Osteosarcoma

Overview

What is osteosarcoma?

Osteosarcoma is a kind of bone cancer that most often affects children and teenagers. It usually begins in a leg bone (either the femur or the tibia) near the knee or in the upper arm bone (the humerus) near the shoulder. Osteosarcoma can metastasize (spread) to other parts of the body, most often to the lungs or to other bones.

Symptoms

What are the symptoms of osteosarcoma?

Most people who have osteosarcoma do not feel or look sick. An osteosarcoma tumor may cause a dull aching pain in the bone or joint around the tumor. Often, there is a firm swelling or lump in the area of the pain. This swelling is caused by the tumor growing inside the bone.

If the cancer is in a leg bone, the person may limp. Also, the muscles in the arm or leg that has the osteosarcoma may look smaller than the muscles in the opposite arm or leg. Sometimes, the bone can break in the area of the tumor, because the tumor weakens the bone.

Causes & Risk Factors

Who gets osteosarcoma?

Osteosarcoma occurs most often in children, teenagers, and young adults between the ages of 10 and 20. It is slightly more likely to affect males.

Osteosarcoma is not a common cancer. Only about 400 cases occur in the United States each year. It is the most common bone cancer in children and teenagers.

What causes osteosarcoma?

Osteosarcoma has no known cause. Some researchers believe that genetics may play a role. In some cases, osteosarcoma can develop as a result of radiation therapy.

Diagnosis & Tests

What tests will the doctor use to tell if my child has osteosarcoma?

Physical exam: The doctor will check for general signs of health as well as examine the place around the swelling, lump or break. The doctor will also ask about any previous health conditions or medical treatments.

X-ray: An X-ray is usually the first imaging test your doctor will order. If there is a tumor, it will usually show up on the X-ray.

MRI and CT: The doctor may also order an MRI scan, a CT scan (also called a CAT scan), or both. MRI scans take pictures that help the doctor see if the tumor has destroyed any of the bone, and a CT scan is useful to look at the chest and belly to see if the disease has spread. Before a CT scan, the doctor may inject or ask you to swallow a special kind of dye. The dye helps the organs or tissues show up more clearly on the scan.

Biopsy: A biopsy is important because other malignant (cancerous) tumors and some infections can look like osteosarcoma on an X-ray. For the biopsy, a doctor with training in the treatment of bone cancer takes a piece of the tumor from the bone, sometimes with a needle, sometimes through an incision. This piece of tissue is looked at under a microscope to see if the tumor is an osteosarcoma.

Other tests: The doctor may recommend other tests to see if the cancer has spread to the lungs or other organs. For example, a bone scan will help the doctor see if the cancer has spread to other bones. Other tests may also be needed.

Treatment

How is osteosarcoma treated?

Osteosarcoma is treated with a combination of chemotherapy, surgery, and/or radiation therapy. For chemotherapy, your child or teenager will be given medicines that kill the main tumor and any tumor cells that have moved to other parts of the body. This treatment is usually started before surgery to kill the tumor or make it smaller.

Surgery is performed to remove the tumor. Almost everyone who has this type of cancer can have "limb-sparing" surgery. In this surgery, the tumor is removed along with the area of bone that it grew in. Then the doctor replaces the missing bone so that, after rehabilitation, the joint will still work normally. In some cases, the doctor may recommend amputation (removal of the limb) as the best way to remove the tumor.

After the surgery, the doctor may recommend more chemotherapy and/or radiation therapy. Chemotherapy and radiation therapy help to kill any remaining cancer cells in the body that might be left after surgery.

What can we expect after treatment?

Today, about 3 out of 4 people who have osteosarcoma can be cured if the cancer has not spread to other parts of the body. Almost everyone who is treated with limb-sparing surgery ends up with that arm or leg working well.

Many people who have osteosarcoma will need physical therapy for several months after the surgery. If amputation is necessary, rehabilitation may last for much longer. There are many new prosthetic treatments now available to help people who have had amputations regain movement and independence.

After the treatment is over, you or your loved one will:

  • Need to see the bone cancer specialist regularly for several years

  • Have frequent CT scans of the lungs, bone scans, and X-rays to see if the tumor comes back or travels to the lungs or other parts of the body

  • Have X-rays to check for problems with any replaced pieces of bone

Other Organizations

Questions to Ask Your Doctor

  • If I have osteosarcoma once, am I more likely to get it again?

  • My child has osteosarcoma. How can I make him/her more comfortable?

  • If I have osteosarcoma, will I lose my leg/arm?

  • My child walks with a limp, but there’s no swelling. Should he/she be tested for osteosarcoma?

  • After my treatment for osteosarcoma is over, how often will I have to come back for follow-up visits?

  • I’m in my 40s and I have a swelling in my leg. Could it be osteosarcoma?

  • How long will I have to be in physical therapy after surgery?

Citations

  • Osteosarcoma: A Multidisciplinary Approach to Diagnosis and Treatment by JC Wittig, J Bickels, D Priebat, J Jelinek, K Kellar-Graney, B Shmookler, MM Malawer( 03/15/02, http://www.aafp.org/afp/20020315/1123.html)