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Which tumours need surgery on the sacrum? | CION Cancer Clinics
Most surgery on the sacrum is for a chordoma, a rare slow-growing tumour at the base of the spine. Chondrosarcoma, giant cell tumour, some bone sarcomas and rectal cancer grown into the bone can also need it. This page explains each tumour, how the type is confirmed by a planned biopsy, and when surgery is not the main treatment. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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On this page
- Which tumours lead to surgery on the sacrum?
- What are the tumours that most often need it?
- How is the tumour type confirmed?
- Is it a tumour of the bone, or cancer spread from elsewhere?
- What do people often believe about these tumours?
- What should you ask once the tumour type is known?
- Common questions about sacral tumours
The short answer
Which tumours lead to surgery on the sacrum?
The most common reason is a chordoma, a rare slow-growing tumour that starts in the bone at the base of the spine. Other bone tumours, some sarcomas and a rectal cancer that has grown back into the bone can also need it.
Why these tumours, and not others
Surgery on the sacrum is offered when the tumour is most reliably controlled by removing it whole, and when it has not spread widely. Tumours that respond well to radiotherapy or medicines alone are usually treated that way instead. The type of tumour, confirmed by biopsy, is what decides the plan.
Why it is often found late
The sacrum sits deep in the pelvis, with room around it for a tumour to grow without pressing on anything. The first signs are often a dull low back ache, pain in the buttock or tailbone, constipation, or numbness around the back passage. These are easily blamed on a slipped disc or piles, sometimes for months.
What this page cannot tell you
A scan can suggest a chordoma, but it cannot confirm one. Only the biopsy can say what the tumour is, and only your treating team can say whether surgery is the right step for you.
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One thing that cannot wait
If someone with back or buttock pain suddenly cannot pass urine, loses control of the bladder or bowel, goes numb between the legs, or develops new weakness in both legs, go to the nearest emergency department the same day. These can be signs of pressure on the nerves at the base of the spine. Do not wait for the next clinic appointment, and do not wait to see whether it settles.
Not sure whether this applies to you?
Ask an oncologistTumour types
What are the tumours that most often need it?
Each behaves differently, and the plan around the operation changes with the type.
Chordoma
A rare tumour that grows from leftover cells from before birth. It grows slowly but pushes into nerves and tends to come back if any is left behind.
What usually happens
- Removal in one piece
- High-dose radiotherapy in some cases
Chondrosarcoma
A cancer of cartilage-forming cells. It responds poorly to chemotherapy and ordinary radiotherapy, so surgery is the main treatment.
Giant cell tumour
Usually not a cancer, but it can destroy bone and come back. Some are shrunk with a medicine first, which can make the operation smaller.
Not every giant cell tumour needs a sacrectomy.Ewing sarcoma and osteosarcoma
Bone cancers seen more in younger people. Chemotherapy usually comes first, and surgery or radiotherapy follows once the tumour has responded.
Rectal cancer grown into bone
A rectal cancer that has come back low in the pelvis may involve the sacrum. Removing part of the bone can then be part of a larger pelvic operation.
Before any decision
How is the tumour type confirmed?
MRI of the pelvis
Shows the size of the tumour, which nerves it touches and how close it sits to the rectum and blood vessels.
CT of the chest and bone
Shows how much bone is destroyed and checks the lungs, the most common place for spread from bone tumours.
A planned needle biopsy
Taken through the back along a route the surgeon chooses, so that the track can be removed later with the tumour. A biopsy through the rectum should be avoided.
Tumour board review
The pathologist, radiologist and surgical, radiation and medical oncologists agree on the type and the plan before anything is booked.
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Is it a tumour of the bone, or cancer spread from elsewhere?
Tumour starting in the sacrum
Cancer spread to the sacrum
Often a single mass, growing slowly over time
Often one of several spots in different bones
Surgery to remove it whole is often the main treatment
Radiotherapy and medicines are usually the main treatment
Biopsy is planned by the surgical team
Biopsy may be taken from an easier site
Aim is long-term control of the tumour
Aim is usually pain relief and protecting the nerves
Commonly believed
What do people often believe about these tumours?
"It is only a slipped disc, the pain will pass."
Most back pain is not a tumour. But back pain that keeps getting worse, wakes you at night, or comes with constipation or numbness around the back passage needs an MRI, not another course of painkillers.
"A benign tumour does not need a big operation."
Some tumours that are not cancer still destroy bone and press on nerves. A giant cell tumour is one. How it behaves matters more than the label.
"Take a quick biopsy locally, then go to the big
centre."
A biopsy through the wrong route can seed tumour cells along the track. For a suspected chordoma, the biopsy is safer when planned by the team who will operate.
"Chemotherapy will shrink it first."
That is true for Ewing sarcoma and osteosarcoma, but chordoma and chondrosarcoma respond poorly to it. Your biopsy result decides what is given, and when.
Next steps
What should you ask once the tumour type is known?
Once the biopsy names the tumour, the conversation moves from what it is to what can be done. It helps to go in with a short list of questions, and with the family member who will help decide.
Questions about the plan
Ask whether surgery is the main treatment for this tumour type, and whether radiotherapy or a medicine comes before or after it. Ask whether high-dose radiotherapy alone has been considered, and why it was or was not chosen.
Questions about the operation
Ask how high the cut is likely to go, which nerves are at risk, and whether metal rods will be needed. Ask how many operations of this kind the team does, and who else will be in theatre.
Questions about life afterwards
Ask how long the hospital stay usually runs, when you can expect to sit and walk, and who will teach the family catheter and bowel care if it is needed. Ask what follow-up scans are planned, how often, and whether they can be done closer to home. These answers help a family plan leave, travel and money before the date is fixed.
Who surgery may not suit
If the tumour has spread widely, or if general health makes a long operation too risky, other treatment is often gentler and more useful. Your team should explain that option as fully as surgery.
Bring every scan on a CD or pen drive, not only the printed report. The surgeon needs to see the pictures.Questions we are asked
Common questions about sacral tumours
Is a chordoma a cancer?
Yes, it is treated as a low-grade bone cancer. It grows slowly and does not often spread early, but it presses into nearby nerves and bone and tends to come back where it started. That is why removing it whole, with a margin of healthy tissue, matters so much in planning.
What symptoms made doctors suspect it?
Usually a low back or tailbone ache that slowly gets worse, pain on sitting, constipation, trouble passing urine, or numbness around the back passage. Sometimes a lump is felt. None of these alone means a tumour, but together they are reason for an MRI.
Why was the biopsy taken from the back?
Because the surgeon may need to remove the needle track later along with the tumour. A route through the back can be included in the operation. A route through the rectum could spread tumour cells into the bowel, which would make the operation bigger.
Can it be treated without surgery?
For some people, yes. High-dose radiotherapy is used when surgery is not possible or would cost too much function. A tumour that has spread to the sacrum from elsewhere is usually treated with radiotherapy and medicines. Your tumour board explains which applies to you.
Does every sacral tumour need the whole sacrum removed?
No. Many tumours sit low enough that only part of the bone is removed. The height of the tumour on the MRI decides how much bone and which nerves are involved. A total sacrectomy is the largest version and is needed less often.
Will I need chemotherapy as well?
It depends on the tumour type. Ewing sarcoma and osteosarcoma are treated with chemotherapy before and after surgery. Chordoma and chondrosarcoma are not usually helped by it. A giant cell tumour may be given a targeted medicine first. Your biopsy result decides this.
Is it hereditary? Should my children be checked?
Most chordomas and sacral bone tumours are not inherited. Very rarely, a family carries a change that raises the risk. If more than one relative has had a chordoma, mention it to your oncologist, who can say whether genetic advice would be useful.
Where should this kind of tumour be treated?
At a centre that sees sacral and pelvic bone tumours regularly, with surgical, spine, plastic, radiation and rehabilitation teams working together. Ask how often the team treats this tumour type and whether your case will go to a tumour board before any date is fixed.
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Sources
- National Cancer Institute — Bone Cancer
- Cancer Research UK — Bone cancer
- American Cancer Society — Bone Cancer
- NHS — Bone cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
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