are able to have their limbs spared. Ask the surgeon to explain the best way to remove the cancer and keep as much use of the arm or leg as possible. Because the rods or grafts are often used in growing children, they are designed to grow with the child. They can be made longer without any extra surgery. Some have tiny devices in them that can lengthen the implant when needed to make room for growth.
Problems with this approach can include infection and grafts or rods that become loose or broken. Patients may also need more surgery during the next 5 years, and some may need an amputation after all. On average, it takes a year for patients to learn to walk again after such surgery on a leg. Rehabilitation is more intense than after amputation. If the patient does not take part in the rehab program, the salvaged arm or leg may become useless.
Tumors in other places
Bone cancer in the pelvis is treated with a wide-excision when possible. If needed, bone grafts can be used to rebuild the pelvic bones.
For a tumor in the lower jaw bone, the whole lower half of the jaw may be removed and later replaced with bones from other parts of the body.
For tumors in places like the spine or the skull, it may not be possible to safely do a wide-excision. Cancers in these bones may need a number of different treatments like cutterage, cryosurgery, and radiation.
Curettage: This treatment involves scooping out the tumor from the bone. This leaves a hole in the bone. In some cases, after most of the tumor has been removed, the surgeon will treat the nearby bone tissue to kill any remaining tumor cells. This can be done with cryosurgery or by using bone cement.
Cryosurgery: For this treatment, liquid nitrogen is poured into the hole that is left in the bone after the tumor was removed. This kills tumor cells by freezing them. After cryosurgery, the hole in the bone can be filled by bone grafts or by bone cement.
Bone cement: A bone cement called PMMA starts out as a liquid and hardens over time. It can be put into a hole in the bone in liquid form. As PMMA hardens, it gives off a lot of heat. The heat helps kill any remaining tumor cells. This allows PMMA to be used without cryosurgery for some types of bone tumors.
Surgery for cancer that has spread
In order to be able to cure a bone cancer, it must be completely removed with surgery, even in any places where it has spread. The lungs are the most common place for bone cancer to spread. Surgery to remove bone cancer that has spread to the lungs must be planned very carefully. Before the operation, the surgeon takes into account the number of tumors, where they are (one lung or both lungs), their size, and the general condition of the patient.
A chest CT scan may not show all the lung tumors. The surgeon must have a plan in case more tumors are found during the operation than can be seen in the chest CT scan.
Removing all the lung metastases likely gives the patient the only chance for cure. But some tumors are too big or are too close to important structures in the chest (such as large blood vessels) to be removed safely. And patients whose general health is not good may not be able to withstand the stress of surgery. Then other treatments are needed.
Last Revised: 01/24/2013