Surgical removal of the tumor is the mainstay of treatment for bone cancers. Improved surgical techniques allow for most bone cancers to be removed without requiring amputation of an affected limb. However, reconstructive surgery is often done in addition to tumor removal in order to maximize function.
For most types of bone cancers, chemotherapy drugs are given in addition to surgery. One exception is chondrosarcoma, which is typically not treated with chemotherapy. Radiation therapy is often used for chondrosarcomas and for Ewing sarcomas.
Ewing sarcomas that do not respond well to other treatments are sometimes treated with high-dose chemotherapy followed by a stem cell transplant. In this procedure, the patient's stem cells (blood cells that have the potential to make all the different kinds of blood cells) are harvested from the bloodstream in a way similar to a blood donation. After high doses of chemotherapy medications to destroy the bone marrow, the harvested stem cells are returned to the body as with a blood transfusion. Over the next three to four weeks, the stem cells produce new blood cells from the bone marrow.
How is bone cancer pain managed?
The pain of bone cancer is medically treated with analgesic (pain-relieving medications). These may be nonprescription or prescription medications. Mild-to-moderate pain is treated with medications such as acetaminophen (Tylenol) or nonsteroidal anti-inflammatory medications (NSAIDs), including ibuprofen and naproxen. However, people taking anticancer chemotherapy drugs may need to avoid the use of NSAIDs due to the increased risk of bleeding.
Prescription medications may be used for moderate-to-severe cancer pain. Opioids -- stronger narcotic pain medications -- like codeine, morphine, oxycodone (Oxycontin), hydromorphone (Dilaudid), and fentanyl may be required to control severe pain. Sometimes a combination of medications is used to treat cancer pain. Opioid medications can be associated with side effects like drowsiness, constipation, and nausea.
What is the prognosis for bone cancer?
The prognosis, or outlook, for bone cancer depends upon the particular type of cancer and the extent to which it has spread. The overall five-year survival rate for all bone cancers in adults and children is about 70%. Chondrosarcomas in adults have an overall five-year survival rate of about 80%.
The five-year survival rate specifically for localized osteosarcomas is about 60%-80%. If metastases are present, meaning that the cancer has spread beyond bone, the survival rate is about 15%-30%, but there are factors that may affect the prognosis. Osteosarcomas tend to have a more favorable prognosis if they are located in an arm or leg, respond well to chemotherapy, and are able to be completely removed at surgery. Younger patients and females also tend to have a more favorable prognosis than males or older patients.
Ewing sarcomas have a five-year survival rate of about 70% when they are found in a localized stage. If they have spread to other sites (metastasized), the survival rate drops to 15%-30%. Certain factors have been associated with a more favorable prognosis for Ewing sarcomas, including smaller tumor size, patient age less than 10, having a tumor in an arm or leg (in contrast to a tumor in the pelvis or chest wall), and having a good response to chemotherapy drugs.