Bone cancer is a malignant tumor that arises from the cells that make up the bones of the body. There is a mass of unusual cells growing in a bone. Bone cancer surgery involves removal of the tumor and some surrounding healthy tissue during an operation. It involves a wide of excision of the tumor. Surgery is based on the damage done by the tumor. Some of the surgical options are –
1. Limb salvage surgery – the main aim of limb salvage surgery is to remove all of cancer without affecting the function of the body part. Most patients are able to salvage their limb although it is a highly complex surgery. The challenge is to remove the entire tumor while still saving the nearby tendons, nerves, and vessels. In this surgery, a bone graft or an endoprosthesis is used to replace the bone that is lost to cancer.
2. Amputation – It is a surgery when cancer has spread to the inside of the bones. There is need of removal of a part of the whole limb. Amputation may be needed if removing cancer means removing key nerves, arteries or muscles that would leave limb without function. Surgery is planned so that the muscles and the skin will form a cuff around the amputated bone. This cuff fits into the end of an artificial limb.
3. Reconstructive surgery – Reconstructive surgery is needed after amputation to rebuild or reconstruct a new limb. Forex – in case of a leg that is amputated mid-thigh, the lower leg and foot can be rotated and attached to the thigh bone. The old ankle joint becomes the new knee joint.
4. Radiation therapy – For bone cancer, radiation therapy is most often used for patients who have a tumor that cannot be removed with surgery. It may be done before the surgery to shrink the tumor or may be done after the surgery to destroy any remaining cancer cells. It makes possible to perform less extensive surgery often preserving the arm or leg.
After the physical assessment, you shall be medically investigated for your bone problem. Once investigations and medical assessment are completed your surgery shall be planned.
You would be encouraged to ask any questions you may have regarding surgery, stay recovery and activities after surgery.
You and/ or your relative has explained the procedure in detail and consent is undertaken. Pre-anaesthesia checkup (PAC) is done. The intravenous line (IV) is given to provide fluids. You are shifted to OT for the procedure. You are given anesthesia before surgery. Post-procedure, you will be moved to Post Anaesthesia Care Unit (PACU) and once fully awake, you will be moved to Intensive Care Unit for overnight observation.
You are shifted to the regular room. You may have pain, fever and may not feel like eating anything, which is ok for post-surgical day 2 to say 4. You are monitored in the room and shall be given appropriate medication including pain relievers. You may have Patient Controlled Analgesia (PCA) pump. You would have a drain in your back (Hemovac) and a catheter to help you pee.
You would be slowly mobilized by rehabilitation team. You will also undergo mild physiotherapy. Your pain should have decreased by now. Your catheter would be removed and you would be encouraged to use a regular washroom.
Your incision would be inspected and if the wound has healed, stitches or staples shall be removed. You shall continue to have a bandage for another day.
Discharge process is undertaken. You will be explained about the discharge medication, exercises to be done at home and follow up. You will be discharged in stable condition.
The first follow up will be after 3 weeks of the surgery followed by six weeks and six-month checkups. Anytime thereafter you could have a follow up if there are any questions /concerns about the recovery.
During this time you would need to slowly start getting back to normal routine, however, it may be difficult for you to join office/school immediately. You will be asked to refrain from smoking.
You can return to rigorous activities after 4-6 months of the surgery.