Bone cancer (sarcoma) - Treatment for bone cancer

If you are diagnosed with bone cancer, it's likely you will be referred to a specialist centre with experience in treating bone cancer.

Your care team

At specialist bone cancer centres teams of specialist health professionals work together to treat bone cancer. These teams are known as multi-disciplinary teams (MDTs).

Members of the MDT may 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)
a pathologist (a specialist in diseased tissue)
a radiologist (a specialist in radiotherapy)
a palliative care specialist (a specialist in pain relief and symptom control)
a social worker
a psychologist
a specialist cancer nurse, who will usually be your first point of contact between yourself and the rest of the team

Your treatment plan

Depending on the type of bone cancer you have, the main treatment will include a combination of:

chemotherapy - treatment using powerful cancer-killing medication
radiotherapy - where pulses of radiation are used to destroy cancerous cells
surgery - to remove the section of cancerous bone

In many cases, it is possible to reconstruct the bone that has been removed. This is known as limb-sparing surgery.

However, sometimes the only way to treat bone cancer is to amputate some, or all, of the limb. Due to advances in diagnosis and treatment, only a minority of patients (around one-in-seven cases) need an amputation.

Chemotherapy

There are four ways chemotherapy can be used to treat bone cancer. It can be used:

before surgery to shrink the tumour, making it more likely you will only require limb-sparing surgery
in combination with radiotherapy before surgery (chemoradiation); this approach works particularly well in the treatment of Ewing’s sarcoma
after surgery to prevent the cancer returning
to control symptoms in cases where a cure is not possible (known as palliative chemotherapy)

Chemotherapy treatments are 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.

Chemotherapy for bone cancer involves taking a combination of different medications. These are usually delivered via a drip into your vein, or into a tube connected to one of the blood vessels in your chest.

Side effects of chemotherapy include:

nausea or vomiting
diarrhoea
mouth ulcers
tiredness
infertility
hair loss (following treatment, your hair should take between three to six months to grow back)

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.

Chemotherapy can also weaken your immune system, making you more vulnerable to infection.

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 is usually given five days a week with a break from treatment over the weekend. Each session of radiotherapy usually lasts around 10 to 15 minutes. Most people require between two and five weeks of treatment.

Common side effects of radiotherapy include:

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.

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 as well as 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. However, there are other ways to replace bone, for example by using a bone graft.

If the cancer is near a joint, such as the knee joint, it may be necessary to remove the joint and replace it with an artificial one, which may be made from plastic, metal, or ceramics.

Read more about knee joint and hip joint replacement.

Amputation

Amputation may be required if you develop a serious complication after limb-sparing surgery, if the cancer involves structures which are important for the function of the limb, or if the cancer:

has spread beyond the bone into major blood vessels or nerves
has spread beyond the bone into your skin
has developed in a part of the body where limb-sparing surgery is not technically possible, such as in the ankle

Being told you need an amputation can be devastating, particularly for children. Your care team will understand the shock and fear that you, or your child, may be feeling 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.

Artificial limbs are now very advanced and convenient to use. For example, people with an artificial leg are able to walk, run and play sport. In many cases, an artificial limb allows a wider range of movement than a limb repaired with limb-sparing surgery.

Research has also found most people who have an amputation enjoy the same quality of life as people who have limb-sparing surgery.

When you are able to leave hospital, you will be referred to a local limb centre. Limb centres provide advice, support and treatment for people with artificial limbs. You will also be given physiotherapy and occupational therapy (therapy to improve the skills needed for day-to-day living) to make the best use of your artificial limb.

Read more about living with an amputation.

Mifamurtide

A medication called mifamurtide may be used as part of the treatment of high-grade osteosarcoma.

Mifamurtide is what is known as an immune macrophage stimulant. This means it works by encouraging the immune system to produce specialised cells known to kill cancerous cells.

Mifamurtide is given after surgery, in combination with chemotherapy, to kill any remaining cancerous cells and help prevent the cancer from returning.

Mifamurtide is slowly pumped into one of your veins over the course of an hour, this is known as infusion. It is usually carried out at your local hospital (you will be able to go home once the infusion has been completed) or possibly at your GP’s surgery.

The recommended course of treatment is usually twice a week for 12 weeks and then once a week for a further 24 weeks after that.

Mifamurtide can cause a wide range of side effects, usually mild to moderate.

They include:

feeling or being sick
diarrhoea or constipation
headache
dizziness
loss of appetite
muscle and joint pain
blood in your urine
blurred vision
hearing loss

Read the leaflet that comes with your medication for a full list of side effects.

It's unclear whether it is safe to take mifamurtide during pregnancy, so as a precaution it's important to use an effective method of contraception if you are a sexually active woman. You will need to tell your MDT as soon as possible if you think you're pregnant and avoid breastfeeding while taking mifamurtide.

Follow up

If tests show your body is now free of cancerous cells, your treatments will end. But you'll still need to attend regular follow-up appointments to check the cancer hasn't returned.

You will be asked to attend frequent appointments in the first two years after treatment has finished – possibly every two to four months depending on the grade of the cancer. These will become less frequent as the years go on.

Outlook

The expected outlook for people with bone cancer is outlined below.

Five-year survival rates

Health professionals use a general measurement of a "five-year survival rate" when describing cancer statistics. However, it's important to make clear the five-year measurement is not an absolute measurement and does not mean people with bone cancer only have a five-year life expectancy.

Osteosarcoma

Six out of 10 people with localised osteosarcoma will live at least five years after diagnosis and most of these people will be completely cured.

The outlook for metastatic osteosarcoma is much poorer as only 1 in 10 people will live at least five years after being diagnosed.

Ewing's sarcoma

Seven out of 10 people with localised Ewing’s sarcoma will live at least five years after diagnosis, and again, most of them will be completely cured.

Only 3 out of 10 people with metastatic Ewing’s sarcoma will live at least five years after diagnosis.

Chondrosarcoma

In cases of chondrosarcoma, the grade of the cancer is the most important factor in determining the outlook.

The outlook for low-grade chondrosarcoma is generally good, with 8 out of 10 people living at least five years after a diagnosis.

The outlook for high-grade chondrosarcoma is poorer, with only 3 out of 10 people living at least five years after diagnosis.

Spindle cell sarcoma

Six out of 10 people with localised spindle cell sarcoma will live at least five years after diagnosis.

Only one-in-four people with metastatic spindle cell sarcoma will live at least five years after diagnosis.