Osteosarcoma is a type of cancer/tumor that affects the bones. Osteosarcoma can affect people of any age, but it is most common at a young age and is the most common bone cancer affecting children and adolescents under the age of 20. You can find more information below.

What is osteosarcoma?

Osteosarcoma is a type of bone cancer that starts in bone-forming cells . Osteosarcoma is most often found in the long bones – more often the legs, but sometimes the arms – but it can start in any bone. In very rare cases, it also occurs in soft tissue other than bone.

Osteosarcoma tends to occur in teenagers and young adults, but it can also occur in younger children and older adults.

Treatment usually includes chemotherapy, surgery, and sometimes radiation therapy. Doctors determine treatment options based on where this bone cancer started, the size of the cancer, the type and grade of osteosarcoma, and whether the cancer has spread beyond the bone.

Treatment innovations for osteosarcoma have greatly improved the outlook (prognosis) for this cancer over the years. After completion of treatment, lifelong observation is recommended to monitor for potential late effects of intensive treatments.

Causes of osteosarcoma

It is not clear what causes this type of cancer. Doctors think this cancer occurs when something goes wrong with one of the cells responsible for making new bone.

Osteosarcoma begins when a healthy bone cell develops changes in its DNA. A cell’s DNA contains instructions that tell a cell what to do. The changes tell the cell to start making new bone when it’s not needed.

The result is a mass of poorly shaped bone cells (tumor) that can invade and destroy healthy body tissue. Cells can break down and spread (metastasize) throughout the body.

Who is at risk?

The following factors increase the risk of osteosarcoma:

  • Previous treatments with radiation therapy
  • Other bone disorders such as Paget’s disease of bone and fibrous dysplasia
  • Certain inherited or genetic conditions, including hereditary retinoblastoma, Bloom syndrome, Li-Fraumeni syndrome, Rothmund-Thomson syndrome, and Werner syndrome
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Symptoms of osteosarcoma

Symptoms of osteosarcoma may include:

  • swelling near a bone
  • Bone or joint pain
  • Bone injury or bone fracture for no clear reason

When should you see a doctor?

It’s a good idea to see a doctor if you or someone near you has persistent symptoms that are worrying. The symptoms of this type of bone cancer are similar to many more common conditions, such as sports injuries, so your doctor may look for these causes first.

Osteosarcoma diagnosis

Your doctor may start with a physical exam to make a diagnosis and better understand the symptoms. Then he may consider the following procedures:

Imaging tests

Imaging tests help your doctor look for your bone symptoms, look for cancer, and look for signs that the cancer has spread.

Imaging tests may include:

  • X-ray
  • computed tomography
  • magnetic resonance imaging
  • positron emission tomography
  • bone scan

Removing a sample of cells for testing (biopsy)

A biopsy procedure is used to collect a sample of suspicious cells for laboratory testing. Tests can show whether cells are cancerous. Laboratory tests can determine the type of cancer and whether it is aggressive ( grade ).

Biopsy procedures used to diagnose osteosarcoma include:

  • Needle biopsy: The doctor inserts a thin needle into the skin and guides it to the tumor. The needle is used to remove small pieces of tissue from the tumor.
  • Surgical biopsy: The doctor makes an incision in the skin and removes the entire tumor (excisional biopsy) or part of the tumor (incisional biopsy).

Careful planning is required by the medical team to determine the type of biopsy needed and how it will be done. Doctors need to do the biopsy in a way that doesn’t interfere with future surgery to remove the cancer.

Therefore, it is always good to seek treatment from a team of specialists with extensive experience in pre-biopsy osteosarcoma management.

Osteosarcoma treatment

Treatment of this type of bone cancer typically includes surgery and chemotherapy. Radiation therapy may also be an option in some cases.

Surgical treatment

The goal of surgery is to remove all cancer cells. But planning the operation also takes into account how it will affect your ability to go about your daily life. The extent of surgery for osteosarcoma depends on several factors, such as the size and location of the tumor.

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Operations used to treat osteosarcoma include:

  • Surgery to remove only cancer (limb-sparing surgery): Most osteosarcoma operations can be performed to remove all cancer and work the limb so that function can be preserved. Whether this procedure is an option depends in part on the size of the cancer and how much muscle and tissue needs to be removed. If a section of bone is removed, the surgeon rebuilds the bone. The method of reconstruction depends on your situation, but options include metal prostheses or bone grafts.
  • Surgery to remove the affected limb (amputation): With advances in limb-sparing surgery, the need for amputation – removal of all or part of a limb – has drastically decreased over the years. If amputation is necessary, advances in prosthetic joints can significantly improve outcomes and function.
  • Surgery to remove the lower part of the leg (rotationoplasty): Sometimes used for children who are still growing, the surgeon removes the cancer and the area around it, including the knee joint. The foot and ankle are rotated and the ankle functions as the knee. A prosthesis is used for the lower leg and foot. Results typically allow the person to function very well in physical activities, sports and daily life.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. Chemotherapy treatment usually combines two or more drugs that can be administered as an injection, pill, or infusion by both methods.

For osteosarcoma, chemotherapy is usually recommended before surgery ( neoadjuvant therapy ). Doctors monitor how cancer cells respond to chemotherapy to plan further treatments.

If the osteosarcoma shrinks in response to chemotherapy, it may enable limb-sparing surgery.

If osteosarcoma does not respond to treatment, it may indicate that the cancer is very aggressive. Doctors may recommend a different combination of chemotherapy drugs or suggest a more aggressive operation to remove all of the cancer.

Chemotherapy can also be used after surgery to kill any remaining cancer cells.

If osteosarcoma comes back after surgery or has spread to other parts of the body, chemotherapy may be recommended to try to slow the growth of the disease.

radiation therapy

Radiation therapy uses high-energy rays such as X-rays and protons to kill cancer cells. Radiation may be an option in some situations, such as when surgery is not possible or surgeons are unable to remove all the cancer during surgery.

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During radiation therapy, energy beams are transmitted through a machine that moves around you as you lie on a table. Lights are carefully directed at the osteosarcoma area to reduce the risk of damaging surrounding healthy cells.

coping and support

The diagnosis of osteosarcoma can be frightening. Over time, you will need to find ways to cope with the distress and uncertainty of cancer. Until then, the following may help:

  • Learn enough about osteosarcoma to make a decision about care: Ask your doctor about this sarcoma, including treatment options. The more you learn, the more confident you will feel about understanding and making decisions about treatment options. If your child has cancer, seek guidance from the healthcare team on sharing this information in a compassionate and age-appropriate way.
  • Keep your friends and family close: Keeping close relationships strong can help you cope with cancer. Friends and relatives can provide the practical and emotional support you will need, especially when you feel overwhelmed.
  • Maintain your mental health: The support of a counselor, medical social worker, psychologist, or other mental health professional can help. If your child has cancer, you can ask your health and care team for information about emotional, social support and professional mental health support.

Osteosarcoma complications

Complications usually include:

  • Spread of cancer (metastasize): Osteosarcoma can spread from where it started to other areas, making treatment and recovery more difficult. It most commonly spreads to the lungs and other bones.
  • Adaptation to limb amputation: Surgery that removes the tumor and spares the limbs is a method used whenever possible. Sometimes it is necessary to remove part of the affected limb to remove all the cancer. Learning to use an artificial limb (prosthesis) takes time, practice and patience. Experts can help you adapt.
  • Side effects of long-term therapy: The aggressive chemotherapy needed to control osteosarcoma can cause significant side effects, both in the short and long term. Your healthcare team can help you manage side effects that occur during treatment and may ask you to make a list of side effects to monitor for years after treatment.

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