Understanding Bone Cancer: Explore Your Options

If you’ve been diagnosed with bone cancer, it’s important to explore all options related to bone cancer treatment. Below, learn what’s next, what questions to ask the doctor, and what treatments are available.

Finding an Oncologist

The first step on the bone cancer treatment journey is to find an oncologist (medical or surgical) who inspires trust. It may seem overwhelming to choose an oncologist. First, start with referrals from your primary care physician, specialist, or insurance carrier. Talk to family and friends who may have recommendations.  

Here are some things to consider when choosing an oncologist:

  • Is the oncologist board certified?
  • How much experience does he or she have in treating bone cancer?
  • Do you feel comfortable talking with this doctor? Does he or she listen well?
  • Is the staff compassionate? Is the environment a good one or do you feel rushed?
  • What hospital(s) does this oncologist see patients in?
  • What are the office hours?
  • What if you have an emergency? Can you call?
  • Can this doctor be contacted after hours?

You will be spending a lot of time with the oncologist and staff nurses and technicians, so it’s important to feel comfortable with them. 

As you and your doctor explore the treatment options open to you, make sure you find out the answers to the following:

  • What are the chances my cancer will come back after this treatment?
  • What do we do if the cancer comes back or the treatment doesn’t work?
  • ·Will I lose my hair?
  • Will it hurt?
  • Will there be scars? 

Choosing a Cancer Center

Choosing where to receive treatment is just as important as selecting an oncologist. It’s good to know the differences between hospitals. Here are some guidelines:

  • Academic cancer centers: These are affiliated with medical schools. At these locations, high priority is put on research. They are usually located in large cities.
  • Community cancer centers: The main focus is on patient care. 
  • Cancer centers: These are noted for a high quality of science and research.

Some questions to ask before choosing where to get your treatment include:

  • Volume: How many bone cancer surgeries does the surgeon do annually?
  • Travel: How far do you want to travel? Would there be extra costs?
  • Cost: Is the hospital covered by your insurance plan?
  • Accreditations: What accreditations does the hospital hold? 

Treatment Options

It’s helpful to understand the possible treatments for bone cancer. Following are overviews of the most common treatments. Reading these should help you know what to expect, what the potential side effects are, and what the advantages are to each.  

The main types of treatment for bone cancer are:

Often, more than one type of treatment is necessary.

What You Need to Know About Specific Bone Cancer Treatments

Where bone cancer is concerned, there is not one treatment that fits all bone cancers. Specific bone cancers require their own certain treatment.

Chondrosarcomas

Once a biopsy has confirmed the diagnosis, surgery removes the tumor. If the chondrosarcoma is low-grade and in an arm or leg, it may be treated with curettage with cryotherapy. If the tumor is high-grade, limb-sparing surgery will be done if possible. Sometimes amputation is needed to completely remove the cancer. If the chondrosarcoma has spread to the lung and there are only a few metastases, they may be removed surgically.

Chondrosarcomas in the skull are hard to treat. It is hard to completely remove them all. Some low-grade tumors are treated with curettage and cryosurgery. You may also be treated with radiation therapy. Chondrosarcomas are resistant to radiation. This means that high doses are required. Proton-beam radiation works well for these tumors.

Chemotherapy (chemo) is not typically used to treat chondrosarcoma. However, it is sometimes used together with another treatment like surgery.

Malignant fibrous histiocytomas (MFH)

You will first be given chemotherapy to shrink the tumor. Then a wide-resection is done to remove the tumor. Then the bone may be reconstructed with a bone graft or a prosthesis (metallic rod). Amputation is rarely needed. In some cases, chemotherapy is also given after surgery.

Fibrosarcomas

Surgery is the main treatment for this kind of cancer. The goal is to remove the tumor as well as a margin of normal bone. If your doctor suspects that some cancer has been left behind, he or she will recommend radiation after surgery. If the tumor cannot be completely removed with surgery, radiation therapy may be used. Radiation is also used if a fibrosarcoma returns after surgery.

Giant cell tumors of bone

These are treated mainly with surgery. The type of surgery depends on the size and location of the tumor. One option is to remove the part of the bone affected by the tumor. It is replaced with a bone graft or prosthesis (such as a metal rod). This approach is very effective if it can be done without:

  • Causing damage to nearby tissues.
  • Affecting the movement of the arm or leg.

Another option for giant cell tumors is curettage followed by cryosurgery. The defect (hole) in the bone can then be filled in with bone cement or a bone graft. Radiation therapy may sometimes be used if surgery is difficult to do without hurting nearby sensitive tissues − such as the skull and the spine. Radiation is not often used to treat giant cell tumors.

Amputation is rarely needed to treat a giant cell tumor.

The most common site for a giant cell bone tumor to spread is the lung. If there are only a few metastatic tumors in the lung, it may be possible to remove them surgically. Metastases can also be treated by radiation.

Chordomas

This primary bone tumor usually occurs in the base of your skull or the bones of your spine. It is not always possible to remove the tumor completely with surgery. This s because the spinal cord and nerves nearby may be involved. Radiation after surgery reduces the change the tumor will grow back. Proton-beam radiation, either alone or with intensity-modulated radiation therapy, is often used. Imatinib (Gleevec) is often used for a chordoma that has spread widely. It rarely shrinks the tumors, but can often stop them from growing for a while. Chemo is not usually effective with chordomas. Chordomas can come back, even 10 or more years after treatment, so long-term follow-up is important.

Questions to Ask Your Doctor

  • What kind of bone cancer do I have?
  • Has my cancer spread beyond the primary site?
  • What is the stage of my cancer?
  • What treatment choices do I have?
  • Do you think I will have to have an amputation?
  • What kind of rehabilitation can I expect?
  • What do you recommend and why?
  • What risks or side effects are there to the treatments you suggest?
  • What are the chances of my cancer coming back with these treatment plans?
  • What should I do to be ready for treatment?
  • Based on what you've learned about my cancer, how long do you think I'll survive?

When you first meet with your doctor, it can be helpful to bring someone else with you. That way, there’s someone else to hear what is said and to ask questions. Here are some other tips for talking with your doctor:

  • Write out your questions ahead of time.
  • Write down the answers your doctor gives you.
  • If you don’t understand something, ask your doctor to say it in a different way. It’s important that you understand, and you have a right to know. 

Back to “Understanding Bone Cancer: An Introduction”