Surgical Procedures: Surgery and Staging for Osteosarcoma

Osteosarcoma is a type of bone cancer. Osteosarcoma is more common in children and young adults. It most often affects the bones of the legs and arms. In adults, common sites of osteosarcoma are the hips, shoulder, and jaw.

What is staging and how is it done?

Staging is a way to find out if and how far the cancer has spread in your body. Your provider will have you get a few tests to figure out the stage of your cancer. For osteosarcoma, these tests may be:

Physical Exam: This is a general exam to look at your body and to talk about your past health issues.

Imaging: Radiology tests can look inside your body to look at the cancer and see if it has spread. These tests can include:

• X-Ray.
• CAT scan (CT scan).
• Positron emission tomography (PET).
• Bone scan.
• Magnetic resonance imaging (MRI).

Procedures: These may include:

• Biopsy: A biopsy takes cells from the cancer, or a piece of the cancer, to see what type of cancer it is and how it behaves. A doctor called a pathologist looks at the sample under a microscope. There are two types of biopsies often used in osteosarcoma:
  • Core biopsy: A needle with a hollow center is used to remove tissue.
  • Surgical biopsy: Surgery is done to remove all or part of the mass or tumor.

The stage tells how extensive the cancer is, how far it has spread, and helps guide your treatment.

Osteosarcoma stage is described as “localized” or “metastatic":

• Localized cancer is within the bone. Localized osteosarcoma is further broken down into:
  • Resectable osteosarcomas: All of the tumor that can be seen by the eye can be removed (resected) by surgery.
  • Non-resectable (or unresectable) osteosarcomas: Cannot be removed completely by surgery.
• Metastatic osteosarcoma has spread to other parts of the body. Osteosarcoma spreads to other parts of the body through the tissue, lymph, and blood systems.

Surgical Procedures Used in the Treatment of Osteosarcoma

Surgery is often used to treat osteosarcoma. The type of surgery depends on where the cancer is and the extent of the cancer. Whenever possible, the biopsy and surgery to remove the tumor should be planned together and done by an experienced orthopedic surgeon.

There are different types of surgeries used to treat osteosarcoma:

• Wide local excision: The cancer is removed, along with part of the healthy tissue around the tumor.
• Limb-sparing surgery: When osteosarcoma affects the legs or arms, the surgeon will try to save as much of the limb’s function and appearance by doing a limb-sparing surgery. The surgeon will do a wide local excision, followed by placing graft tissue, bone, or an artificial bone/metallic implant into the affected area.
• Amputation: In some cases, the whole limb is removed.
• Rotationplasty: The surgeon will take out the tumor and the knee joint. The surgeon then attaches the remaining part of the leg and creates a new knee joint using the ankle. The foot will face backward, and the ankle will function as a knee joint with the ability to have a fitted prosthesis attached to the foot.

Note: For tumors affecting other parts of the body (not the limbs), surgeons often try to remove as much cancer as possible, while leaving the affected bone. You may need grafting (skin or bone taken from another area of the body) and/or placement of a prostheses. Your surgeon will talk with you about the specifics of your surgery.

In cases where the cancer has metastasized (spread) to other parts of the body, more surgery may be needed.

What are the risks of osteosarcoma surgery?

As with any surgery, there are risks and possible side effects. These can be:

• Reaction to anesthesia: Anesthesia is the medication you are given to help you sleep through the surgery, to not remember it, and to manage pain. Reactions can include wheezing, rash, swelling, and low blood pressure.
• Bleeding.
• Blood clots.
• Infection.
• Pain.
• Problems with prosthetic implants.
• Skin breakdown.
• Long-term physical problems.

Before surgery, your care team will talk to you about any other risk factors based on your health and the surgery you are having.

What is recovery like?

Recovery from surgery to treat osteosarcoma depends on the procedure you have had.

You will be told how to care for your incisions and will be given any other instructions before leaving the hospital.

Your care team will talk to you about the medications you will be taking, such as those for pain, blood clot, infection, and constipation prevention and/or other conditions.

Your provider will talk to you about any changes you will need to make to your activity level, which depends on the surgery you had.

How can I care for myself?

You may need a family member or friend to help you with your daily tasks until you are feeling better. It may take some time before your team tells you that it is ok to go back to your normal activity.

Be sure to take your prescribed medications as directed to prevent pain, infection and/or constipation. Call your team with any new or worsening symptoms.

There are ways to manage constipation after your surgery. You can change your diet, drink more fluids, and take over-the-counter medications. Talk with your care team before taking any medications for constipation.

Taking deep breaths and resting can help manage pain, keep your lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to do deep breathing and relaxation exercises a few times a day in the first week, or when you notice you are extra tense.

• Example of a relaxation exercise: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.

This article contains general information. Please be sure to talk to your care team about your specific plan and recovery.