Surgery for bone cancer that has spread

You might have surgery to remove primary bone cancer that has spread to a different part of the body. When cancer spreads it is called secondary or metastatic bone cancer. Surgery to remove cancer that has spread is called a metastectomy.

Primary bone cancer most often spreads to the lungs. Surgery to remove bone cancer that has spread to the lung is a major operation. This is because the surgeon needs to operate inside the chest.

This page is about cancer that starts in your bone (primary bone cancer) and spreads to a different part of your body. 

If your cancer has spread into bone from another part of the body, it is also called secondary or metastatic bone cancer. This is different to primary bone cancer that has spread. You need to look at the section for your type of primary cancer which is named after the part of your body where your cancer started.

When do you have surgery?

Your doctor might suggest surgery to remove areas of primary bone cancer that have spread to your lung. This type of surgery sometimes cure’s the cancer.

Removing metastases from the lung is a major operation so you need to be fit and well enough. Your doctor will talk to you about what the operation involves. This will depend on many factors including:

• your type of bone cancer
• where the secondaries are in your lungs
• the size and number of secondaries 
• how well your doctor expects your lungs to work after surgery
• your general health and fitness and how well you might cope with surgery
• if there is cancer spread anywhere else in your body
• how well treatment is controlling your primary cancer

Even if your surgeon is not sure it will be possible to remove your secondary cancer, you might have chemotherapy to try to shrink it. If the chemotherapy works well, it may shrink enough for you to have surgery. 

Sometimes the chemotherapy alone will get rid of the lung tumours. This means you may not need surgery to remove them.

Surgeons are more likely to suggest lung surgery for osteosarcoma than other types of bone cancer. Occasionally the surgeon will remove chondrosarcoma that has spread. It is much rarer to have surgery to remove Ewing sarcoma that has spread to the lungs.

If you can’t have surgery

You are unlikely to have surgery if your cancer has spread to more than one area of your body. Your doctor usually suggests you have chemotherapy instead. This is because chemotherapy circulates throughout the body. So it aims to treat all areas the bone cancer has spread to.

For certain types of bone cancers you might have radiotherapy to treat the secondary cancer. You might also have radiotherapy to relieve the symptoms caused by a secondary cancer. 

Other possible treatment options include:

• radiofrequency ablation (RFA)
• cryotherapy

Getting ready for your surgery

You meet your surgical team before your surgery. The surgeon talks to you about the risks and benefits. They ask you to sign a consent form. This is a good time to ask all the questions you need to.

What happens

You have the surgery in an operating theatre with a general anaesthetic . Before you go you need to put on a hospital gown. Your nurse takes you to the operating theatre.

You have a small tube put into a vein in the back of your hand. This is called a cannula. The anaesthetist gives you the anaesthetic medicine through the cannula and you go to sleep. 

Once asleep your surgeon opens the chest wall by making a cut between the ribs to get to your lungs. This type of surgery is called a thoracotomy.

The surgeon then removes the cancer with a small area of healthy tissue surrounding it.

Opening the chest makes the lung on that side collapse. You have a chest drain after the operation so that your lung fills up with air again (reinflates). The drain is a tube that comes out of your chest and is connected to a bottle with gentle suction. A stitch holds the tubing in place and stops it from slipping out. The tube helps blood and fluid to drain out of the wound. The suction helps the lung to inflate again after the operation. This stays in for a few days.

You might have this procedure done as keyhole surgery. The keyhole procedure is called a video assisted thoracoscopic surgery (VATS). It is less invasive than a normal operation.

Some people have metastases in the space between the two lungs (mediastinum). In this case your surgeon will make a cut through your breastbone (sternum). This type of operation is called a sternotomy.

After surgery

You go to the recovery room straight after surgery. You will have one to one nursing care. The nurse looks after you until you are awake and well enough to go back to the ward or high dependency unit (HDU).

At first you’ll have an oxygen mask over your nose and mouth. Or you may have oxygen through 2 small plastic tubes that rest in each nostril (nasal prongs). You may have several other different drains and tubes in place after lung surgery. Your nurse will explain what they are for.

You might have:

• drips to give you medicines and fluids until you are eating and drinking again
• tubes into your neck or arms to measure your blood pressure
• one or more chest drains coming from the lung
• a tube into your bladder (catheter) to collect and measure the urine you pass
• leads connected to sticky pads to check how well your heart is working
• a fine tube into your back that goes into your spinal fluid (epidural) to help relieve pain

Your surgeon gives the nurses and physiotherapists detailed instructions about your recovery. Physiotherapists, nurses and other health professionals will help you after your lung surgery. This includes any rehabilitation you need.

Possible risks

Infection

You are at risk of getting an infection after any operation. This is a particular risk for people having chemotherapy. This includes a wound, chest or urine infection. Your surgical team will do all they can to prevent infection. You will have antibiotics during and after your operation, to try to reduce the risk of an infection.

Tell your doctor or nurse if you have any symptoms of infection.

They include:

• a high temperature
• shivering
• feeling hot and cold
• feeling generally unwell
• cough
• feeling sick
• swelling or redness around your wound and your wound might feel hot
• a strong smell or liquid oozing from your wound
• loss of appetite

Blood clots

Blood clots (deep vein thrombosis, DVT) are a possible complication of having surgery. This is because you might not move about as much as usual. Clots can block the normal flow of blood through the veins. Let your doctor or nurse know if you have an area in your leg that is swollen, hot, red or sore.

There is a risk that a blood clot can become loose and travel through the bloodstream to the lungs. This can cause a blockage in the lungs. This is known as a pulmonary embolism. Symptoms include:

• shortness of breath
• chest pain
• coughing up blood
• feeling dizzy or lightheaded

To prevent clots it's important to do the leg exercises that your nurse or physiotherapist taught you. Your nurse might also give you an injection just under the skin to help lower the risk whilst you are in hospital. You might need to carry on having these injections for 4 weeks, even after you go home. This depends on the type of operation you had.

Your nurse might teach you to do these injections yourself before you go home. Or a district nurse might come to your home to do them.

It's important to continue wearing compression stockings if you have been told to by your doctor.

Bleeding

There is a risk that you will bleed after your operation. The team looking after you will monitor you closely for signs of bleeding. The treatment you need depends on what is causing the bleeding and how much blood you lose. You might need a blood transfusion.

Other risks

There are other risks of having surgery for secondary cancer in the lungs. Your doctor will talk them through with you.

Your doctors will make sure the benefits of having surgery outweigh these possible risks.

Follow up

At your first follow up appointment, your doctor:

• gives you the results of the surgery
• examines you
• asks how you are and if you've had any problems  

This is also your opportunity to ask any questions. Write down any questions you have before your appointment to help you remember what to ask. Taking someone with you can also help you to remember what the doctor says.

How often you have follow up appointments depends on the results of your surgery. Ask your doctor how often you need to have these and what they will involve.