If you have bone cancer of the leg, does it always mean they have to cut it off? I remember when Patrick Kennedy had his cancer. Have things changed since then? I’m asking because my nephew has been told he has osteosarcoma. And that’s all I know about the disease.

Osteosarcoma, also known as osteogenic sarcoma, is a rare malignant tumor that targets fast growing bone cells, which is why children and teens are affected most often. Edward Kennedy, Jr., lost his right leg due to bone cancer at the age of twelve in 1973. Much has changed since then in terms of treatment.

Now surgeons can offer a procedure called limb salvage. Instead of amputation, the tumor is removed and the leg (or arm) reconstructed as close to normal as possible. This is an option now because chemotherapy is done before surgery to shrink the number of circulating tumor cells.

This is important for patients with known metastases and because of the high risk of micrometastases already present. Chemotherapy also helps reduce the amount of blood supply to the tumor, which gives it a chance to shrink the main tumor as well. When chemotherapy has been completed, the body is given a three to four week rest in preparation for surgery. This sounds scary at first — you may think, what if the cancer cells start growing back during that break in time? But studies show no apparent bad effect of waiting in this fashion.

Sometimes it just isn’t possible to save the leg (or arm) and amputation is necessary. Removing as much of the tumor and the metastatic lesions as is possible will improve the prognosis. The decision to have the limb cut off is never easy. But for some patients, by the time the surgeon removes the necessary tissue and begins to do plastic surgery to improve function and appearance, it’s just easier and more functional to have an amputation.

Once the tumor has been removed and the limb restored as close to normal as possible, then a second round of chemotherapy is started. The patient, family members, and health care team must now watch for complications from the surgery such as infection, poor wound healing, failure of any mechanical parts, and joint instability. The treatment team does everything it can to reduce the risk of limb loss and cancer recurrence. The results of a multidisciplinary approach to osteosarcoma with improved treatments have greatly improved survival and quality of life since young Kennedy’s diagnosis.