Most people with primary bone cancer will need a combination of different treatments. The treatments that are used are surgery, chemotherapy and radiotherapy.

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 malignant fibrous histiocytoma. It is often given before surgery and may shrink large tumours enough to avoid amputation (removal of the limb). More chemotherapy is given after the 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.

In most hospitals a team of specialists will discuss with you the treatment that they feel is best for your situation. This multidisciplinary team (MDT) will include a surgeon who specialises in bone cancers, a medical oncologist (chemotherapy specialist), a clinical oncologist (who specialises in radiotherapy as well as chemotherapy) and may include a number of other healthcare professionals such as a:

• nurse specialist
• dietitian
• physiotherapist
• occupational therapist
• psychologist or counsellor.

Together the doctors will be able to advise you on the best course of action and plan of treatment, taking into account a number of factors. These include your age, general health, the type and size of the tumour, and whether it has begun to spread.

If two treatments are equally effective for your type and stage of cancer, your doctors may offer you a choice of treatments. Sometimes people find it very hard to make a decision in this situation. If you are asked to make a choice, make sure that you have enough information about the different treatment options, what is involved and the side effects you might have, so that you can decide what is the right treatment for you.

Remember to ask questions about any aspects that you do not understand or feel worried about. You may find it helpful to discuss the benefits and disadvantages of each option with your cancer specialist, nurse specialist or with our support service nurses.

If you have any questions about your treatment, don't be afraid to ask your doctor or nurse. It often helps to make a list of questions and to take a close friend or relative with you.

Even though a number of cancer specialists work together as a team and they use national treatment guidelines to decide on the most suitable treatment, you may want to have another medical opinion. Either your specialist, or your GP, may be willing to refer you to another specialist for a second opinion, if you feel it will be helpful. The second opinion may cause a delay in the start of your treatment, so you and your doctor need to be confident that it will give you useful information.

If you do go for a second opinion, it may be helpful to take a friend or relative with you, and have a list of questions ready, so that you can make sure your concerns are covered during the discussion.

Before you have any treatment, your doctor will explain the aims of the treatment to you. They will usually ask you 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 other possible 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.

It is often a good idea to have a friend or relative with you when the treatment is explained, to help you remember the discussion more fully. You may also find it useful to write down a list of questions before you go to 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. 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. 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, so that they 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.

Many people are frightened at the idea of having cancer treatments, particularly because of the side effects that can occur. Some people ask what would happen if they did not have any treatment.

Although many of the treatments can cause side effects, these can usually be controlled with medicines.

Treatment can be given for different reasons and the potential benefits will vary depending upon the individual situation.

In people with early-stage bone cancer, surgery is often done with the aim of curing the cancer. Occasionally, additional treatments are also given to reduce the risk of it coming back.

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 to control the cancer for a period of time, it may be more difficult to decide whether to go ahead with treatment.

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