Your care teamIf you are diagnosed with bone cancer, it’s likely that you will be referred to a specialist centre with experience in treating bone cancer.At specialist bone cancer centres there are teams of specialist health professionals who work together to treat bone cancer. These types of 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)a social workera psychologista specialist cancer nurse, who will usually be your first point of contact between yourself and the rest of the teamYour treatment planDifferent types of bone cancer are usually treated in a similar way.First, chemotherapy is given to try to shrink the tumour and to treat any cancer cells that may have spread..Following chemotherapy, surgery may be carried out 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.In some cases – for example, if the cancer has spread beyond the bone into the surrounding blood vessels – reconstruction may not be possible and it may be necessary to amputate some, or all, of the limb. However, due to advances in diagnosis and treatment, only a minority of patients (around one-in-seven cases) need an amputation.If cancer has spread to the lungs, surgery can also be used to remove the affected portion of the lungs. Read more about the treatment of lung cancer.Following surgery, further chemotherapy treatment may be given to destroy any remaining cancerous cells.Radiotherapy may also be used for treatment and is particularly helpful for some types of cancer (such as Ewing’s sarcoma, for example).ChemotherapyChemotherapy uses powerful cancer-killing medication to treat cancer.There are four ways that chemotherapy can be used to treat bone cancer. It can be used:before surgery to shrink the tumour, making it more likely that you will only require limb-sparing surgeryin combination with radiotherapy before surgery (chemoradiation); this approach works particularly well in the treatment of Ewing sarcomaafter surgery in order to prevent the cancer returningto control symptoms in cases where a cure is not possible (this is known as palliative chemotherapy)Chemotherapy treatments are usually given in cycles. A cycle involves taking the chemotherapy medication for several days, and then having a break for a few weeks to allow your body to recover from the effects of the treatment.The number of cycles that you require will depend on the type and the grade of your bone cancer.Chemotherapy for bone cancer involves taking a combination of different medications. The medications are usually delivered via a drip into your vein, or into a tube that is connected to one of the blood vessels in your chest.Side effects of chemotherapy include:feeling sickbeing sickdiarrhoealoss of appetitemouth ulcerstirednessskin rashesinfertilityhair loss (following treatment, your hair should take between three to six months to grow back)Most of the side effects associated with chemotherapy should resolve once your treatment has finished. However, there is a risk that you will be permanently infertile. Your care team will be able to provide more detailed information about the specific risk to your fertility.If you want to have children, it may be possible to take samples of your sperm (men) or eggs (women) so that they can be used later in fertility treatments such as IVF.Chemotherapy can also weaken your immune system, making you more vulnerable to infection. Inform your care team or your GP as soon as possible if you experience the possible signs of an infection, such as:a high temperature (fever) of 38C (100.4F) or abovecoughssore throata feeling of being generally unwellRead more about chemotherapy.RadiotherapyRadiotherapy is a type of treatment that uses pulses of radiation to destroy cancerous cells.As with chemotherapy, radiotherapy can be used before and after surgery to treat bone cancer, or it can be 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 treatedfeeling sickhair loss in the body part being treatedtirednessThese side effects will pass once the radiotherapy has been completed, although feelings of tiredness may persist for several weeks.Read more about radiotherapy.SurgeryLimb-sparing surgeryLimb-sparing surgery is usually possible when the cancer has not spread beyond the bone, and the affected bone itself is in an easily accessible position, such as:Limb-sparing surgery is usually possible when the cancer has not spread beyond the bone, and the affected bone itself is in an easily accessible position, such as:the armthe legthe shoulderthe pelvisthe hipThe 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 is then replaced with a metal implant called a prosthesis.In some cases, it may be possible to take a sample of bone from another part of the body and use it as an alternative to prosthesis. This type of operation is known as 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 is made from a combination of plastic, metal, and ceramics.Read more about knee joint and hip joint replacement.AmputationAmputation may be required if:The cancer has spread beyond the bone into major blood vessels or nerves.The cancer has spread beyond the bone into your skin.You develop a serious infection after limb-sparing surgery.The cancer has developed in a part of the body where limb-sparing surgery is not technically possible, such as in the ankle.Being told that you need to have 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 will be able to provide you with counselling and other support.In some cases, your care team may be able to introduce you or your child to someone who has already had an amputation, and they will be able to give you advice and support about living with 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 that most people who have an amputation are able to enjoy the same quality of life as people who have limb-sparing surgery.Once your stump has healed and the swelling has settled after surgery, you can be fitted with an artificial limb. These are usually custom-made to make wearing it and using it as comfortable as possible.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.At the limb centre, you will be given physiotherapy and occupational therapy (therapy to improve the skills you’ll need for day-to-day living) so that you can make the best use of your artificial limb.Any adjustments to your limb that may be required as you grow older can also be carried out at the limb centre.Read more about living with an amputation.MifamurtideA new medication called mifamurtide has recently been approved for 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 which are known to kill cancerous cells.Mifamurtide is given after surgery, in combination with chemotherapy, to kill any remaining cancerous cells and to help prevent the cancer from returning.Mifamurtide is given using a process known as infusion, which means that it is slowly pumped into one of your veins over the course of an hour. This is usually done 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, but they are usually mild to moderate.They include:feeling or being sickdiarrhoea or constipationheadachedizzinessloss of appetitemuscle and joint painblood in your urineblurred visionhearing lossRead 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 upIf tests have shown that your body is now free of cancerous cells, your various treatments will come to an end. But you’ll still need to attend regular follow-up appointments to check that the cancer hasn’t returned.Followup appointments usually involve using X-rays and computerised tomography (CT) scan.You will be asked to attend frequent appointment in the first two years after treatment has finished – possibly every two to four months depending on the grade of the cancer – and then these become less frequent as the years go on.Your MDT will be able to provide more detailed information about the schedule of your follow-up appointments.OutlookThe expected outlook for people with bone cancer is outlined below.Five-year survival ratesHealth professionals use a general measurement of a “five-year survival rate” when describing cancer statistics. However, it’s important to make clear that the five-year measurement is not an absolute measurement and it does not mean that people with bone cancer only have a five-year life expectancy.OsteosarcomaSix out of 10 people with localised osteosarcoma will live for 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 for at least five years after being diagnosed.Ewing’s sarcomaSeven out of 10 people with localised Ewing’s sarcoma will live for 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 for at least five years after diagnosis.ChondrosarcomaIn 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 for at least five years after a diagnosis.The outlook for high-grade chondrosarcoma is poorer, with only 3 out of 10 people living for at least five years after diagnosis.Spindle cell sarcomaSix out of 10 people with localised spindle cell sarcoma will live for at least five years after diagnosis.Only one-in-four people with metastatic spindle cell sarcoma will live for at least five years after diagnosis.Chemotherapy:Chemotherapy is a treatment of an illness or disease with a chemical substance, e.g. in the treatment of cancer.Joint:Joints are the connection point between two bones that allow movement.Radiotherapy:Radiation therapy uses x-rays to treat disease, especially cancer.Spine:The spine supports the skeleton, and surrounds and protects the delicate spinal cord and nerves. It is made up of 33 bones called the vertebrae.Veins:Veins are blood vessels that carry blood from the rest of the body back to the heart. Google+ Treatment for bone cancer
Your care team
If you are diagnosed with bone cancer, it’s likely that you will be referred to a specialist centre with experience in treating bone cancer.
At specialist bone cancer centres there are teams of specialist health professionals who work together to treat bone cancer. These types of teams are known as multi-disciplinary teams (MDTs).
Members of the MDT may include:
Your treatment plan
Different types of bone cancer are usually treated in a similar way.
First, chemotherapy is given to try to shrink the tumour and to treat any cancer cells that may have spread..Following chemotherapy, surgery may be carried out 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.
In some cases – for example, if the cancer has spread beyond the bone into the surrounding blood vessels – reconstruction may not be possible and it may be necessary to amputate some, or all, of the limb. However, due to advances in diagnosis and treatment, only a minority of patients (around one-in-seven cases) need an amputation.
If cancer has spread to the lungs, surgery can also be used to remove the affected portion of the lungs. Read more about the treatment of lung cancer.
Following surgery, further chemotherapy treatment may be given to destroy any remaining cancerous cells.
Radiotherapy may also be used for treatment and is particularly helpful for some types of cancer (such as Ewing’s sarcoma, for example).
Chemotherapy
Chemotherapy uses powerful cancer-killing medication to treat cancer.
There are four ways that chemotherapy can be used to treat bone cancer. It can be used:
Chemotherapy treatments are usually given in cycles. A cycle involves taking the chemotherapy medication for several days, and then having a break for a few weeks to allow your body to recover from the effects of the treatment.
The number of cycles that you require will depend on the type and the grade of your bone cancer.
Chemotherapy for bone cancer involves taking a combination of different medications. The medications are usually delivered via a drip into your vein, or into a tube that is connected to one of the blood vessels in your chest.
Side effects of chemotherapy include:
Most of the side effects associated with chemotherapy should resolve once your treatment has finished. However, there is a risk that you will be permanently infertile. Your care team will be able to provide more detailed information about the specific risk to your fertility.
If you want to have children, it may be possible to take samples of your sperm (men) or eggs (women) so that they can be used later in fertility treatments such as IVF.
Chemotherapy can also weaken your immune system, making you more vulnerable to infection. Inform your care team or your GP as soon as possible if you experience the possible signs of an infection, such as:
Read more about chemotherapy.
Radiotherapy
Radiotherapy is a type of treatment that uses pulses of radiation to destroy cancerous cells.
As with chemotherapy, radiotherapy can be used before and after surgery to treat bone cancer, or it can be 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:
These side effects will pass once the radiotherapy has been completed, although feelings of tiredness may persist for several weeks.
Read more about radiotherapy.
Surgery
Limb-sparing surgery
Limb-sparing surgery is usually possible when the cancer has not spread beyond the bone, and the affected bone itself is in an easily accessible position, such as:
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 is then replaced with a metal implant called a prosthesis.In some cases, it may be possible to take a sample of bone from another part of the body and use it as an alternative to prosthesis. This type of operation is known as 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 is made from a combination of plastic, metal, and ceramics.
Read more about knee joint and hip joint replacement.
Amputation
Amputation may be required if:
Being told that you need to have 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 will be able to provide you with counselling and other support.
In some cases, your care team may be able to introduce you or your child to someone who has already had an amputation, and they will be able to give you advice and support about living with 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 that most people who have an amputation are able to enjoy the same quality of life as people who have limb-sparing surgery.
Once your stump has healed and the swelling has settled after surgery, you can be fitted with an artificial limb. These are usually custom-made to make wearing it and using it as comfortable as possible.
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.
At the limb centre, you will be given physiotherapy and occupational therapy (therapy to improve the skills you’ll need for day-to-day living) so that you can make the best use of your artificial limb.
Any adjustments to your limb that may be required as you grow older can also be carried out at the limb centre.
Read more about living with an amputation.
Mifamurtide
A new medication called mifamurtide has recently been approved for 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 which are known to kill cancerous cells.
Mifamurtide is given after surgery, in combination with chemotherapy, to kill any remaining cancerous cells and to help prevent the cancer from returning.
Mifamurtide is given using a process known as infusion, which means that it is slowly pumped into one of your veins over the course of an hour. This is usually done 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, but they are usually mild to moderate.
They include:
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 have shown that your body is now free of cancerous cells, your various treatments will come to an end. But you’ll still need to attend regular follow-up appointments to check that the cancer hasn’t returned.
Followup appointments usually involve using X-rays and computerised tomography (CT) scan.
You will be asked to attend frequent appointment in the first two years after treatment has finished – possibly every two to four months depending on the grade of the cancer – and then these become less frequent as the years go on.
Your MDT will be able to provide more detailed information about the schedule of your follow-up appointments.
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 that the five-year measurement is not an absolute measurement and it does not mean that people with bone cancer only have a five-year life expectancy.
Osteosarcoma
Six out of 10 people with localised osteosarcoma will live for 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 for at least five years after being diagnosed.
Ewing’s sarcoma
Seven out of 10 people with localised Ewing’s sarcoma will live for 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 for 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 for at least five years after a diagnosis.
The outlook for high-grade chondrosarcoma is poorer, with only 3 out of 10 people living for at least five years after diagnosis.
Spindle cell sarcoma
Six out of 10 people with localised spindle cell sarcoma will live for at least five years after diagnosis.
Only one-in-four people with metastatic spindle cell sarcoma will live for at least five years after diagnosis.
Chemotherapy:Chemotherapy is a treatment of an illness or disease with a chemical substance, e.g. in the treatment of cancer.Joint:Joints are the connection point between two bones that allow movement.Radiotherapy:Radiation therapy uses x-rays to treat disease, especially cancer.Spine:The spine supports the skeleton, and surrounds and protects the delicate spinal cord and nerves. It is made up of 33 bones called the vertebrae.Veins:Veins are blood vessels that carry blood from the rest of the body back to the heart.
