PRIMARY BONE CANCER
( By JASCAP )

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Treating bone cancer

Treatment overview for primary bone cancer

Most people will need a combination of different treatments. The treatments used for primary bone cancer are surgery, chemotherapy and radiotherapy.

Surgery is a very important part of treatment and is used to remove the tumour in the bone.

Radiotherapy may be used as well as surgery.

If you have radiotherapy you will usually be given it after surgery or chemotherapy.

Radiotherapy is particularly effective at treating Ewingís sarcoma. And, in some situations where surgery isnít possible or would cause serious disability, radiotherapy and chemotherapy are the only treatments that are needed.

Radiotherapy is used less often to treat osteosarcoma and chondrosarcoma, but can be helpful in treating these types of bone cancer in certain circumstances.

Chemotherapy is an important treatment for osteosarcoma, Ewingís sarcoma and other high-grade bone sarcomas. It is often given both before and after surgery. When given before surgery, it may shrink large tumours enough to allow limb-sparing surgery to be carried out, so that the limb doesnít need to be removed.

Specialist treatment centres

Your treatment will be planned and given in a sarcoma treatment centre. This will either be one hospital or a group of hospitals that are close to each other and that work together. Sarcoma treatment centres (sometimes called sarcoma units) specialise in treating people with primary bone tumours and soft tissue sarcomas. Because primary bone cancer is rare there are only a small number of sarcoma treatment centres in the UK. This means you may need to travel quite a long distance to reach one.

A team of specialists, called a multidisciplinary team (MDT), will meet to discuss what treatments are best for your situation.

The specialists in the team will have expert knowledge about bone cancer and will include a:

  • Surgeon who specialises in bone cancers.
  • Radiologist (doctor who reads and interprets x-rays and scans).
  • Pathologist (doctor who examines samples from the tumour to see if it is a cancer and what type it is).
  • Medical oncologist (doctor who specialises in treating cancer with chemotherapy).
  • Clinical oncologist (doctor who specialises in treating cancer with radiotherapy and chemotherapy).
  • Paediatric oncologist (doctor who specialises in treating children with cancer).
  • Key worker, who will be your main contact and will make sure you get help and support throughout your treatment. Your key worker may be a specialist nurse or another healthcare professional such as a physiotherapist.

Other healthcare professionals who work closely with the MDT may include:

  • nurse specialists
  • physiotherapists
  • occupational therapists
  • dietitians
  • psychologists or counsellors
  • social workers.

How treatment is planned

The doctors in the MDT will meet to plan your treatment. They will take into account a number of factors. These include your age and general health, the type of bone cancer you have, where the tumour is, its size and whether it has spread.

Your doctors will discuss with you what treatments are best for your situation. If there are two treatments that could work equally well for your type and stage of cancer, they may offer you a choice. You may find you need to ask questions about what is involved with each treatment and the possible side effects before you decide.

Your cancer specialist and specialist nurse can talk you through the benefits and disadvantages of each treatment.

The benefits and disadvantages of treatment

Many people are frightened at the idea of having cancer treatments, particularly because of some of the side effects that can occur. Some people ask what would happen if they donít have treatment.

Although many of the treatments can cause side effects, these can usually be controlled with medicines. Treatment can be given for different reasons and the potential benefits will vary depending upon the individual situation.

If you have early-stage bone cancer, the aim of treatment will usually be to cure the cancer. The most common treatment is an operation to remove the tumour completely. You may also be given additional treatments to reduce the risk of the cancer coming back.

If the cancer is at a more advanced stage the treatment may only be able to control it. This may help you to live for longer or it may reduce your symptoms and improve your quality of life. But for some people the treatment doesnít work against the cancer and causes side effects without giving any benefit. If you are having treatment you will be monitored closely for signs that it is working. This is done so that if the treatment isnít helping and is only causing side effects it can be stopped.

Giving your consent

Before you have a treatment, your doctor will explain its aims to you. They will usually ask you to sign a form saying that you give your permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent, and before you are asked to sign the form you should have been given full information about:

  • the type and extent of the treatment you are advised to have
  • the advantages and disadvantages of the treatment
  • any other possible treatments that may be available
  • any significant risks or side effects of the treatment.

If you donít understand what you have been told, or if you have any questions about your treatment, don't be afraid to ask your doctor or nurse. Some cancer treatments are complex so itís not unusual for people to need repeated explanations.

Itís often good to have a relative or friend with you when the treatment is explained. They can help you to remember the discussion more fully. You may also find it useful to write down a list of questions before you go to your appointment.

If you have been offered treatment that aims to cure your cancer, deciding whether to accept the treatment may not be difficult. But, if a cure isnít possible and the aim of treatment is to control the cancer for a period of time, it may be more difficult to decide whether to go ahead with it. You can always ask for more time to decide if you feel that you canít make a decision when it is first explained to you.

If you choose not to have treatment for the cancer itís important to tell your doctor. They will record your decision in your medical notes. You can still have treatment to control symptoms. This type of treatment is called supportive or palliative care.

Second opinion

Even though a number of cancer specialists work together as a team and use national treatment guidelines to decide on the most suitable treatment, you may want another medical opinion. Either your specialist or your GP can refer you for a second opinion at any time if you feel it will be helpful. Getting a second opinion may cause a delay in your treatment, so you and your doctor need to be confident that it will give you useful information.

If you go for a second opinion, it may be helpful to take someone with you. You can also have a list of questions ready so that you can make sure your concerns are covered during the discussion.

Surgery for primary bone cancer

There have been major improvements in surgery for bone cancer over the last few years.

In the past, it was often necessary to remove (amputate) the limb if cancer was found. But now, itís usually possible just to remove the affected part of the bone and replace it with a specially designed metal fitting (endoprosthesis) or with a bone from another part of the body (bone graft). If the cancer affects a bone in or near a joint, the whole joint can be replaced with an artificial one.

These operations, called limb-sparing surgery, have made it possible for many people to avoid amputation. They are only carried out in specialist hospitals, so your doctor should refer you to one of these hospitals to see if this type of operation would be possible for you. Unfortunately, it isnít always possible to avoid an amputation.

The type of surgery you have will depend on a number of factors. Your surgeon will discuss the different types of surgery with you in detail before any decision is made about your treatment.

Surgery if the cancer has spread to the lungs

If a bone cancer spreads to the lungs it may still be possible to cure it with an operation to remove the part of the lung that is affected. This operation is called a thoracotomy. It shouldnít affect your breathing as itís possible to breathe properly if part of a lung, or even a whole lung, is removed.

When deciding whether this type of operation is possible, the surgeon will consider several factors including the number of secondary cancers in the lungs, their size and where they are in the lungs. They will also take into account your age and general health as this is a major operation.

Sometimes a course of chemotherapy is given first. This can help to shrink the cancers and may make an operation possible if the cancers are larger.

If this operation is necessary, your doctor will discuss it fully with you.

Limb-sparing surgery

Before your operation, your doctor will discuss it with you to make sure that you fully understand what is involved.

You may find it helpful to talk to someone who has had the same operation. The medical staff may be able to arrange this for you. Some hospitals have a counsellor who can help you to talk through any worries before your operation.

Some people like to see the replacement part or endoprosthesis (often just called a prosthesis) that will be used during their operation. If you would like to do this your surgeon or the hospital staff can usually arrange it for you.

A physiotherapist will talk to you before your operation and may give you some exercises to help strengthen your muscles.

If youíve had chemotherapy, it usually takes a couple of weeks or so before your blood cell levels get back to normal and youíre ready to have your operation.

After your operation

At first your limb will be firmly bandaged, or you may have a splint in place to keep it still. This will give the bone graft, or artificial joint or bone, time to start joining firmly onto the rest of the bone in the limb. You will probably also have a tube (drain) coming out of your wound. This will drain excess fluid and blood into a small container attached to the other end of the tube. Drains are usually taken out after 3Ė4 days.

Eating and drinking

You probably wonít feel like eating or drinking much for the first few hours after your operation so youíll be given fluids into a vein in your hand or arm. This is called a Ďdripí or intravenous infusion. A nurse will take it out once you begin eating and drinking again.

Pain

You may feel quite sore for a few days after your operation. To start with you will probably need a strong painkiller such as morphine.

Painkillers can be given in different ways. They can be given into a vein (intravenously), into the space around your spinal cord (epidural), into a muscle (intramuscularly) or as tablets.

For the first day or so you may be given intravenous painkilling drugs through a syringe connected to an electronic pump. The pump can be set to give you a continuous dose of painkiller, so you are getting some all the time.

You may also have a hand control with a button to press if you feel sore. This is called patient controlled analgesia (PCA). Itís okay to press it whenever you are uncomfortable, as the pump is designed so that you canít give yourself too much painkiller.

If you find you need to press the button a lot tell the nurse in case you need a higher dose.

If youíve had an operation on your arm or leg you may be given painkilling drugs into the space around your spinal cord to begin with. This is called epidural analgesia and it works by numbing the nerves to the arms or legs. The drugs are often given through a syringe and tubing attached to an electronic pump.

It is important to let the nurses know if your painkillers donít seem to be working.

Physiotherapy

Physiotherapy is a very important part of your recovery. It helps you to regain muscle strength and to get good movement back in your limb. A physiotherapist will come to see you soon after your operation. They will show you some exercises to do. These exercises keep the muscles in the limb strong and supple, so that as soon as it is strong enough you can use it normally.

Once you are able to get up and around the physiotherapist will give you more exercises to do. These can be hard work but itís important to keep going with them as they will help you to recover. You may need to continue to have physiotherapy as an outpatient for some time after your operation.

Physiotherapy exercises

Going home

You will usually be able to go home once your wound has healed. For most people this is about a week to ten days after the operation.

Most people recover well after their surgery and are able to move around quite soon, some people take longer and need extra help. Before you go home the staff will talk to you about your home situation. If you live alone or have several stairs to climb, you may need some help at home.

If you have any worries about going home, make sure you discuss them with the nursing staff in advance so that help can be organised.

Living with limb-sparing surgery

After limb-sparing surgery people are often able to do most things they could before, including taking part in exercise and sports. But depending on what limb was affected, there may be some things you canít do or that you find more difficult. Your surgeon can give you detailed advice about the particular risks of the operation you are to have, how well the limb will work afterwards and the risk of complications such as infection.

Knee joint

When the knee joint is replaced, the new joint normally works very well. Itís fine for you to go swimming or cycling but your doctor might advise you against doing high impact sports like hockey, football, tennis or rugby. This is because of the risk that the joint will be damaged or loosen.

In some people the prosthesis may become loose or cause pain and may need to be replaced after a few years. Around 1 in 4 people (25%) who have a new knee joint will need to have a further operation within 10 years of having the knee replacement.

Hip joint

Replacement of the hip joint is usually very successful. Young people will have good strength in the hip, but older people usually need to use a walking stick. This is because their joint and muscles may not be as strong as they were before the operation. Hip replacements may also loosen and around 10% of people (1 in 10) will need to have a further operation within 10 years of having the hip replaced.

Shoulder joint

People who have shoulder replacements can normally move their arms around very well below shoulder height. However, they are usually not able to raise their arms above shoulder height. Itís uncommon for a shoulder joint prosthesis to loosen. These generally last for many years after the operation and cause few problems.

Infection

With any prosthesis the main problem that can occur is infection. If the prosthesis gets infected it will need to be taken out and replaced. The area needs to be cleaned completely with antibiotics before a new replacement joint can be put in.

Bone grafts

Limb-sparing surgery on a straight part of the bone may use a piece of bone taken from another area of the body to replace the bone that has been removed. This is known as a bone graft. The main problem that can occur with these operations is infection of the replacement bone.

Children and teenagers

If you have a prosthesis put into your limb while youíre still growing it will need to be lengthened as the leg or arm grows. Some types of prosthesis are lengthened during further surgery, while other types can be lengthened without the need for surgery.

Your specialist or nurse will explain how the prosthesis will be lengthened. If a bone graft is taken from a limb, that may also mean that the limb does not grow normally and so further surgery may be needed to keep the limb at the same length as the unaffected limb.

Amputation as a treatment for primary bone cancer

It is not always possible to use limb-sparing surgery and occasionally removing (amputating) the whole limb may be necessary. This is often because the cancer has spread from the bone into the surrounding blood vessels.

The preparation for amputation is similar to that for limb-sparing surgery. You should be given psychological support before and after the operation, as facing an amputation can feel overwhelming (see the information about living with an amputation below).

The medical staff looking after you will be able to offer help and support. It may also be helpful to talk to someone who has had the same operation and can offer practical advice and encouragement. The hospital staff may be able to arrange this for you. They can also arrange counselling.

After your operation

You probably wonít feel like eating or drinking much for the first few hours after your operation, so youíll be given fluids into a vein in your hand or arm. This is called a Ďdripí or intravenous infusion. A nurse will take it out once you begin eating and drinking again.

You may also have an oxygen mask on when you first wake up. Some people will have a tube in their bladder (catheter) to drain urine into a bag until they are up and around.

The part of your body that has been operated on will be covered with bandages or a plaster cast to control swelling. There will be a tube (drain) coming from your wound to drain off excess blood and fluids into a small container. This will usually be taken out after 3Ė4 days. You will also have stitches or staples to close the wound. These are usually taken out about 10Ė14 days after the operation.

Pain

You may feel sore for a few days after your operation. To start with youíll probably need a strong painkiller such as morphine.

Painkillers can be given in different ways. They can be given into a vein (intravenously), into the space around your spinal cord (epidural), into a muscle (intramuscularly) or as tablets.

You may be given intravenous painkilling drugs through a syringe connected to an electronic pump. The pump can be set to give you a continuous dose of painkiller, so you are getting some all the time.

You may also have a hand control with a button you can press if you feel sore. This is called patient controlled analgesia (PCA). Itís okay to press the button whenever you are uncomfortable, as itís designed so that you canít give yourself too much. If you find you need to press the button a lot tell the nurse in case you need a stronger dose of painkiller.

Some people are given painkilling drugs into the space around the spinal cord for the first day or so. This is called epidural analgesia and it works by numbing the nerves. The drugs are often given through a syringe and tubing attached to an electronic pump.

It is important to let the nurses know if your painkillers donít seem to be working.

Phantom pain

To begin with you may have a pain that feels as if it is coming from the part of the limb that has been amputated. This is known as 'phantom pain' or 'phantom sensation'. Most people find that phantom pains get less in time and eventually go away, but there may be some discomfort in the area for a while after the operation. Some people find that the phantom pain or sensation is difficult to control and they need to take painkillers long-term.

Physiotherapy

A physiotherapist will visit you a day or so after your operation. They will show you how to do exercises to keep the muscles around the operation site strong and supple, making it easier to work an artificial limb.

You will be encouraged and helped to move around as soon as possible after the operation. If you have had an upper limb amputated you will be able to be up and around once your pain is controlled and you have recovered from the anaesthetic. If you have had a leg amputated your physiotherapist will show you how to move around in bed and transfer to a chair. You'll probably be moving around with crutches or in a wheelchair within a few days.

Once you are moving around more you will go to the hospital gym for physiotherapy. This is a very important part of your recovery. Your physiotherapist will give you different exercises to do as you heal and gain strength. If you are going to be fitted with an artificial limb youíll also be taught how to use this to help you to regain independence in everyday activities.

Occupational therapy

You will see an occupational therapist soon after your operation. Their aim is to help you to become as independent as possible in everyday activities. And they may suggest different ways of doing things or aids or equipment that you can use.

Artificial limb (prosthesis)

Following an amputation, most people are fitted with an artificial limb, known as a prosthesis. Many different types of artificial limbs are available. There are lower limbs adapted for walking, swimming, riding a bike and playing sports, and upper limbs adapted for playing golf, swimming and so on.

One of the team looking after you will dis cuss limb fitting with you and explain whatís invol ved. It takes a few months for the re sidual limb to shrink to its final size and shape. So you wonít be able to be measured and fitted with a pe rmanent prosthesis until this happen s.

In th e meantime, if you have lost a lower limb you will normally b e measure d and have a fitting for a temporary prosthesis about 4Ė6 w eeks after your operati on. This usually happens at a limb fitting centre. About two weeks after t his youíll get your prosthesis and be ready to le arn how to use it in physiotherapy.

People who have lost an upp er limb are usually read y to be fitted with a lon g-term prosthesis after a bout three months, for a lower limb it is a bit lo nger, about six months. The timing varies fr m person t o person.

The staff at the limb fitting ce ntre will be able to sho w you the di ferent types of prostheses and e xplain how they work. They will talk over your needs, and help you to choose the best types of p rostheses for your situa tion. For example, if you swim you may want an additional prosthesis you can wea r in water.

A person with a prosthesis ri ding a bike

Going home

You will be able o go home once your w ound has healed. If you are to continue with physiotherapy after you go home, the physiotherapis t will make arrangemen ts for you to have this.

If you donít live close to the hospital where you had your operation youíll be able to go to a physiotherapist nearer to you.

Sometimes people need changes made to their homes to make them safer or more independent. The occupational therapist will work with social services to arrange these alterations for you if they are needed.

Your emotions

Losing an arm or a leg can feel like a bereavement. You will need time to grieve for your loss and to start to cope with the emotional and practical difficulties this type of surgery can bring.

You may find it helpful, either before or after your operation, to talk to someone who has had an amputation. The doctor or nurses on your ward may be able to arrange this.

Even if you thought you were prepared for losing a limb, you may still feel shocked and distressed after the operation. You will be used to what your body looks like and it can be hard to come to terms with such a major change. The sense of looking different from other people can seriously affect your self-confidence and make you afraid of how other people might react.

These are very strong emotions and you will need time and help to come to terms with them. The staff on the ward will know this and will help you all they can. They can also make suggestions to help you cope with the reactions of others.

Other people's reactions

You may be frightened of other peopleís responses to your amputation. You may feel worried about what your partner, family or friends will say or think and whether you will be able to cope with their reactions.

Although this fear is very real, the fear is often worse than the reality. Try to focus on the fact that the people who love you do so because of who you are. The qualities you are loved for are not removed by an amputation. Be open about your fears. Given the chance, most people will be very keen to reassure you that they still love you.

As you become more used to the way you look, you will become more confident about dealing with the reactions of people you donít know as well. Some people find it helpful to get out and about as soon as possible after the operation. But itís important to do things in your own time. You may want to take someone with you at first to offer support. You may find that other people donít even notice your amputation, especially if you are wearing an artificial limb.

You may feel different about yourself sexually and be worried that you arenít as sexually attractive. This can be distressing no matter what your age or whether you have a partner or not. Many people find it helpful to discuss their feelings with their partner, a close friend or with a counsellor.

We have information on relationships, sexuality and cancer that we can send you if you think it may be helpful.

We can give you details of s upport grou ps or couns lling servic es in your area. Support groups c an give both practical and emotion al advice and help to sto p you feelin g as if you have to cop e alone.

Chemotherap y for prim ary bone cancer

Che motherapy is an important treatment for some types of prim ary bone cancer. It is the use of anti-ca ncer (cytot oxic) drugs to destroy ca ncer cells.

How chemotherapy is given

Che motherapy drugs are so metimes given as tablets or, more often, by injection into a vein (intravenously). Sometimes, to m ake this easier and to avoid you having to have frequent injections, a fi ne plastic tube (called a central line ) can be put into a vein in your chest. The line is put in under a general or local ana esthetic.

A central line

Instead of a central line, a tube may be p ut into a vein in the crook of your arm: this is known as a PICC (Peripherally inserted central catheter) line. A tube with a injectable port ju st under the skin may s ometimes be used: this is known as an implantable port

The PICC lin e is threaded through the vein until the end is near to your heart

A session of chemotherapy treatment usually lasts a few days. This is follow ed by a rest period of a f ew weeks to allow your body to recover from any side effects of the treatment. The number of sessions you have will depend on the type of bone cancer you have and how well it is responding to the drugs.

Chemotherapy will usually mean spending a few days in hospital. Sometimes it may be given to you as an outpatient. In this situation it is given continuously into a vein through a central line or PICC line. The dose is controlled by a small portable pump.

Depending on the type of bone cancer you have, your doctor may recommend a course of chemotherapy before you have surgery or radiotherapy. This can shrink the tumour and make it easier to remove. It can also reduce symptoms such as pain and reduce the chances of the cancer spreading. Treatment given before an operation is known as neo-ad juvant therapy.

If you have an osteosarcoma or Ewingís sarcoma you will have more chemotherapy after surgery or radiotherapy. This is to destroy any remaining cancer cells a nd prevent the sarcoma from spreading outside the bone. This is k nown as adjuvant chemotherapy. It is given because tiny amounts of cancer may be present, especially in the lungs, which are too small to be detected by a scan.

Before having chemotherapy you may have tests to check your hearing and how well your heart, liver and kidneys are working. The results are normally available after a few days. Your doctor will discuss them with you.

You may be offered chemotherapy treatment as part of a clinical research trial. Clinical trials are very important in improving the way that bone cancer is treated. Your doctor or research nurse can discuss any relevant trials with you.

Side effects of chemotherapy

Chemotherapy can sometimes cause unpleasant side effects. Any side effects that occur are usually temporary and can often be well controlled with medicines. The main side effects are described here, with tips on ways to avoid or reduce them.

Lowered resistance to infections

Chemotherapy can temporarily reduce the number of normal cells in your blood. When these cells are reduced your body is less able to fight off infections. Itís important to contact your doctor or the hospital straight away if you think you may have an infection, if your temperature goes above 38ļC (100.5ļF), or if you suddenly feel unwell, even with a normal temperature.

During chemotherapy the doctors will check your blood regularly. If your white blood cell numbers are very low you may be given medicines called growth factors. These stimulate your bone marrow to make more white cells to reduce the chance of you getting an infection.

Anaemia

If the level of red blood cells in your blood is low this is called anaemia. If you are anaemic you may feel tired and lacking in energy. You may also become breathless. Anaemia can be treated by having a blood transfusion.

Bruising and bleeding

Platelets are a type of cell that helps the blood to clot. If the number of platelets in your blood is low you will bruise more easily and may bleed heavily from even minor cuts or grazes.

If you develop any unexplained bruising or bleeding, contact your doctor or the hospital immediately, as you may need to have a platelet transfusion.

Feeling sick

Some of the drugs used to treat primary bone cancer may make you feel sick (nauseous) and possibly make you vomit. Anti-sickness drugs (anti-emetics) can prevent or greatly reduce nausea and vomiting. Your doctor will prescribe these for you.

Sore mouth

Some chemotherapy drugs can make your mouth sore and cause mouth ulcers. Regular mouthwashes are important and your nurse will show you how to do these properly. If you donít feel like eating during treatment, talk to your nurse or ask to see a dietitian for advice Ė our website also has some useful tips on coping with eating problems.

Hair loss

Some chemotherapy drugs can cause temporary hair loss. Your doctor or nurse will be able to tell you if the drugs you are having are likely to cause hair loss. People who lose their hair during chemotherapy often cover up by wearing wigs, hats or scarves. Hospital inpatients are entitled to a free wig from the NHS, and your doctor or nurse will be able to arrange for a wig specialist to visit you. However, people being treated as outpatients may have to pay for their wigs. If you lose your hair due to chemotherapy, it will grow back over 3Ė6 months.

Changes in hearing

Some chemotherapy drugs can affect your ability to hear high-pitched sounds. You may also have ringing in your ears (tinnitus) but this usually gets better when the treatment ends, although for some people it may be permanent. Tell your doctor if you notice any loss of hearing or tinnitus.

Although they may be hard to bear at the time, the side effects from chemotherapy usually disappear once your treatment is over.

Chemotherapy affects everyone differently. Some people are able to lead a fairly normal life during their treatment, but many people find they become very tired and have to take things much more slowly. Just do as much as you feel like and try not to overdo it.

Fertility

Your ability to become pregnant or father a child may be affected by some of the chemotherapy drugs used to treat bone tumours. It is important to discuss fertility with your doctor or nurse before starting treatment, as it may be possible for men to store sperm, and for women to store embryos or eggs.

Some women who have chemotherapy have an earlier menopause than they would otherwise have done. This means they may not have as many years of fertility. Your doctor can tell you if you may be affected in this way.

Women with signs of an early menopause, such as hot flushes and sweats, can be given hormone replacement therapy (HRT) to replace the hormones that are no longer being produced.

Contraception

It is not advisable to become pregnant or father a child while having any of the chemotherapy drugs used to treat bone tumours, as they may harm the developing foetus. Again, you can discuss this with your doctor or chemotherapy nurse.

JASCAP booklet on Chemotherapy discusses treatment and its side effects in more detail. Information on individual drugs and their particular side effects is also available.

Radiotherapy for primary bone cancer

Radiotherapy treats cancer by using high-energy rays, which destroy the cancer cells while doing as little harm as possible to normal cells.

Treatment is usually given in the hospital radiotherapy department, every weekday, with a rest at the weekend. How long your treatment takes will depend on the type and size of the cancer, but it will normally be a few weeks. Your doctor will discuss your treatment with you beforehand.

Radiotherapy works well for Ewingís sarcoma and is often given together with chemotherapy and surgery. If surgery to remove the tumour is not possible, radiotherapy may be used as the main treatment.

If the tumour is in the spine or pelvis, radiotherapy may be used if the doctor thinks surgery to the area might cause disability. Sometimes, before the start of radiotherapy, the surgeon operates to place a water-filled balloon into the pelvis. The balloon moves the organs in the pelvis out of the way of the radiotherapy beam. This protects them from any damage the radiotherapy may cause.

Radiotherapy is not often used to treat osteosarcoma as this type of bone cancer isnít very sensitive to radiation. However, if a limb has fractured this can mean there is a higher risk that the cancer could spread elsewhere. In this situation, radiotherapy may be given after surgery to destroy any cancer cells that may remain in the surrounding tissues.

Radiotherapy given after surgery may help to reduce the chance of a chondrosarcoma or a spindle cell sarcoma coming back.

Planning your treatment

To make your radiotherapy as effective as possible, it must be carefully planned. On your first few visits to the radiotherapy department youíll be asked to lie in a CT scanner, which will take images of the area to be treated. The planning will be done by a clinical oncologist and medical physicist, and may take a few visits.

Marks may be drawn on your skin to help the radiographer, who gives you your treatment, to position you accurately and to show where to direct the rays. These marks must stay visible throughout your treatment, but they can be washed off once it is over. At the beginning of your radiotherapy youíll be told how to look after the skin around the area to be treated.

Positioning the radiotherapy machine

Before each session of radiotherapy the radiographer will position you carefully and make sure that youíre comfortable. During your treatment, which takes only a few minutes, youíll be left alone in the room. But you can talk to the radiographer who will be able to see you from the next room. Radiotherapy is not painful but you do have to lie still for a few minutes while it is being given.

Side effects of Radiotherapy

Radiotherapy can cause general side effects such as feeling sick (nausea) and tiredness. These side effects can be mild or more troublesome, depending on the strength of the radiotherapy dose and the length of your treatment. The radiotherapist will be able to advise you what to expect.

Tiredness

Radiotherapy can make you tired so you may need more rest than usual, especially if you have to travel a long way for treatment every day.

Feeling sick

Nausea can usually be effectively treated by anti-sickness drugs (anti-emetics). Your doctor can prescribe them for you. If you donít feel like eating, speak to your nurse or ask to see a dietitian for advice.

Our section on diet and nutrition has some helpful hints on how to eat well when you are feeling sick.

Hair loss

Radiotherapy can make your hair fall out in the area being treated. This may grow back after treatment is over but for some people the hair loss is permanent. It depends on the total dose of radiotherapy that is given. Your doctor can tell you if your hair is likely to grow back after treatment.

All these side effects should disappear gradually once your course of treatment is over, but it is important to let your doctor know if they continue.

Radiotherapy doesnít make you radioactive. Itís safe for you to be with other people, including children, throughout your treatment.

JASCAP has booklet about Radiotherapy, which gives more details about this treatment and its side effects.

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