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Treatment of bone tumours

Xrays of upper arm. Left panel shows a malignant bone tumour (red arrowed) of the distal humerus and right panel shows the surgical prothesis that has replaced the diseased bone.
Xrays of upper arm. Left panel shows a malignant bone tumour (red arrowed) of the distal humerus and right panel shows the surgical prothesis that has replaced the diseased bone.
Treatment of early bone tumours depends heavily on the expert input of several groups of experts.

 

Where the tumours can be surgically removed, then expert orthopaedic input is required and any operation may be attended by the immediate placement of a prosthetic implant (see figure).

 

However, it may not be best to go straight to operation. Often and for both Ewing's sarcoma and osteogenic sarcoma - for which there is no evidence of spread, primary therapy is with chemotherapy.  The drugs are given intravenously, which immplies  that they circulate around the body and not only shrink down the original/primary tumour but also knock out early spread of microscopic cells that could otherwise later clone in other body areas to become established metastases.

 

For both osteogenic sarcoma and Ewings sarcoma, a several month programme of chemotherapy precedes any surgery. In many cases, cancers that had grown beyond the confines of the bone can be shrunk back into the bone by such chemotherapy and the subsequent operation then has a better chance of obtaining clear margins (i.e getting that highly desirable buffer of uninvolved tissue between the cancer and the cut margin). Any cancer cells (that might have travelled away from the primary bone cancer) are also attacked at an early stage of their development (and hopefully annihilated).

 

The operation is often able (as shown in the figure) to place a prosthesis where the bone tumour was, so that the patient has a return to function of the limb. However, sometimes, the tumour is just too extensive and large to allow the approaches just outlined, and the patient may have to undergo a limb amputation.

 

Radiotherapy has a selected place when it is not possible to resect (cut out) the tumour completely, for example in the vertebral column (where it is less easy to fully resect the tumour).


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