Bone Cancer Surgery

Bone Cancer Surgery is the surgical removal of the tumor in the bone by an experienced orthopedic surgeon.

April 23, 2022

Bone Cancer Surgery is the surgical removal of the tumor in the bone by an experienced orthopedic surgeon.

Some facts about Bone Cancer Surgery:

Noncancerous bone tumors are more common than cancerous ones.
Bone cancer most commonly affects the pelvis or the long bones in the arms and legs. But, it can begin in any bone in the body.
Surgery, chemotherapy or radiation therapy can be done based on the type of bone cancer being treated.
Bone pain, swelling and tenderness near the affected area, weakened bone, leading to fracture, fatigue and unintended weight loss are some of the symptoms of bone cancer.
Based on the type of cell where the cancer began, Bone Cancer can be Osteosarcoma, Chondrosarcoma or Ewing sarcoma.
The main purpose of surgery is to remove all of the cancer.
It might grow and make a new tumor, and might even spread to other parts of the body even if a small amount of cancer is left behind.
The tumor will be removed along with some of the normal tissue around it to lower the risk of leaving behind any part of tumor. This is known as a wide excision.

Types of Bone Cancer Surgery:

  • The type of Bone Cancer surgery done depends mainly on the location and size of the tumor.
  • Tumors in the arms or legs are generally easy to remove compared to those in the jaw bone, at the base of the skull, in the spine, or in the pelvic bone.
  • Tumors in the arms or legs can be treated with either Limb-salvage (limb-sparing) surgery or Amputation.
  • Cancer and some surrounding normal tissue will be removed leaving the limb basically intact in Limb-salvage (limb-sparing) surgery.
  • the cancer and all or part of an arm or leg will be removed in Amputation.
  • Limb-salvage is more complex operation and can have more complications than Amputation.
  • Limb-salvage surgery is done for most people with arm or leg tumors. But this also depends on the location, size of the tumor and if it has spread into nearby structures.
  • All of the cancer can be removed leaving a working leg or arm in limb-salvage surgery. The nearby tendons, nerves and blood vessels will be saved to keep as much of the function and appearance of the limb as possible.
  • These structures need to be removed along with the tumor if the cancer has grown.
  • The part of bone that is removed along with the tumor will be replaced with a bone graft which can be a piece of bone from another part of the body or from another person.
  • A device made of metal and other materials known as endoprosthesis or internal prosthesis can also be used to replace part or all of a bone.
  • A graft and a prosthesis is combined in some newer devices.
  • Infections and grafts or rods that become loose or broken are the complications of limb-salvage surgery.
  • Amputation of part or all of a limb is the best option for some patients if the tumor is very large or if it has grown into important nerves and/or blood vessels.
  • The portion of arm or leg needs to be amputated will be determined by the surgeon based on the results of MRI scans and examination of removed tissue by the pathologist at the time of surgery.
  • Cuff around the amputated bone will be formed which fits into the end of an artificial limb (external prosthesis).
  • A prosthesis can also be implanted into the remaining bone, the end of which remains outside the skin which can then be attached to an external prosthesis.
  • Tumors in the pelvic (hip) bones can be treated with chemotherapy first to help shrink the cancer to make the operation easier as it is hard to remove the tumor completely with surgery.
  • The entire lower half of the jaw will be removed and replaced with bone from other parts of the body for tumors in the lower jaw bone. Radiation therapy may be used as well if all of the tumor is not possible to remove by the surgeon.
  • It might not be possible to remove all of the tumor safely for tumors in areas like the spine or the skull. A combination of treatments such as curettage, cryosurgery and radiation is required for cancers in these bones.
  • It might not be possible to reconstruct the joint, after the removal of a tumor that involves a joint. Surgery might be done to fuse the two bones together in this case.
  • Joint fusion or arthrodesis can be used for tumors in the spine, shoulder or hip. It can help stabilize the joint, but may results in loss of motion.
  • The tumor will be scraped out with a sharp instrument called a curette without removing a section of the bone for some types of bone tumors that are less likely to spread or to come back after treatment. It leaves a hole in the bone.
  • The nearby bone tissue might be treated with other techniques such as chemicals or extreme cold (cryosurgery) after as much of the tumor is removed as possible by the surgeon in order to try killing any remaining tumor cells.
  • The bone cement PMMA (polymethylmethacrylate) which can be used as a liquid that hardens over time can be put into the hole after curettage. It might help kill any remaining tumor cells as it gives off a lot of heat when it hardens.
  • The tumors need to be removed if bone cancer has spread to other parts of the body, to have a chance at curing the cancer.
  • It most often goes to the lungs when bone cancer spread. The surgery must be planned very carefully if surgery can be done to remove these metastases.
  • The number of tumors, where they are located as in one or both lungs, their size, and the overall health of the person has to be considered before surgery.
  • Generally, the surgeon will have a treatment plan ready in case more tumors are found during the operation as imaging tests such as a chest CT scan might not show all of the tumors.