Osteosarcoma

What is osteosarcoma?

Osteosarcoma is the most common type of pediatric bone cancer. It begins in the cells that form bone and can develop in any bone, though the tumors are typically found in the bones just above and below the knee and in the upper arm near the shoulder. Osteosarcoma may occur at any age but most often affects adolescents and young adults.

Children can also get benign (noncancerous) bone tumors. Like cancerous tumors, benign bone tumors may grow and compress healthy tissue, but they don’t spread to other parts of the body and are rarely life-threatening.

Scientists aren't sure what causes most bone tumors. A small number are due to hereditary conditions. For example, children with hereditary retinoblastoma, an uncommon cancer of the eye, have a higher risk of developing osteosarcoma.

If your child is diagnosed with osteosarcoma, rest assured that our team of doctors, nurses, physical therapists and other experts will help your child – and your family – through each step of their treatment and recovery.

Signs & symptoms of osteosarcoma

Common symptoms of this tumor include:

• Bone pain that may be worse at night or during physical activity.
• A lump, swelling or redness at the painful site (typically somewhere on an arm or leg).
• A bone fracture from a routine movement, such as throwing a ball. (Osteosarcoma weakens the bone, so breaks occur easily.)
• Limited range of motion.
• Numbness or a pins-and-needles sensation in the affected limb.

Other possible signs include fatigue, fever, weight loss and anemia (low levels of red blood cells), but none is a sure sign of cancer. Specific tests must be performed to diagnose the condition.

Diagnosis of osteosarcoma

To determine whether a child has osteosarcoma, the doctor may order various tests, including:

• X-ray. If osteosarcoma is suspected, this is often the first test performed. A bone tumor can be seen on a plain X-ray.
• Computed tomography (CT or CAT) scan. This imaging method, which uses a series of X-rays and a computer, can show whether the tumor has grown into nearby muscles and other soft tissues. A chest CT scan may be done to check whether the cancer has spread to the lungs.
• Blood tests. Standard blood tests provide indications of overall health, while certain special tests check for high levels of the enzymes alkaline phosphatase and lactate dehydrogenase, which can indicate damaged or diseased tissue.
• Bone scan. This test allows doctors to check the entire skeleton for spread of the cancer. The patient is injected with a small amount of low-level radioactive material, which travels through the bloodstream to the bones. A special camera can detect any clustering of the radioactive material, which may indicate cancer.

Treatment of osteosarcoma

This cancer is usually treated with surgery and chemotherapy.

Surgical treatments for osteosarcoma

The goal of surgery is to remove the cancer entirely. The type of surgery chosen depends on the tumor's size and location. Surgical approaches include:

• Amputation. If the cancer has infiltrated a large area, the only option may be to remove all or part of the affected leg or arm.
• Limb-sparing surgery. The goals of this approach are to remove all of the cancer and to preserve the limb's function and appearance as much as possible. The surgeon takes out the tumor, as well as some surrounding healthy tissue (to ensure no cancer remains), while saving nearby tendons, nerves and blood vessels. The removed section of bone may be replaced with an implant made either of metal or of human bone (from a donor or the patient). In some cases, an expandable implant that will grow with the child can be used.
• Rotationplasty. This technique may be an option for a tumor near the knee. The surgeon removes the diseased bone, the knee, the bottom end of the thigh bone, and the top of the calf bone. The remaining calf bone is rotated and reconnected to the thigh bone, so that the foot faces backward and the ankle bends like a knee. In time, the child is fitted with a prosthesis that allows for full mobility.

Chemotherapy for osteosarcoma

Chemotherapy may be administered before or after surgery. When given first, the drugs are used to shrink the tumor so it will be easier to remove. This may also prevent the need for amputation.

Because surgery can't always remove all cancerous cells, chemotherapy may be used afterward to destroy any remaining malignant cells and prevent their spread.

Recovery from osteosarcoma treatment

After surgery, patients need certain kinds of care, such as:

• Follow-up. Your child will have regular appointments (with both physical and imaging exams) to monitor their progress and detect any recurrence. If the cancer comes back, your child's care team will devise a new treatment plan.
• Rehabilitation. Physical and occupational therapists will work with your child on rebuilding strength and learning to perform daily activities with their altered limb or a prosthetic limb, depending on the surgery they had. After leg amputation, patients are usually walking in three to six months. It can take up to a year for patients to walk again after limb-sparing surgery.