Surgery for bone cancer that has spread

You might have surgery to remove primary bone cancer that has spread to the lungs (secondary cancer).

This page is about cancer that starts in your bone (primary bone cancer). If your cancer has spread into bone from another part of the body, it is called secondary or metastatic bone cancer.

Why you have it

Primary bone cancer can spread to the lungs (secondary lung cancer).

Your specialist may consider surgery to remove secondary lung cancer depending on:

• your type of bone cancer
• where the secondaries are in your lungs
• the size of the secondaries 
• how well your doctor expects your lungs to work after surgery
• if there is cancer spread anywhere else in your body

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

Sometimes the chemotherapy alone will get rid of the lung tumours, so you will not need surgery to remove them.

Osteosarcoma

If osteosarcoma spreads to the lungs, you might have surgery to remove the secondary cancer. Your cancer might be cured even if the cancer has spread when it is diagnosed. Occasionally it is possible to remove single bone secondaries with surgery.

If you are diagnosed with osteosarcoma and secondary lung cancer at the same time you will probably have:

• chemotherapy
• surgery to remove your bone tumour
• more chemotherapy
• surgery to remove lung tumours after chemotherapy is finished

Chondrosarcoma

Surgeons occasionally remove chondrosarcoma that has spread.

Ewing sarcoma

It is much rarer to have surgery to remove Ewing sarcoma that has spread to the lungs.

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

Surgery for secondary lung cancer is a major operation. As the surgeon needs to operate inside the chest, you have an operation called a thoracotomy.

Your surgeon opens the chest wall between the ribs to get to your lungs. 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 (reinflate). The drain is a tube that comes out of your chest and is connected to a bottle with gentle suction. The tube helps blood and fluid to drain out of the wound. The suction helps the lung to inflate again after the operation. 

You might have this procedure done as keyhole surgery. The keyhole procedure to remove bone cancer secondaries growing in the lung is called video assisted thorascopic surgery. It is less invasive than a normal operation.

After surgery

Your multidisciplinary team (MDT) will help you after your lung surgery. This includes physiotherapy and any rehabilitation you need.

Possible risks

Infection is a risk with any surgery, and is a particular risk for people having chemotherapy. You will have antibiotics during and after your operation, to try to reduce the risk of an infection.

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.