Bone Cancer Treatment Options and Their Side Effects

  • Medical Author:
    Jason C. Eck, DO, MS

    Dr. Eck received a Bachelor of Science degree from the Catholic University of America in Biomedical Engineering, followed by a Master of Science degree in Biomedical Engineering from Marquette University. Following this he worked as a research engineer conducting spine biomechanics research. He then attended medical school at University of Health Sciences. He is board eligible in orthopaedic surgery.

  • Medical Author: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

What is the treatment for bone cancer?

There are many different methods available for your doctor to treat bone cancer. The best treatment is based on the type of bone cancer, the location of the cancer, how aggressive the cancer is, and whether or not the cancer has invaded surrounding tissues or has spread to distant tissues (metastasized). There are three main types of treatment for bone cancer:

These can be used either individually or combined with each other. Treatment of bone cancer usually involves a multidisciplinary team approach in which specialists from all three disciplines meet and arrive at a treatment plan for the patient with primary bone cancer.

Surgery is often used to treat bone cancer. The goal of surgery is usually to remove the entire tumor and a surrounding area of normal bone. After the tumor has been removed, a pathologist examines it to determine if there is normal bone completely surrounding the tumor. If a portion of the cancer is left behind, it can continue to grow and spread, requiring further treatment. If the tumor specimen has normal cells completely surrounding it, there is a much better chance that the entire tumor has been removed and less chance for recurrence. Historically, amputations were frequently used to remove bone cancer. Newer techniques have decreased the need for amputation. In many cases, the tumor can be removed with a rim of normal bone without the need for an amputation. Depending on the amount of bone removed, the surgeon will replace something in its location. For smaller areas, this may be either bone cement or a bone graft from another place in your body or from the bone bank. For larger areas, the surgeon may place larger grafts from the bone bank or metal implants. Some of these metal implants have the ability to lengthen when used in growing children.

You may be referred to a medical oncologist for chemotherapy. This is the use of various medications used to try to kill or at least stop the growth of the cancer cells. Chemotherapy can be used prior to surgery to try to shrink the bone tumor to make surgery easier. It can also be used after surgery to try to kill any remaining cancer cells left following surgery.

You could also be referred to a radiation oncologist for radiation therapy. The radiation therapy uses high-energy X-ray aimed at the site of the cancer to try to kill the cancer cells. This treatment is given in small doses daily over a period of days to months. As with chemotherapy, radiation therapy can be used either before or after a potential surgery, depending on the specific type of cancer.

What are the side effects of treatment for bone cancer?

Unfortunately, there are risks and side effects with each of the treatments for bone cancer. The main risks associated with surgery include infection, recurrence of the cancer, and injury to the surrounding tissues. In order to remove the entire cancer and reduce the risk of recurrence, some surrounding normal tissue must also be removed. Depending on the location of the cancer, this may require the removal of portions of bone, muscle, nerves, or blood vessels. This could cause weakness, loss of sensation, and the risk of fracture of the remaining bone. You could be referred to a rehabilitation specialist for physical and occupational therapy after surgery to try to improve your strength and function.

Chemotherapy uses very powerful medication to try to kill cancer cells. Unfortunately, some normal cells are also killed in the process. The medications are designed to kill rapidly dividing or growing cells. The normal cells that are affected often include hair, blood-forming cells, and cells lining the digestive system. Side effects include nausea and vomiting, loss of hair, infection, and fatigue. Fortunately, these side effects are better controlled today than they were in the past, but some may be unavoidable. The side effects usually resolve after the chemotherapy is over. Good nutrition is important for your body to fight the cancer. You may be referred to nutrition specialist to help with this, especially if you experience nausea and loss of appetite.

The main side effects from radiation therapy include fatigue, loss of appetite, and damage to the surrounding skin and soft tissues. Prior radiation therapy can also increase the risk of wound problems from surgery in the same area.

Children receiving treatment for bone cancer may have a higher risk of other cancer problems in the future including leukemia, and regular follow-up after treatment for bone cancer survivors is warranted.

What does the future hold for patients with bone cancer?

There has been much recent advancement in the understanding and treatment of bone cancer. These developments have led to more focused radiation therapy techniques to reduce the risk to surrounding tissues, better combinations of chemotherapy with less risk and side effects, and improved treatment options, including limb-salvaging surgery, that decrease the need for amputation.

Clinical trials investigating these new techniquesm as well as new types of treatment for bone cancer are ongoing. Patients with primary bone cancers should ask their doctors if they may be eligible to participate in such trials.

There is currently much work being conducted in each of these areas as well as investigations into the causes of cancer. It is hoped that a better understanding of the specific causes of cancer will lead to newer techniques to target specific cancer cells with limited risk to other normal cells.

Can bone cancer be prevented?

No. There is no method of preventing bone cancer.

Medically reviewed by American Board of Internal Medicine with subspecialty in Medical Oncology

REFERENCES:

Bone tumors: Diagnosis and biopsy techniques. UptoDate.com

Osteosarcoma: Epidemiology, pathogenesis, clinical presentation, diagnosis, and histology. UptoDate.com

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Reviewed on 2/2/2017 12:00:00 AM