Physicians use the results of diagnostic tests to determine the site of the cancer and to stage it—or tell how far it has spread. This helps determine the outlook for recovery and the best course of treatment. There have been great advancements in the treatment of bone cancer over the last three decades. Historically the only treatment available was cutting off the limb (amputation). Today, this is rarely necessary. Still, patients should work together with their physician to choose among several treatment options that may be used alone or in combination, and understand the risks and benefits of each.
In order to cure bone cancer it must be completely removed—even from areas where it has spread—so surgery is the primary treatment. The goal is to remove all of the cancer as well as some of the surrounding tissue so that it can be examined for any traces of cancer cells. Adjunct therapies may be necessary in cases where the tumor cannot be completely removed surgically.
Limb-Salvage Surgery While it requires special expertise on the part of the surgeon, “limb-salvage” surgery leaves the patient with as much of the working limb as possible. Removed bone is replaced with bone grafts from donors, or rods made of metal or other material. Problems with this approach can include infection and grafts or support rods that become loose or broken. Patients may also need additional surgery or amputation.
Amputation For arms and legs, full amputation may be necessary to remove all of the cancer, but in most cases this is not necessary.
In this procedure, the tumor is cut from the bone, leaving behind a hole. Curretage is often followed by cryosurgery, a therapy in which liquid nitrogen is poured into the hole to freeze and kill any remaining cancer cells. The hole is then filled with bone grafts or surgical bone cement called PMMA. The heat given off by PMMA as it cures also helps kill any remaining cancer cells.
Chemotherapy (also called “chemo”) employs oral or injected drugs to kill cancer cells. These drugs enter the bloodstream and travel throughout the body, making the treatment useful for cancers that have spread to distant organs. Except for Ewing sarcoma and osteosarcoma, chemotherapy is seldom used for bone cancer unless it has spread.
Because chemo kills some normal cells in addition to malignant ones, it can cause side effects that vary depending on the type of drug used. These include, but are not limited to, fatigue, nausea, vomiting, loss of appetite, hair loss, mouth sores, changes in menstrual cycle and infertility. It can also cause low white blood cell and platelet counts resulting in higher risk of infection and easy bruising/bleeding. Most side effects cease once treatment stops. Chemotherapy is typically given in cycles with rest periods in-between.
Radiation therapy uses various forms of radiation to kill or shrink cancer cells. It is not as widely used as a primary treatment for bone cancer as bone cancers are not easily killed by this method. Instead, radiation is helpful as an adjunct therapy to shrink tumors before surgery or to destroy remaining cancer cells when tumors cannot be completely removed by surgery. It is also helpful in controlling symptoms such as pain and swelling when surgery is not an option. Side effects are usually limited to irritation around the radiation site, although many patients also report fatigue.
External-Beam Radiation Therapy Much like a traditional x-ray, radiation beams are focused on the affected area from outside the body. This outpatient treatment is typically administered five days a week for a defined number of weeks, depending on the size, location and type of cancer and the goals of treatment. This allows enough radiation to get into the body to kill the cancer while giving healthy cells time each day to recover. Radiation treatment takes only minutes and is usually painless, but it can ultimately cause damage to nearby, healthy tissue.
Intensity Modulated Radiation Therapy (IMRT) and Image-Guided Radiation Therapy (IGRT) IMRT/IGRT are rapidly replacing traditional external-beam radiation therapy for treating certain cancers. These methods deliver higher radiation doses more precisely to cancerous tumors while avoiding healthy tissue. With IMRT/IGRT, physicians may be able to treat some bone cancers for which radiation therapy previously was not an option. They can also potentially shorten the duration of therapy. Like traditional radiation, IMRT/IGRT for bone cancer is used in conjunction with, or following another primary treatment, typically surgery.