Primary Bone Cancer: Surgery
Surgery is part of the main treatment for most primary bone cancers (cancers that start in the bones). Your doctor will try to remove the tumor without affecting your appearance. If the tumor is in your arm or leg (limb), your doctor will also try to remove the tumor without affecting limb function.
You may be treated with chemotherapy, radiation therapy, or both to shrink the tumor before surgery. This might allow the surgeon to do a less extensive operation.
Types of surgery for bone cancer
Many types of surgery can be used to treat bone cancers. The type of surgery you have depends on the location and stage (extent) of the tumor, your overall health, and other factors.
Surgery for tumors in an arm or leg
Limb-sparing or limb-salvage surgery. This is the most common surgery for a bone tumor in an arm or leg. The goal is to remove the tumor and some of the normal tissue around it, while still having the arm or leg look and function as normal as possible. The part of bone that is removed along with the tumor is replaced. It may be replaced with a bone graft, an internal metal rod (prosthesis), or a combination of a bone graft and metal rod. A bone graft can be taken from another part of your body. Or it might be a donated bone from another person.
Limb amputation. In some cases the surgeon may not think the tumor can be removed completely while saving the limb. Then surgery to remove the limb, called an amputation, might be needed. The surgeon will remove the limb and some normal tissue above the level of the tumor. You will then be fitted with an artificial limb, called a prosthesis (see below).
Rotationplasty. In special cases where the tumor is in the thigh bone or around the knee, you may need surgery called a rotationplasty. In this surgery, the tumor is removed. Then the lower part of the leg is rotated halfway around (180 degrees) and attached to the upper part of the leg. This means that your ankle becomes your new knee joint. An external prosthesis is then used to replace the lower part of your leg. This surgery sounds strange, but it can allow you to still be able to walk. In very rare cases, a surgery like this is done for arm tumors. You will have a shorter arm, but still be able to keep your hand.
Surgery for tumors in other parts of the body
If the cancer is in your lower jaw, the surgeon can remove the part of your jaw where the tumor was located. Then, the surgeon will replace it with bones from other parts of your body.
Surgery to treat bone tumors in other parts of the body, such as the hip (pelvic) bones, are complex, but can sometimes be done.
If the cancer has spread to other parts of the body, such as the lungs, these tumors need to be removed to have a chance at curing the cancer. These types of surgeries are complex and need to be planned carefully.
Possible risks, complications, and side effects of surgery
All surgery has risks. Some of the risks of any major surgery include:
Reactions to anesthesia
Too much bleeding
Blood clots in the legs or lungs
Damage to nearby organs
Risks from bone cancer surgery
Along with the risks above, bone cancer surgery can sometimes cause these problems:
Pain. The pain will often be at the incision site. If you have had part or all of a limb amputated, you may have feelings that seem to come from the amputated limb. This is normal and expected. It is called phantom sensation. At first, it may be painful. Usually, the painful feeling fades over time. The sensation of the amputated limb remains, though.
Infection. Infections are uncommon after surgery, but they can occur. Often, they will happen 1 or 2 weeks after surgery. Tell your surgeon if you have increasing pain at your surgical site, a fever that doesn’t go away, or drainage from your incision more than 2 weeks after surgery. Also tell your surgeon if you have swelling and redness at the incision.
Problems with wound healing. Sometimes radiation, chemotherapy, or both, can delay wound healing. The surgical incision may open. You may need special bandage changes. Or you may need plastic surgery with a muscle flap or skin graft to help close the wound.
Constipation. You may have trouble having a bowel movement. This can be caused by using opioid painkillers, not moving much, or not eating much. If you have trouble having a bowel movement, tell your doctor so you can be treated.
Broken grafts or rods. If you have had limb-sparing surgery with a graft (bone transplant) or prosthesis (metal bone and joint), it can break or become loose. Breakage is rare during the first year after surgery. It occurs more often after 5 to 10 years. It can sometimes be linked to lack of healing.
Even with these possible problems, the benefits of removing a tumor usually outweigh the risks.
Getting ready for your surgery
Before you go for surgery, you will meet with your surgeon to talk about the procedure. At this time, you can ask any questions and discuss any concerns you may have. After you have discussed all the details with the surgeon, you will sign a consent form that says that the doctor can do the surgery.
Your surgeon might also give you special instructions. These may include avoiding certain medicines or following a special diet in the days before your surgery.
You will also meet with the anesthesiologist. This is the provider who will give you general anesthesia, the medicine that puts you to sleep so that you won't feel any pain during surgery. He or she also monitors you during surgery to keep you safe. He or she will ask about your medical history and your medicines.
What to expect during surgery
When it is time for your surgery, you will be taken into the operating room. Your healthcare team will include the anesthesiologist, the surgeon, and several nurses.
During a typical surgery:
You will be moved onto the operating table.
Someone will place special stockings on your legs. These are to help prevent blood clots.
You will have EKG (electrocardiogram) electrodes put on your chest. These are to keep track of your heart rate. You will also have a blood pressure cuff on your arm.
You will be given anesthesia through an IV (intravenous) line into your arm or hand.
When you are asleep, the surgeon will do the surgery.
A urinary catheter will be put into your bladder during surgery.
You will also have a breathing tube placed in your windpipe (trachea). A machine called a ventilator will control your breathing.
Also, a nasogastric tube may be placed in your nose. This is a suction tube that goes into your food pipe (esophagus) and stomach to drain your stomach contents.
What is removed during surgery and where your incisions are depend on the type of surgery you have. This is based on where the tumor is.
What to expect after surgery
Each surgery is different. You should ask the surgeon and your treatment team (residents, nurse practitioners, or physician assistants) about what to expect right after surgery. In general, you may expect these things:
You will wake up in a recovery room. You will be watched closely by healthcare providers. Once you are awake and stabilized, the staff will move you to a regular hospital room.
You’ll have a large bandage that may prevent you from moving one of your limbs or joints. This will stay in place for a few days to 2 weeks.
You may have plastic drainage tubes coming out of the dressing. The nurse empties these tubes. They’ll be removed after a few days, when the drainage stops.
You’ll have pain and be on pain medicine. Medicine is usually given in a vein. You may be able to control it by pushing a button. This is called PCA (patient-controlled analgesia).
You’ll get fluids through a vein in your arm, called an IV drip. You will have this until you can eat and drink on your own. Often, you will be able to eat the day after surgery.
You’ll get antibiotics the day of surgery and sometimes for a day or 2 after surgery to prevent infection.
You may have a urinary catheter for a few days. This is a tube that drains your urine. This means you don’t have to get out of bed to urinate, or struggle to use a bedpan or urinal.
After surgery, you may need to have chemotherapy or radiation to reduce the chance that any cancer cells that are left will spread. Having another type of treatment after surgery is called adjuvant therapy. Your surgical incision must be healed before you can start any adjuvant treatment. Often, additional treatment can begin a few weeks after surgery.
The amount of time it takes to recover from surgery is different for each person. It depends on the type of surgery that was done. Most people stay in the hospital for about a week.
Before you can go home, your wound needs to look healthy. This should be about a week after your operation. But it may take months for your bone to fully heal. You also need to be able to get out of bed safely. To do that, you may need physical therapy. It's important to have rehabilitation after limb-sparing surgery. This will help you learn how to use your arm or leg and make sure it is working well.
You may have problems with the wound, or have trouble moving around. If that is the case, you may go to a rehab facility from the hospital for a short period of time before returning home.
If you had a limb-sparing surgery and needed a bone graft or internal prosthesis, you may require more surgery over time. This is often needed after 10 or 20 years, but it might be needed sooner. Over time, some people need to have the limb amputated. Children may need more surgery to lengthen the limb as the other leg or arm grows. This keeps both limbs the same length.
If you have an amputation
If you have all or part of a limb amputated, you will be fitted with an artificial limb. This is called a prosthesis. Modern technology has made artificial limbs very effective. Many people with artificial limbs can walk, run, and even play sports. It may take a few months for your final prosthesis to be made. In the meantime, you may be fitted with a short-term one, so that you can begin to get used to it. The person who makes the prosthesis is called a prosthetist. Prosthetists are specially educated and trained in designing and customizing prostheses. You will also see your prosthetist for adjustments. These might be done because of weight loss or gain, wear and tear on your prosthesis, or problems with skin irritation.
You will also see a physical therapist. He or she will show you how to do exercises to keep the muscles around the surgery site strong and flexible. These exercises will make it easier for you to use your artificial limb. The therapist will also show you how to wrap your stump (residual limb). This is important for healing and allows you to get a prosthesis sooner.
December 22, 2017
Alteri, Rick, MD,Images Reviewed by Staywell medical art team.,Levin, Mark, MD