Bone cancer – treatment

What types of treatment are used?

 
  • Types of treatment
  • Giving your consent
  • The benefits and disadvantages of treatment

Types of treatment

Most people with primary bone cancer will need a combination of different treatments. The treatments that are used are surgery, chemotherapy and radiotherapy. The treatment you have will depend on your age, general health, and the stage and type of the bone cancer.

Surgery is a very important part of treatment and is used to remove the tumour in the bone. If surgery is not possible then radiotherapy, which is particularly effective in Ewing’s sarcoma, may be used instead.

Chemotherapy is an important treatment for most people with osteosarcoma, Ewing’s sarcoma and fibrous histiocytoma. It is often given before surgery and may shrink large tumours enough to avoid amputation. The course of chemotherapy will then continue after surgery.

When radiotherapy is used to treat Ewing’s sarcoma, it is most often given after or instead of surgery. Although radiotherapy is used less often to treat osteosarcoma and chondrosarcoma, it is still helpful in certain situations.

If you have any questions about your treatment, don’t be afraid to ask your doctor or nurse. It often helps to take a close friend or relative to the consultation with you to help you remember what is said.

Some people find it reassuring to have another medical opinion to help them decide about their treatment. Most doctors will be pleased to refer you to another specialist for a second opinion, if you feel this will be helpful.

Giving your consent

Before you have any treatment your doctor will explain the aims of the treatment to you and you will usually be asked 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 possible alternative treatments that may be available
  • any significant risks or side effects of the treatment.

If you do not understand what you have been told, let the staff know straight away so that they can explain again. Some cancer treatments are complex, so it is not unusual for people to need repeated explanations. You may find it useful to write down a list of questions before you go for your appointment.

Patients often feel that the hospital staff are too busy to answer their questions, but it is important for you to be aware of how the treatment is likely to affect you and the staff should be willing to make time for you to ask questions.

You can always ask for more time to decide about the treatment if you feel that you can’t make a decision when it is first explained to you. You are also free to choose not to have the treatment, and the staff can explain what may happen if you do not have it.

It is essential to tell a doctor, or the nurse in charge, immediately so that he or she can record your decision in your medical notes. You do not have to give a reason for not wanting to have treatment, but it can be helpful to let the staff know your concerns so that they can give you the best advice.

 

The benefits and disadvantages of treatment

Many people are frightened at the idea of having cancer treatments, particularly because of the side effects that can occur.

Although many of the treatments can cause side effects, knowledge about how these treatments affect people and improved ways of reducing or avoiding many of these problems, have made most of the treatments much easier to cope with.

Treatment can be given for different reasons and the potential benefits will vary depending upon the individual situation. In people with bone cancer, treatment is usually done with the aim of curing the cancer.

If the cancer is at a more advanced stage the treatment may only be able to control it, leading to an improvement in symptoms and a better quality of life. However, for some people in this situation the treatment will have no effect upon the cancer and they will get the side effects without any of the benefit.

If you have been offered treatment that aims to cure your cancer, deciding whether to accept the treatment may not be difficult. However, if a cure is not possible and the treatment is being given to control the cancer for a period of time, it may be more difficult to decide whether to go ahead.

Making decisions about treatment in these circumstances is always difficult, and you may need to discuss it in detail with your doctor. If you choose not to have treatment, you can still be given supportive (palliative) care, with medicines to control any symptoms.

Surgery

There have been major improvements in surgery for bone cancer over the past few years. In the past, it was often necessary to remove (amputate) the limb if cancer was found. Now, however, it is often possible just to remove the affected part of the bone and replace it with a specially designed metal fitting (endoprosthesis) or a bone graft (bone from another part of the body). If the cancer affects a bone in or near a joint the whole joint can be replaced with an artificial one.

These operations, sometimes called limb-sparing surgery, have made it possible for many people to avoid amputation. They are only carried out in specialist hospitals and your doctor should refer you to one of these hospitals to see if such an operation would be possible in your case. It is important to realise that it is not 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.

Limb-sparing surgery

Before your operation your doctor and the nurses on the ward will discuss it with you to make sure that you fully understand what it involves. It is often helpful to talk to someone who has had the same operation as you are going to have, and the medical staff will be able to arrange this for you. On some wards a special counsellor may be available to discuss any worries you may have.

Some people like to see the prosthesis (replacement part) that will be used during their operation and the staff can also arrange this for you. A physiotherapist will talk to you before your operation and may give you some exercises to help strengthen your muscles.

If you have had chemotherapy, your body will need some time to recover before surgery can be done. Usually it takes a couple of weeks before your blood counts return to normal and you are 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 on to the rest of the bone in the limb.

You will probably have a drainage tube from the wound in place for 3–4 days. A ‘drip’ will give fluids into a vein in your arm until you are able to eat and drink properly. The drip will then be removed by the nurses on the ward.

It is likely that you will have some pain and discomfort after your operation, and painkillers will be prescribed for you. To start with you will probably need a strong painkiller such as morphine. This will be given to you in one of two ways: as injections (given by the nurses), or through a small pump which is attached to a needle in your arm and releases the drug as you need it (which you control yourself).

It is important to let the nurses know if your painkillers don’t seem to be working.

For people who have had surgery on their leg a different method of pain relief, called an epidural, may be available. For this method, your doctor injects a local anaesthetic into the epidural space around the spine, in your lower back, to numb the nerves which run to your legs.

Your physiotherapist will visit you shortly after your operation and show you some exercises to do in bed. 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.

If you have had surgery to your leg, you will probably be left with a slight limp. Sometimes trying to walk normally with a limp puts pressure on the leg and causes pain elsewhere in the body. Although it is important to have any persistent pain checked by your doctor, it does not necessarily mean that the cancer has come back.

Most people are able to go home once their wound is well healed, usually within a week to 10 days after their operation.

Living with limb-sparing surgery

Many different types of limb-sparing surgery operation can be carried out. The most common type uses a metal replacement part to replace the piece of bone that has been removed. The metal replacement part is called an endoprosthesis. The most commonly replaced joint is the knee joint. The next most common are the hip joint and then the shoulder joint. The benefits and possible problems of limb-sparing surgery are described below.

When the knee joint is replaced the new joint normally works very well. People who have had this operation can swim or take part in activities such as walking, but should not run or play contact sports due to the risk of damaging or loosening the prosthesis. In some people the endoprosthesis may work loose or cause pain and may need to be replaced after a few years. Around 25% of people (1 in 4) who have a knee prosthesis will need to have a further operation within 10 years of having the knee replacement.

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 as 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.

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. It is uncommon for shoulder joint prostheses to loosen. These generally last for many years after the operation and cause few problems.

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.

Limb-sparing surgery on a straight part of the bone may replace the bone that has been removed with bone taken from other areas of the body. The main problem with these operations is infection of the replacement bone. Your surgeon will be able to 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.

If the prosthesis has been put into the limb of a child or teenager he or she will need to have further surgery to lengthen the limb as their other leg or arm grows. 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

 
  • Amputation
  • After your operation
  • Artificial limb (prosthesis)
  • Living with an amputation

Amputation

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. Very occasionally, after discussion with their specialist doctor and family, people choose to have an amputation instead of limb-sparing surgery.

The preparation for amputation is similar to that for limb-sparing surgery. Psychological support for people who are about to have an amputation is very important, as facing an amputation can be devastating. The medical staff looking after you and often a counsellor 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.

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After your operation

The operation site will be covered with special bandages which shape the area, so that an artificial limb can be fitted properly later. Tubes from the wound site will drain off excess blood and usually stay in place for 3–4 days.

A ‘drip’ of fluids will be inserted into a vein in your arm. This will give you fluids and nutrients until you are able to eat and drink properly. The drip will then be removed by the nurses on the ward.

You will feel some pain and discomfort after your operation, and painkillers will be prescribed for you. To start with you will probably need a strong painkiller such as morphine. This will be given to you in one of two ways: as injections (given by the nurses), or through a small pump which is attached to a needle in your arm and releases the drug as you need it (which you control yourself).

It is important to let the nurses know if your painkillers don’t seem to be working.

Some people have a pain that may appear to come from the part of the limb that has been amputated. This is known as phantom pain or sensation. Most people find that the pain gradually fades, 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 may need to take painkillers permanently.

About two to three days after surgery, you will be encouraged and helped to move around. The physiotherapist will visit you shortly after your operation and 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.

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Artificial limb (prosthesis)

Following an amputation most people can be fitted with an artificial limb, known as a prosthesis. Modern technology means that artificial limbs are now very effective – people can walk, run or even play sport.

An artificial-limb fitter may visit you before or after your operation to show you the different types of prosthesis and how they work. Careful measurements have to be taken so that the prosthesis fits properly. It may take several weeks for your prosthesis to be made and in the meantime you may be fitted with a temporary one so that you can begin to get used to it. Artificial limb fittings are usually arranged through the ward and supplied by disablement services.

Once your wound has healed you will be able to go home, normally after a couple of weeks.

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Living with an amputation

The advances in surgery over the last few years have meant that many people with primary bone cancer can have limb-sparing surgery instead of an amputation. Unfortunately, there are still some people who will have to have a limb amputated as the only way to treat their cancer.

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 had a good idea of what to expect before surgery, you may still feel shocked and distressed after the operation when the full realisation of having lost an arm or leg hits you. You will be used to what your body looks like and it can be extremely hard to come to terms with a major change such as an amputation. The sense of looking different from others can seriously affect your self-confidence and make you afraid of being rejected – both socially and sexually. You may even wish you had never agreed to the operation.

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.

After you have had time to get used to how you feel, the next hurdle will be facing the reactions of your partner, family and friends. You may be frightened of what they will say or think and whether you will be able to cope with their reactions.

Although this fear is very real, it is often unfounded. 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 any fear of rejection. If they are given the chance, most people will be very keen to reassure you that they still love you.

It may never be easy to overcome the fear of letting other people see you after your amputation. As you and the people close to you become more used to the way you look, you will become more confident about dealing with the reactions of people you don’t know as well. Some people find it helpful to get out and about as soon as possible after the operation. However, it is important to take the time you need to become accustomed to your amputation and to do things in your own time. You may want to take someone with you at first to offer moral support. You may find that other people do not even notice your amputation, especially if you are wearing an artificial limb.

Fear of being sexually rejected, no matter what your age or whether you have a partner, is a feeling that many people who have had an amputation go through. Feeling unattractive and ashamed of your body can make you feel that no one will ever find you sexually attractive again and that perhaps even your present partner will be affected. Meeting new partners may seem particularly daunting. CancerBACUP’s section on sexuality and cancer discusses these issues and you may find it helpful.

Many people find it helpful to discuss their feelings in depth with a close friend or someone who is more removed from their situation, like a counsellor.

Chemotherapy

In recent years chemotherapy has become an important treatment for some types of primary bone cancer and has greatly improved the results of treatment.

  • What is chemotherapy?
  • Side effects of chemotherapy

What is chemotherapy?

Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells.

Chemotherapy drugs are sometimes given as tablets or, more usually, by injection into a vein (intravenously). Sometimes, to make this easier and to avoid your having to have frequent injections, a fine plastic tube (called a central line) can be placed into a vein in your chest. The line is put in under a general or local anaesthetic. Instead of a central line, a tube may be put into a vein in the crook of your arm: this is known as a PICC line. A tube with an injectible port just under the skin may sometimes be used: this is known as an implantable port.

A session of chemotherapy treatment usually lasts a few days. This is followed by a rest period of a few 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 cancer you have and how well it is responding to the drugs.

Chemotherapy may be given to you as an out-patient, but usually it will mean spending a few days in hospital. Sometimes chemotherapy can be given as a continuous out-patient infusion by a small portable pump.

Depending on the type of tumour 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.

If you have an osteosarcoma or Ewing’s sarcoma you will continue your chemotherapy after surgery or radiotherapy, to destroy any remaining cancer cells and prevent the sarcoma from spreading outside the bone. This is known as adjuvant chemotherapy and it is given because research has shown that 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 will have some tests to check how well your heart, liver and kidneys are working. This will usually involve blood tests. In order to check your kidneys you may have an injection of a small amount of mildly radioactive liquid into one of your veins. The radioactive liquid is passed out in your urine. A few hours after the injection, blood tests are taken.

You may have an electrical trace taken of your heartbeat (an ECG) or a scan of your heart in which the doctor can see your heart beating.

Your doctor will discuss the results of these tests with you. The results are normally available after a few days.

You may be offered chemotherapy treatment as part of a clinical 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 can often be well controlled with medicines. The main side effects are described here, with tips on ways of avoiding or reducing them.

Lowered resistance to infections

While the drugs are acting on the cancer cells in your body, they also temporarily reduce the number of normal cells in your blood. When these cells are reduced you are more likely to get an infection and you may tire easily. CancerBACUP has information about coping with tiredness. During chemotherapy your blood will be tested regularly and, if necessary, you may be given antibiotics to treat any infection. Medicines called growth factors may also be given to stimulate the production of white blood cells by the bone marrow.

If your temperature goes above 38ºC (100.5ºF), or you suddenly feel unwell even with a normal temperature, contact your doctor or the hospital straight away.

Anaemia

If the level of red blood cells (haemoglobin) in your blood is low you will become very tired and lethargic. You may also become breathless. These are all symptoms of anaemia – a lack of haemoglobin in the blood. Anaemia can be very successfully treated by blood transfusions. You will feel more energetic and the breathlessness will be eased.

Bruising and bleeding

Platelets are a type of cell which help to clot the blood. If the number of platelets in your blood is low you will bruise very 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. CancerBACUP has information about blood transfusions and platelet transfusions.

Feeling sick

Some of the drugs used to treat primary bone cancer may make you feel sick (nauseated) and possibly cause you to vomit. There are now very effective anti-sickness drugs (anti-emetics) to 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 small ulcers. Regular mouthwashes are important and your nurse will show you how to do these properly. If you don’t feel like eating during treatment, you could try replacing some meals with nutritious drinks or a soft diet – CancerBACUP’s section on diet and the cancer patient has some useful tips on coping with eating problems.

Hair loss

Unfortunately, some, but not all, of the drugs can also cause hair loss. Ask your doctor if the drugs you are taking are likely to cause hair loss or other specific side effects. People who lose their hair often cover up by wearing wigs, hats or scarves. Hospital in-patients 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. People being treated as outpatients, however, usually have to pay for their wigs. If you do lose your hair as a result of chemotherapy, it will grow back over a period of 3–6 months.

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

It is important to remember that chemotherapy affects different people in different ways. Some find that they are able to lead a fairly normal life during their treatment, but many 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 taking some of the chemotherapy drugs used to treat bone tumours. It is important to discuss fertility with your doctor before starting treatment. Some women may find that the chemotherapy treatment causes them to go into the menopause, and they may have signs of menopause such as hot flushes and sweats. In many cases, replacement hormones (HRT) can be given to replace the hormones that are no longer being produced. You may find it helpful to talk this through with your doctor or one of the support organisations listed.

Contraception

It is not advisable to become pregnant or father a child while taking 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.

CancerBACUP’s section on chemotherapy discusses the treatment and its side effects in more detail. Information on individual drugs and their particular side effects is also available.

Radiotherapy

 
  • General
  • Planning your treatment
  • Side effects

General

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

Radiotherapy is given in the hospital radiotherapy department. The treatment is usually given every weekday in the hospital radiotherapy department, with a rest at the weekend. The length of your treatment will depend on the type and size of the cancer, but will normally last a few weeks. Your doctor will discuss your treatment with you beforehand.

Ewing’s sarcoma responds very well to radiotherapy and this treatment is often used after chemotherapy and before surgery. If surgery is not possible – for example, if the tumour is in the spine – radiotherapy may be given in place of surgery.

Radiotherapy is not often used to treat osteosarcoma as the tumour is not very sensitive to radiation. However, if a limb has fractured and the risk of spread is increased it may be given after surgery to destroy any remaining cancer cells, especially in the surrounding tissues.

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

 

Planning your treatment

For maximum benefit your radiotherapy must be carefully planned. On your first few visits to the radiotherapy department you will be asked to lie under a large machine called a simulator, which takes x-rays of the area to be treated. Sometimes a CT scanner can be used for the same purpose. Treatment planning is an important part of radiotherapy and it may take a few visits before the clinical oncologist, the doctor who plans and supervises your treatment, is satisfied with the result.

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

Before each session of radiotherapy the radiographer will position you carefully on the couch and make sure that you are comfortable. During your treatment, which takes only a few minutes, you will be left alone in the room, but you will be able to talk to the radiographer who will be watching you carefully 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

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.

Feeling sick

Nausea can usually be effectively treated by anti-sickness drugs (called anti-emetics), which your doctor can prescribe. If you don’t feel like eating, you can replace meals with nutritious, high-calorie drinks. These are available from most chemists and can also be prescribed by your GP.

CancerBACUP’s section on diet and the cancer patient has some helpful hints on how to eat well when you are feeling ill.

Tiredness

As radiotherapy can make you tired you should try and get as much rest as you can, especially if you have to travel a long way for treatment every day.

CancerBACUP has a section with tips on coping with tiredness.

Hair loss

Radiotherapy can cause hair loss in the area being treated.

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 does not make you radioactive and it is perfectly safe for you to be with other people, including children, throughout your treatment.

CancerBACUP has a section on radiotherapy, which gives more details about this treatment and its side effects.

Radiotherapy uses a type of radiation, called ionising radiation, to destroy cancer cells. There are several types of ionising radiation including x-rays, gamma rays and beta rays.  Most radiotherapy treatment for cancer use x-rays.

Ionising radiation works by releasing chemicals in the nucleus of cells. These chemicals, called free radicals,  damage the DNA, the genetic material that is vital for the cell to multiply.  If the DNA is sufficiently damaged by the radiation then it will not be able to divide and will die off.

In order for the radiotherapy to release the free radicals that damage the DNA there needs to be a good supply of oxygen in the cells.   If the cells are starved of oxygen then this actually protects them against the effects of the x-rays and makes treatment less effective.

Oxygen is carried to the tissues and cells in our bodies by the haemoglobin in the red blood cells. If we are anaemic then the haemoglobin level in the blood is low, and so the amount of oxygen carried by the blood to our cells is reduced.

So in order to get the best results from a course of radiotherapy it is important to be sure that you are not very anaemic before you start treatment. 

If you are anaemic then your doctors may well suggest a blood transfusion before you start your treatment.  This will boost your haemoglobin level and will increase the oxygen in your blood, which will increase the chances of success from your radiotherapy treatment.

I am going to have a course of radiotherapy to treat my cancer. The doctors took a blood test today and when I asked about this they said it was important to make sure I wasn’t anaemic before I had the treatment? Why is this?

Very often when a cancer is treated the treatment will take away all evidence of that cancer: symptoms will disappear, physical examination and special tests (like blood tests and scans) will all go back to normal. All the appearances will suggest that the problem has been cured.


But sometimes there will be microscopic traces of the cancer left behind. Because they are so tiny these traces will not cause any symptoms and they will be too small to show up on even the most careful of examinations and most sensitive of special tests. These tiny clusters of cancer cells may lie dormant for months or years but may eventually grow and the cancer may come back.

Since these minute cells that might have been left behind cannot be detected in any way it is impossible to give an absolute guarantee that a cancer has been cured after treatment.

Having said this, very many people are cured of their cancer by modern day treatment. The chances of getting a cure depend on the type of cancer that someone has, how advanced (how large it was and how far it had spread) at the time it was first discovered (this is sometimes known as the ‘stage’ of the cancer) and how well that cancer responds to treatment.

There are now masses of statistics which doctors can use as a guide to predicting the chances of a cure for any particular cancer at any particular stage. These show that for some of the more curable types of cancer the chances of the cancer coming back after treatment are very small indeed, particularly if it was discovered at an early stage. Whereas for other types or  cancers diagnosed when they were more advanced, the outcome is likely to be poorer.

These figures are only ‘statistics’ which means they cannot absolutely predict what will happen to an individual but they do give a good idea of the ‘chances’ of whether, or not, someone will be cured. So doctors rely on these figures for deciding what the likely outcome is for each person at the end of their treatment.

These days many many people are cured of their cancers. So if your doctors have given you the ‘all clear’, although there is no absolute way of proving they are right and guaranteeing you are cured, they obviously think your chances of success are excellent and you should look forward to the future with confidence.

I have recently finished treatment for a cancer. My doctors have given me the all clear but how can I be sure I am cured and the cancer won’t come back?

Despite the advances that have been made in the treatment of cancer there are still many tumours that cannot be cured. In these situations it often possible for different treatments to stop the growth and spread of the cancer, or even to shrink  it for a period of time.

Depending on the type of cancer and treatment which has been given this period of time when the tumour is no longer growing may last from a few weeks to a number of years.During this time the tumour is said to be  under control or ‘stable’. 

Other phrases which are sometimes used to describe this situation are ‘static disease’ and ‘ISQ’ (in status quo). If the cancer has shrunk  by at least 50% before the period of ‘stabilisation’ this may be referred to as a ‘partial remission’ or ‘partial regression’ or ‘partial response’ (all three terms mean the same thing).

Small changes in tumour size, either recorded by direct measurement or by looking at images on x-rays or scans are difficult to assess precisely. Therefore there is general agreement among cancer specialists that in order for a cancer to show signs of progression, or a relapse, there must be a greater than 25% change in the measurements that have been used to assess it. So provided that any change is less then this level, and assuming there has been no other evidence to suggest the disease is becoming active again), then the condition will still recorded as being ‘stable’.

My mother is having treatment for a cancer. The doctors have said she cannot be cured but have told her that because of treatment her condition is now stable. What does this mean?

In the early days of radiotherapy treatment, skin burns during treatment and sometimes permanent damage or scarring of the skin, was common.

This changed during the late 1950s and 1960s as two new types of machine were introduced to give the radiotherapy treatment. These are called Linear Accelerators and Cobalt Units. These machines produce irradiating rays of a much greater energy than the previous machines. This higher energy of the rays give the treatments greater accuracy and greater penetration of the tissues (allowing treatment of cancers deep inside the body and also reduce skin damage. This is because the high energy rays pass through the first centimetre or two of the first tissue they meet, before they actually begin to give out any radiation.
 
Skin problems are uncommon with modern radiotherapy treatment. Occasionally skin problems can occur because of the location of the cancer and the area of the body treated. Usually this will cause no more than some temporary pinkness or redness of the skin for a week or two after treatment. If any soreness does develop it will only last a short time and can usually be eased with creams or lotions, which you will be given at the hospital. Severe or permanent skin damage is  rare indeed.

The fact that skin damage was common forty or fifty years ago means that people can remember friends or relatives who had bad experiences with their radiotherapy treatments which  probably account for the stories you have heard. Nowadays the situation is very different and things have improved enormously.

I have cancer and have been told I will need radiotherapy. I am so frightened that the radiotherapy will burn me. I have heard such a lot of stories about this. What can I do?

Radiotherapy is almost always a local treatment, limited to a particular part of the body. Only the skin in that area will be irradiated and the skin elsewhere will not be affected.

The doses of radiotherapy used can vary but even with quite high doses modern radiotherapy machines usually cause a little skin irritation. Even so this does mean that the skin which has been irradiated will be more sensitive to sunlight than your normal skin.

The degree of sensitivity will vary from person to person. The increased sensitivity also reduces gradually with time but probably never disappears completely.

Having had radiotherapy does not mean you must avoid the sun completely but you should take care over exposing the treated skin. It is very important to cover the treated area for at least the first year after radiotherapy. Wear clothing made of cotton or natural fibres which have a closer weave and offer more protection against the sun. Even after this time the area treated will be more delicate, so extra care should be given. You should also use a high factor sunscreen (of at least factor 15). Remember, too much sunbathing does carry the risk of leading to skin cancer and should be avoided.

Very occasionally radiotherapy is given to the whole body. In this situation the doses are normally quite low but you should still take precautions in exposure to strong sunlight. Seek advice  from your doctors if you are having this type of treatment.

I am about to have a course of radiotherapy following an operation for cancer. If I go on holiday in a few months from now, will I be able to go out in the sun?

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Bone cancer – treatment

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