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Tumour Surgery


A tumour is a lump or mass of tissue that forms when cells divide uncontrollably, leading to the replacement of healthy tissue with abnormal tissue. These growths can weaken bones, making them susceptible to fractures. Tumours can be classified as benign (non-cancerous) or malignant (cancerous), and their behaviour and growth vary based on their type.

Symptoms of a tumour may include the presence of a lump, pain, swelling, or fractures. Prompt diagnosis and treatment are essential to preventing complications and assessing the need for surgery.

Tumour surgery is a widely recognised and effective method for managing certain bone tumours, particularly giant cell tumours. Surgical interventions may involve techniques such as excision or curettage, which are employed based on the specific characteristics of the tumour.

Indications and Contraindications

Treatment decisions for bone tumours are highly individualised and depend on factors such as the type of tumour, its stage and the patient’s overall health. Here are some of the indications and contraindications of this procedure.


  • Primary Bone Tumours: Surgery is generally indicated for the treatment of primary bone tumours, which originate within the bone itself. These may include osteosarcoma, chondrosarcoma, and Ewing’s sarcoma, among others.

  • Localised Disease: When the tumour is localised and has not spread to distant sites, surgical removal is often the primary treatment option.

  • Pain and Dysfunction: Surgery is indicated when the tumour causes significant pain, impairs mobility, or threatens the structural integrity of the bone, leading to fractures or deformities.

  • Biopsy Confirmation: Surgical biopsy may be required to obtain a definitive diagnosis when other diagnostic methods, such as imaging and core biopsies, are inconclusive.

  • Adjuvant Therapy: Surgery is often followed by adjuvant treatments, like chemotherapy or radiation therapy, to target any remaining cancer cells and prevent recurrence.


Contraindications for bone tumour surgery

  • Distant Metastasis: If the cancer has already spread to distant organs or tissues, surgery may not be indicated as the primary treatment. In such cases, other systemic treatments may be considered.

  • High Surgical Risk: Some patients may have significant underlying health issues that make surgery too risky. In such cases, alternative treatment approaches may be explored.

  • Inaccessible Locations: Tumours located in areas that are difficult to access surgically or near vital structures (e.g., major blood vessels or nerves) may not be suitable for surgery.

  • Patient Preferences: The patient’s preferences and desires play a crucial role in treatment decisions. In cases where patients are not willing to undergo surgery, alternative treatment options should be discussed.

Benefits and Risks

Benefits of Bone Tumour Surgery:

  • Tumour Removal: The primary benefit of bone tumour surgery is the complete or partial removal of the tumour, which helps eliminate or reduce the cancerous growth within the bone.

  • Pain Relief: Surgery can alleviate the pain and discomfort associated with bone tumours, improving the patient’s quality of life and mobility.

  • Preservation of Function: When possible, surgeons aim to preserve the function of the affected bone and surrounding tissues, allowing patients to maintain their mobility and independence.

  • Diagnosis Confirmation: Surgical biopsies performed during the procedure can provide a definitive diagnosis and help guide further treatment decisions.

  • Prevention of Complications: Surgery can prevent fractures and deformities caused by the tumour, reducing the risk of complications.

  • Adjuvant Treatment: After surgery, patients may receive additional treatments, such as chemotherapy or radiation therapy, to target any remaining cancer cells, reducing the risk of recurrence.

Risks of Bone Tumour Surgery:

  • Infection: Infection at the surgical site is a potential risk and may require antibiotic treatment.

  • Bleeding: Surgery can lead to bleeding, and in some cases, blood transfusions may be necessary.

  • Nerve or Blood Vessel Damage: There is a risk of damage to nearby nerves or blood vessels, which can lead to sensory or motor deficits.

  • Incomplete Tumour Removal: In some cases, it may be challenging to completely remove the tumour without compromising the bone’s structural integrity, and residual tumour cells may remain.

  • Complications of Anaesthesia: Anaesthesia used during surgery carries its own set of risks, including allergic reactions and adverse effects.

  • Functional Impairment: Depending on the extent of surgery, there may be some loss of bone function or mobility.

  • Long Recovery: Recovery from bone tumour surgery can be lengthy and may involve physical therapy and rehabilitation.

  • Recurrence: Although surgery aims to remove the tumour, there is always a risk of local or distant recurrence of cancer.

  • Cosmetic Changes: In some cases, surgery may result in cosmetic changes or limb length discrepancies, which can affect a patient’s self-esteem.

Surgical Approach

Tumour removal is a highly effective approach to managing tumours. Various surgical techniques are available, including excision or curettage, tailored to the specific case. These procedures can range from straightforward to intricate, depending on the tumour’s nature and its impact on surrounding tissues.

Treating giant cell tumours:

  • Curettage: Curettage, a widely employed technique for giant cell tumours, involves meticulously scraping the malignant growth from the bone using specialised tools. The process aims to remove the tumour while preserving the affected bone’s integrity.
  • Bone Graft: Following the curettage, the cavity left behind is carefully filled with a bone graft to ensure the bone remains stable. The source of this graft may be from a donor or another section of the patient’s own body, most commonly the hip. In some cases, surgeons may also use a specialised cement mixture to fill any holes within the cavity. Additional chemicals like liquid nitrogen, hydrogen peroxide, or phenol may be added to reduce the risk of further occurrences.


Other surgical options

For tumours that have recurred or caused extensive damage to bones or tissues, our surgeon may opt for more intricate removal and reconstruction procedures. These procedures may involve the use of bone grafts, artificial joints, bone, or soft tissue regions. The aim is to restore them to their usual functioning state so that they can carry out normal everyday tasks.

Malignant tumours: When a tumour becomes malignant, treatment options become more complex.

Limb Salvage Surgery: This surgical approach aims to remove the cancerous portion of the bone while carefully preserving nearby muscles, tendons, nerves, and blood vessels when possible. Following the removal of the tumour and an area of surrounding tissue, either an implant (prosthesis), a bone from elsewhere in the patient’s body, or a donor’s bone is used to fill the void.
Amputation: In cases where the tumour is large or involves nerves and blood vessels, amputation may be necessary to remove all or part of a limb. Following amputation, a prosthetic limb or osseointegration may be employed to aid in functionality.

This approach to your tumour removal surgery and subsequent recovery is highly individualised based on the type of tumour and the specific procedure performed. During your consultations and pre-surgical discussions, your surgeon will provide detailed information tailored to your condition.

Pre-Surgery Information

The following is what can be expected before a bone tumour surgery:

Before the surgery, routine blood tests will be conducted to check your general condition,   infection and inflammatory markers. Additionally, bone scans, x-rays, and CT scans will be taken to closely examine the patient’s anatomy.

  1. Patient Evaluation: A thorough assessment of the patient’s overall health, medical history, and orthopaedic condition. When necessary, your health might need optimisation and we may refer you to another specialist.
  2. Medications: Inform your healthcare provider about any medications you’re taking, as some may need to be adjusted before surgery. You should stop taking aspirin or anti-inflammatory medications 10 days prior to the surgery. Also, you should discontinue any naturopathic or herbal medications during this period.
  3. Imaging: X-rays, CT scans, and MRIs are used to evaluate the extent of damage and plan the surgery. CT scans are especially helpful in planning the surgical steps.  
  4. Skin preparation: The night before and on the morning of the operation, you will be asked to wash the leg with a sponge provided at the pre-admission clinic. If there is any suspicion of an iodine allergy, a Betadine Skin test might be used.
  5. Bowel Prep: Glycerin suppositories will be provided at the pre-admission clinic, and you will need to administer them the evening prior to the surgery. An instruction leaflet will be given to guide them.
  6. Patient education: During a physiotherapy assessment, a qualified physical therapist will provide you with personalised instructions on gait training, the use of crutches, and pre- and postoperative exercises. You will be fitted with crutches to take home and practise before the surgery.

On the day of the Surgery

  • Surgical paperwork will be administered by the nurses, and the anaesthetist will meet with the patient to ask a few questions.
  • A hospital gown will be given, and the operation site will be shaved and cleaned.
  • Betadine skin prep will be applied to the area above the operation site and wrapped.
  • All x-rays are to be sent with the patient to the theatre.

Surgical Procedure

The specific surgical procedure for bone tumour surgery can vary significantly based on factors such as the type and location of the tumour, the extent of the surgery, and the patient’s overall health. Here is a general overview of the steps involved in a typical bone tumour surgery:

  1. Anaesthesia: The patient will be placed under general anaesthesia to ensure they are unconscious and pain-free during the procedure.

  2. Incision: The surgeon will make an incision at the surgical site, exposing the affected bone and the tumour.

  3. Tumour Resection: The surgeon will carefully remove the tumour from the bone. The extent of resection will depend on whether it’s a benign or malignant tumour and the goal of treatment. In some cases, a margin of healthy tissue surrounding the tumour is also removed to ensure complete excision.

  4. Reconstruction: If necessary, the surgical team will reconstruct the affected bone to maintain its structural integrity. This may involve techniques such as bone grafting, bone cement, endoprostheses (implantable devices), or other bone-preserving methods.

  5. Biopsy: A biopsy may be taken during the surgery to obtain a small sample of the tumour for pathological analysis to confirm the diagnosis.

  6. Closure: The surgical incision is then closed with sutures or staples. Sterile dressings are applied, and drains may be inserted to remove excess fluid.

  7. Pathological Analysis: The excised tumour is sent to a pathology lab for further analysis to confirm the diagnosis and assess the margins for any cancerous cells left at the edges.

The specific details of the surgical procedure can vary widely based on the individual case and the type of bone tumour. Dr. Al Muderis’ medical team will discuss the procedure, potential risks, and expected outcomes with the patient before surgery. 

Post-Surgery Information

Once the surgery is complete, regular follow-up visits and tests will be necessary to confirm that the tumour has been effectively removed. Early detection is crucial, as there is a possibility of tumour recurrence in some cases. Maintaining a regular monitoring schedule is essential to avoiding potential complications.

Following tumour removal surgery, patients can anticipate the following recovery process: 

On the day after the surgery, the patient’s drains will usually be removed, and they will be allowed to sit out of bed or walk, depending on their condition.

Patients can expect to be discharged either home or to a rehabilitation hospital approximately 5-7 days after surgery. The timing of discharge will depend on the individual’s pain levels and the availability of support at home.

Follow-Up: Regular follow-up appointments with the team will help monitor your progress and address any concerns:

    • 1 week postop: for wound check,
    • 2 weeks postop: for sutures removal. If you need gradual correction or lengthening of bone, you will usually receive a program during this visit. In this case, you will need x-rays follow-up every two weeks, until the program has been completed.
    • 6 weeks postop: for x-ray assessment of healing progressing,
    • Later at 3, 6, 9, 12 months postop and further annually an x-ray will be mandatory.


Each patient’s rehabilitation plan will be tailored based on the specific surgical procedure and approach used. During the recovery period, patients may need to use crutches or a walker for a certain period of time. 

Physiotherapy is highly recommended for optimal recovery. A dedicated physiotherapist will work closely with the patient, guiding them through the post-surgical programme and ensuring safe and effective progress.


If patients are worried about their level of pain, experience significant bleeding, or notice fever or redness around the surgical site, they should contact the office immediately. If assistance is needed after hours, patients can contact the hospital where the surgery was performed, and they will contact Professor Al Muderis on their behalf.

Norwest Private Hospital: (02) 8882 8882

Macquarie University Hospital: (02) 9812 3000