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 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. The hospital staff may be able to arrange this for you. They can also arrange counselling or you can contact the Cancer Counselling Trust.

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 are usually taken out after 3–4 days. You will have a drip in 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.

Pain

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 attached to a needle in your arm, which releases the drug as you need it (you can give extra doses 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 'phantom 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.

Physiotherapy

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.

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 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.

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

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 other people 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, the fear is often worse than the reality. 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 get used to your amputation and to do things in your own time. You may want to take someone with you at first to offer 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 is a feeling that many people who have had an amputation go through. This can be a very disturbing fear, no matter what your age or whether you have a partner or not. 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. You may find our section on sexuality and cancer helpful.

Many people also 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.

We can give you details of support groups or counselling services in your area. Support groups can give both practical and emotional advice and help to stop you feeling as if you have to cope alone. You can also contact the Cancer Counselling Trust.