Understanding Bone Cancer: Surgery
The main treatment for most bone cancers is surgery. Surgery is also needed to obtain a biopsy of the cancer. The biopsy and the surgical treatment are separate operations. However, it’s important that they be planned together. It’s best for the same surgeon to do both.
The main goal of surgery is to remove all of the cancer. Leaving even a few cancer cells behind means they can grow and multiply to form a new tumor. To make sure this doesn’t happen, your surgeon will remove the tumor plus some normal-looking tissue surrounding it. This procedure is called wide-excision.
After surgery, a pathologist will look at the tissue that was removed. He or she will be checking the margins or outer edges of the tissue. If the margins are:
- Positive: that means there are still cancer cells visible on the tissue edges.
- Negative: No cancer cells are visible.
A wide-excision with negative margins reduces your risk of having the cancer grow back.
Tumors in the arms or legs
Sometimes an entire arm or leg needs to be removed in order to do a good wide-excision. This surgery is known as an amputation. The good news is that usually a surgeon can remove the cancer without amputation. This is called limb-salvage or limb-sparing surgery.
When your doctor discusses your treatment options with you, he or she will point out the advantages or disadvantages that go along with each type of surgery. Limb-salvage may seem more acceptable than amputation. However, it is a more complex surgery and can have more complications. Amputation can impact many aspects of your life. Just realize there are options and rely on your medical team to help you think through them.
Regardless of which type of surgery you have, rehabilitation will be needed afterward. Try to meet with a rehabilitation specialist before the surgery. This will help you understand what will be involved in rehabilitation.
Amputation: Amputation is surgery to remove part or all of an arm or leg. The surgeon removes the part of the limb with the tumor. He or she will remove everything below it and some healthy tissue above it. In the past, amputation was the only surgical option for bone cancers of the arms or legs. Now, it is only a last resort if limb-salvage surgery is not possible. For instance, sometimes removing all of the cancer requires removing important nerves, arteries or muscles that make the limb functional.
The pathologists tissue analysis and MRI scans will help the surgeon decide how much of the arm or leg needs to be removed. The surgery will be performed so that muscles and skin will form a cuff around the amputated bone. This cuff fits into the end of an artificial limb. This is called a prosthesis. Part of rehabilitation is learning to use the prosthesis. Most patients are walking again 3 to 6 months after leg amputation.
Limb-salvage surgery: Limb-salvage surgery is designed to remove all of the cancer and leave the patient with a working leg (or arm). The good news is that over 90% of patients with bone cancer in a limb are able to have their limb spared. This type of surgery is complex and requires surgeons with special skills and experience.
In this type of surgery, a wide-excision is done to remove the tumor. A bone graft or an endoprosthesis (meaning internal prosthesis) is used to replace the bone that is lost. Endoprostheses are made of metal and other materials. They can be used in growing children, by being made longer. This allows them to “grow” as the child grows.
You may need more surgery if the bone graft or endoprosthesis becomes infected, loose, or broken.
It may be surprising to learn that rehabilitation is more intense after limb-salvage surgery than after amputation. Most patients take a year to learn to walk again after salvaging a leg.
Tumors in other areas
Bone cancer in other areas may be more difficult to treat, especially if the tumor is close to vital organs or structures. If a wide-excision can be made, bone grafts may be used to rebuild or replace the bone. In some caces, tumors in these bones require a combination of treatments such as curettage, cryosurgery, and radiation.
Curettage: In this procedure the tumor is scooped out of the bone. This leaves a hole in the bone. In some cases, the surgeon will treat the nearby bone tissue to kill any remaining tumor cells. This can be done with cryosurgery or by using bone cement.
Cryosurgery: In this procedure, liquid nitrogen is poured into the hole that is left in the bone after the tumor was removed. This extremely cold material kills tumor cells by freezing them. This treatment is also called cryotherapy. After cryosurgery, the hole in the bone can be filled by bone grafts or bone cement.
Bone cement: Bone cement starts out as a liquid and hardens over time. It can be put into a hole in the bone in liquid form. As this substance hardens, it gives off heat. The heat helps kill any remaining tumor cells. This allows it to be used without cryosurgery for some types of bone tumors.