For people with primary bone cancer, surgery to remove the tumor may be necessary. Bone cancer patients could also get chemotherapy prior to surgery, to help shrink the tumor to a more manageable size for removal, or after surgery, to help destroy any remaining cancer cells.

Bone Cancer: Surgery to Remove the Tumor

Most bone cancer attack the long bones of the arms and legs, so surgery can be tricky. The goal is to remove the tumor while saving the limb, if possible.

In bone cancer surgery, the surgeon removes the entire tumor along with a portion of healthy tissue around the tumor’s edge, to make sure all the cancer cells are removed. This process is known as wide excision. Afterwards, a pathologist will examine the removed tissue to see if the outer edges contain any cancer cells. A wide excision with cancer-free margins means there's less risk the cancer will recur at that spot.

Doctors sometimes must amputate a limb to perform a good wide excision. However, advances in surgical techniques, and the practice of using chemotherapy before the surgery, have reduced the need for amputation: Today, 90 percent of patients with a bone cancer tumor in an arm or leg won’t lose that limb.

Bone Cancer Surgery: Limb-Sparing Surgery

Here, surgeons attempt to remove all the cancer but still leave the limb in working order. The surgery is incredibly complex, as surgeons must remove all of the cancer in the bone while preserving nearby tendons, nerves, arteries, and veins.

Surgeons perform a wide excision to remove the bony tumor and then replace the removed bone with either a bone graft or an endoprosthesis, which is a prosthetic device that is placed inside the body.

  • Bone graft. A graft can be bone taken from elsewhere in the patient's body or frozen bone donated by another person. The bone is shaped to fit the gap left by the removed portion, and held in place with pins, plates, or screws.
  • Endoprostheses. These are artificial supports made of metal or other materials that take the place of bone inside the body. Since bone cancers mainly target children, some of these internal prostheses are adjustable so they can be made longer as the child grows.

Bone Cancer Surgery: Amputation

Sometimes limb-sparing surgery cannot be performed and the patient will have to have an amputation to remove the cancer. Amputation surgery involves the removal of part or all of an arm or leg. This used to be the main way to treat bone cancers found in the limbs, but now amputation is performed only if a reason exists not to save the limb. It may be necessary when the patient has a large tumor or when the cancer has spread to surrounding essential nerves, blood vessels, or muscles that cannot be removed. The surgeon will remove the part of the limb with the tumor, along with some healthy tissue above it.

During amputations, doctors take the remaining muscles and skin and form a cuff around the amputated bone. The cuff is made so that it can later fit snugly into an artificial limb.

Bone Cancer Surgery: Rehabilitation

Patients who have limb-sparing surgery undergo a much longer and more intense rehabilitation than those who have amputations. For example, people who undergo limb-sparing surgery involving a leg take an average of a year to learn to walk again. Patients who have a leg amputated are normally walking within three to six months. The good news is that studies have shown that patients can expect to have a good quality of life after either type of surgery.