Osteosarcoma (Osteogenic Sarcoma) in Children
Overview
Osteosarcoma is very rare, but it's
the most common kind of bone cancer in children and teens. It's most common in teens
and
young adults.
Osteosarcoma is cancer that starts
in the bone. The cancer (malignant) cells look like immature bone cells. The bone
they
form is not strong.
The cancer most often grows in the
ends of long bones, most often the bottom of the thigh bone (femur) and the top of
the
larger shin bone (tibia). The top of the upper arm bone (humerus) close to the shoulder
is another common place it starts.
Your child's treatment team can
explain the type your child has and what it means.
Causes
The exact cause is not known. Cancer is caused by changes in the DNA
of the cells. In most cases of osteosarcoma, these changes are not passed on from
parents to children. They happen by chance.
Risk Factors
A child with certain rare genetic
cancer syndromes may be at higher risk of osteosarcoma. Having radiation or chemotherapy
treatment for other cancers also increases the risk.
Other risk factors for osteosarcoma
include:
- Age between 10 and 30 years
- Tall height
- Being assigned male at birth
- Certain bone diseases
Symptoms
Symptoms can be different in each
child. They can include:
- Bone or joint pain at the tumor
- Swelling at the tumor
- Lump (mass) in the affected bone
- Increased pain with activity or at
night
- A bone that breaks for no known
reason
The symptoms of osteosarcoma can be
a lot like other, more common health conditions. Make sure your child sees a healthcare
provider for a diagnosis.
Diagnosis
Your child's healthcare provider
will ask about your child's health history and symptoms. They will examine your child.
Your child may be referred to a specialist. This may be a bone specialist (orthopedic
surgeon) or a bone cancer specialist (orthopedic oncologist). Your child may need
tests,
such as:
-
X-ray. An X-ray uses a small amount of radiation to take
pictures of bones and other body tissues.
-
Blood tests. Osteosarcoma can cause changes in some blood
tests. For instance, liver tests and the erythrocyte sedimentation rate may be higher
than normal. Blood tests also give an idea of your child's overall health.
-
CT scan. This test uses a series of X-rays
and a computer to make detailed images of the inside of the body.
-
MRI. This test uses large magnets, radio waves, and a
computer to make detailed images of the inside of the body.
-
Bone scan. A small amount of radioactive tracer is put
into a vein. It travels through the blood. Then the whole body is scanned. The tracer
collects in parts of bone where there may be cancer.
-
Positron emission tomography (PET) scan. For this test, a
radioactive sugar is put into the bloodstream. Cancer cells use more sugar than
normal cells, so the sugar will collect in cancer cells. A special camera is used
to
see where the radioactive sugar is in the body. A PET scan can sometimes spot cancer
cells in different parts of the body, even when they can’t be seen on other tests.
This test is often used along with a CT scan. This is called a PET/CT scan.
-
Biopsy of the tumor. A small piece (sample) of the tumor
is taken and tested for cancer cells. A biopsy is needed to diagnose
osteosarcoma. The biopsy may be done with a needle or with surgery. It’s very
important that a biopsy be done by a healthcare provider with experience and
knowledge about bone tumors.
After a diagnosis of osteosarcoma,
other tests might be done. These help your child's healthcare providers learn more
about
the cancer. They can show how much and how far the cancer has spread (metastasized)
in
your child's body. A stage grouping is then assigned.
A commonly used staging system uses
stage groupings with a value of 1 to 3. They are written as Roman numerals I, II,
and
III. Some staging systems add a stage 4 (IV). The higher the number, the more cancer
there is and the more it has spread. Letters and numbers can be used after the Roman
numeral to give more details.
Staging for osteosarcoma also takes
into account the grade of the cancer. This is a measure of how much the cancer cells
look like normal cells. A 1 or 2 is used. In grade 1 (G1) tumors, the cancer cells
look
a lot like normal cells and tend to grow and spread slower than grade 2. This may
also
be called a low-grade tumor. Grade 2 (G2) is called high grade, and the cells look
very
different from normal cells. They tend to grow and spread quickly.
When working on a treatment plan, some healthcare providers use a
simpler way describe osteosarcoma:
- Localized means the cancer is only in the bone and nearby
tissues. Most osteosarcomas are localized when they're first found.
- Advanced or metastatic means the cancer has spread to other
parts of the body, like other bones or the lungs.
Localized osteosarcoma then falls in 1 of these groups:
- Resectable means all of the tumor can be taken out with
surgery.
- Unresectable or nonresectable tumors can't be completely
removed.
The stage of a cancer is 1 of the
most important things to know when deciding how to treat the cancer. Be sure to ask
your
child's healthcare provider to explain the stage of your child's cancer to you in
a way
you can understand.
Treatment
Treatment will depend on the stage
and other factors. Osteosarcoma can be treated with any of these:
-
Surgery. Surgery may be done to try to save the arm or
leg. This is called limb-salvage or limb-sparing surgery. Or surgery may be done to
remove an arm or leg (amputation). Surgery may also be done to remove tumors in other
parts of the body.
-
Chemotherapy. This is treatment with strong medicines that
kill cancer cells. They're usually given before surgery to help shrink the tumor.
This may also be given after surgery to help kill any cancer cells still in the
body. Chemotherapy is given in cycles with periods of rest.
-
Radiation therapy. These are high-energy X-rays or other
types of radiation used to kill cancer cells or stop them from growing. Radiation
is
not often used to treat osteosarcoma. It may be used when a tumor can’t be fully
removed with surgery. Or it may be used to slow the growth of a tumor and control
symptoms. A radioactive medicine may also be given into a vein (IV). It collects in
the cancer cells and kills them.
-
Targeted
therapy.
These medicines target changes that are mostly in or on cancer
cells. This allows them to kill cancer cells and limits damage to normal cells.
-
Clinical trials. Ask your child's healthcare provider if
there are any treatments being tested that may work well for your child. Clinical
trials are a good way to get the best treatment available along with new treatment
that might be better.
With any cancer, how well a child
is expected to recover (prognosis) varies. Keep in mind:
- Getting medical treatment right away
is important for the best prognosis. Cancer that has spread is harder to treat.
- Ongoing follow-up care during
and after treatment is needed.
- New treatments are being tested to
improve outcomes and lessen side effects.
Complications
Some problems linked to
osteosarcoma or its treatment include:
- Infection or bleeding from
surgery
- Loose or broken grafts or rods after
limb-salvage surgery
- Hair loss, mouth sores, nausea,
vomiting, diarrhea, increased risk of infection, easy bruising and bleeding, and
feeling tired from chemotherapy
- Skin irritation, hair loss, nausea,
diarrhea, poor bone growth, organ damage, and new cancers from radiation
- Emotional and physical challenges from
the tumor, surgery, or other treatments
- Heart and lung problems from
chemotherapy or targeted therapy
- Problems with growth and
development
- Problems with the ability to have
children (fertility) in the future
- Return of the cancer (recurrence)
- Growth of other cancers later in life
(secondary cancers)
Living with
A child with osteosarcoma needs
ongoing care. Your child will be seen by oncologists and other healthcare providers
to
treat any late effects of treatment and to watch for signs or symptoms of the tumor
returning. Your child will be checked with imaging tests and other tests. Your child
may
need to see other healthcare providers for problems from the tumor or from treatment.
Your child may need therapy to help with movement and muscle strength. This may be
done
by physical and occupational therapists.
You can help your child manage
treatment in many ways. For instance:
- Your child may have trouble eating. A
dietitian may be able to help.
- Your child may be very tired. They
will need to balance rest and activity. Encourage your child to get some exercise.
This is good for overall health. And it may help to lessen tiredness.
- Get emotional support for your child.
A counselor, therapist, or child support group can help.
- Make sure your child attends all
follow-up appointments.
When to Call a Healthcare Provider
Your child's treatment team will
talk with you about problems you should watch for and what changes they need to be
called about right away. Be sure you know what number to call if you have questions
or
concerns after office hours or on weekends or holidays.
You might be told to call the
healthcare provider if your child has:
- Symptoms that get worse or don't get
better with treatment, like vomiting even though you've been using anti-nausea
medicines.
- New symptoms
- Side effects from treatment, such
as:
- Fever
- Chills
- Shortness of breath
- Cough
- Diarrhea
- Trouble eating or drinking
Key Points
- Osteosarcoma is cancer of the bone. It
is rare, but it is the most common type of bone cancer children and teens.
- Symptoms can include bone pain,
swelling, or a lump (mass).
- The cancer may show up on an X-ray or
on other imaging tests. It's diagnosed with a biopsy.
- The biopsy and surgery should be done
by an orthopedic surgeon with experience treating osteosarcoma.
- Treatment is usually chemotherapy and
surgery. Surgery may be limb-sparing or amputation.
- Ongoing follow-up care during
and after treatment is needed.
Next Steps
Tips to help you get the most from
a visit to your child’s healthcare provider:
- Know the reason for the visit and what
you want to happen.
- Before your visit, write down
questions you want answered.
- At the visit, write down the name of a
new diagnosis, and any new medicines, treatments, or tests. Also write down any new
directions your provider gives you for your child.
- Know why a new medicine or treatment
is prescribed and how it will help your child. Also know what the side effects
are.
- Ask if your child’s condition can be
treated in other ways.
- Know why a test or procedure is
recommended and what the results could mean.
- Know what to expect if your child
doesn't take the medicine or have the test or procedure.
- If your child has a follow-up
appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your child’s
provider after office hours and on weekends and holidays. This is important if your
child becomes ill and you have questions or need advice.