Osteosarcoma

Osteosarcoma is a cancerous (malignant) tumor of the bone. Osteosarcoma usually starts in the osteoblasts (bone cells). It frequently starts in the end of the long bones of the body, such as the arms and legs, but can also occur in other bones.  Most common sites are the distal femur (thigh bone above the knee), proximal tibia (shin bone below knee) and the proximal humerus (arm just below shoulder).

Signs and symptoms

  • Swelling of bone over area of the tumor

  • Pain that is worse with exercise or at night

  • Lump or bump with swelling that develops after days to weeks of pain

  • Limp ( if tumor in hip area)

  • Fracture (break) in bone in area of tumor (the break does not cause cancer rather than it is the result of the tumor)

Tests to help diagnose Osteosarcoma

  • Physical exam and history: The health care provider will check general signs of health, assess for any lumps or anything else that seems unusual. They will also get history of past illnesses, health habits and any family history of illness or cancer.

  • CT scan: A computer assisted X-ray that shows detailed pictures inside the body, such as neck, chest, abdomen and pelvis. A dye may be injected into a vein or swallowed to help the organ and tissues show up more clearly.

  • MRI (magnetic resonance imaging): Is a test that uses magnet, radio waves and a computer to make a series of detailed pictures of areas inside the body.

  • X-rays: Plain film X-ray of the affected area and any other area of concern. 

  • Blood tests:

    • CBC (complete blood count) checks the number of red blood cells (oxygen carriers), platelets (cells that help the blood clot properly) and white blood cells (infection fighters)

    • Blood chemistry studies to check kidney and liver function.

All these tests are usually done at time of diagnosis to rule out other diseases and are also done throughout treatment to monitor response and to monitor for possible side effects of treatment. 

  • Biopsy: There are different types of biopsies. The type of biopsy done will be based on the size of the tumor and where it is in the body

    • Incisional biopsy: Removal of part of a lump or a sample of tissue

    • Core biopsy: Removal of tissue from a lymph node using a wide needle

How is it treated?

Chemotherapy


Chemotherapy medications that are used to help kill cancer cells. Multiple types of chemotherapy medications are used in the treatment of osteosarcoma. Chemotherapy is given in a specific sequenced combination, given IV. Each chemotherapy treatment lasts several days and is given in the hospital. The health care team will explain in detail the treatment plan and possible side effects of the chemotherapy.

Surgery


The timing of the surgery depends on the size and extent of tumor and the tumor’s response to chemotherapy, but it is often done after several rounds of chemotherapy have been given to help reduce tumor size. The type of surgery will depend on the location and the size of the tumor, whether the nerves and/or blood vessels are separate from the tumor, and the age of the child (how much more growth is expected).