Types of surgery for bone cancer

Surgery is one of the main treatments for primary bone cancers. There are different types of surgery and the following is a list of the main types:

• limb sparing surgery 
• removal of a limb (amputation)
• surgery to remove secondary cancer (metastasectomy)

This page is about cancer that starts in your bone (primary bone cancer). If your cancer has spread into bone from another part of the body, it is called secondary or metastatic bone cancer.

Deciding on your treatment

Surgery for primary bone cancer is a very specialised treatment. You have your operation at a specialist centre. The bone surgeons (orthopaedic surgeons) are very experienced and have been trained in this type of surgery. You may need a team of surgeons depending on what you need.

Other health professionals are also involved in your care (a multidisciplinary team). They support you before and after the surgery. 

The operation you have depends on:

• the size of your cancer
• where the primary bone tumour is
• whether it has grown into nearby tissues, or has spread elsewhere in the body

For most bone tumours, the surgery will also depend on how well your cancer responds to chemotherapy. After chemotherapy to shrink some types of bone cancer, you might be able to have limb sparing surgery instead of surgery to remove your limb (amputation).

Types of bone cancer surgery

The aim of surgery is to completely remove the tumour.

Sometimes cancer is in a bone or part of a bone that the surgeon can remove and don't have to replace. These are called expendable bones because they do not need to be replaced (reconstruction) and there is no or little loss of function. These types of bones include a rib or the thin bone in the calf (fibula). So the surgeon removes the bone or part of it along with the cancer.

Limb sparing surgery

Most primary bone cancers are in the arms or legs. Limb sparing surgery is the main operation for these cancers. This means removing the cancer without removing the affected arm or leg. It is also sometimes called limb salvage surgery. 

The surgeon removes the area of bone containing the cancer and may replace it with a:

• metal implant called a prosthesis 
• replacement bone either from another part of the body or from a bone bank

In some cases the affected bone is taken out, treated with radiotherapy and then put back into the body.

Removal of the limb (amputation)

It can be devastating news to be told you must lose an arm or leg. But you may need the operation to try to cure the cancer.

You might need an amputation if the bone tumour has spread into the tissues surrounding the bone, and is affecting the blood vessels or nerves. It may be that if your surgeon only removes the tumour, there is a very high risk of the cancer coming back. Or the tumour may be in a place where the function of the limb wouldn't be very good after limb sparing surgery, such as in the foot or ankle.

After the surgery, a specialist in false limbs (prosthetic limbs) will fit you with a prosthesis made specially for you. The limb specialist and the specialist physiotherapists will make sure you have all the help you need to learn to cope with your prosthesis. The effect an amputation has will depend on how much of the limb has to be removed.

Surgery if cancer has spread or come back

You might have surgery for primary bone cancer that has already spread when you are diagnosed. Or, you might have surgery if the cancer comes back in your lungs or bones. When cancer spreads it is called secondary cancer. 

Surgery to remove secondary cancer is called a metastasectomy. You most often have this for secondary cancer in the lungs. It is more common to have this surgery for osteosarcoma than for other types of bone cancer.

If the cancer is too widespread, surgery may not be possible. But you can have chemotherapy to shrink the tumours. If you have had chemotherapy before, the lung tumours may not respond to the drugs you have already had. So you may have different chemotherapy drugs.

After surgery

Your recovery depends on the type of surgery you have. You will need to spend time in the hospital at first.

Your surgeon will give the nurses and physiotherapists very detailed instructions about your recovery. This includes when you can get up out of bed after surgery and how you can use the area operated on.

The physiotherapist creates an individual plan for you to follow. At first this can seem like very hard work and feels like a long road ahead. Following the plan helps you to gain the best possible function to the operated area.

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