Osteosarcoma (Osteogenic Sarcoma) in Children
Osteosarcoma is very rare, but it's
the most common kind of bone cancer in children and teens. It's most common in teens
Osteosarcoma is cancer that starts
in the bone. The cancer (malignant) cells look like immature bone cells. The bone
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
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.
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.
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
- Age between 10 and 30 years
- Tall height
- Male sex
- Certain bone diseases
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
- A bone that breaks for no known
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.
Your child's healthcare provider
will ask about your child's health history and symptoms. He or she 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
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 (ESR) may
higher than normal. Blood tests also give an idea of your child's overall
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
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 doctor with experience and knowledge about bone
After a diagnosis of osteosarcoma,
other tests might be done. These help your child's healthcare providers learn more
the cancer. They can show how much and how far the cancer has spread (metastasized)
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,
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
a lot like normal cells and tend to grow and spread slower than grade 2. This may
be called a low-grade tumor. Grade 2 (G2) is called high grade, and the cells look
different from normal cells. They tend to grow and spread quickly.
When working on a treatment plan, some providers use a simpler way
- 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
- Unresectable or non-resectable tumors can't be completely
The stage of a cancer is one of the
most important things to know when deciding how to treat the cancer. Be sure to ask
child's healthcare provider to explain the stage of your child's cancer to you in
you can understand.
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 drugs that
kill cancer cells. They're usually given before surgery to help shrink the tumor.
They 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
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 medicines may also be given into a vein (IV). It collects
the cancer cells and kills them.
Targeted therapy. These drugs 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.
Some problems linked to
osteosarcoma or its treatment include:
- Infection or bleeding from
- Loose or broken grafts or rods after
- 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
- Problems with the ability to have
children (fertility) in the future
- Return of the cancer (recurrence)
- Growth of other cancers later in life
A child with osteosarcoma needs
ongoing care. Your child will be seen by oncologists and other healthcare providers
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
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
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. He or
she 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
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
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
- New symptoms
- Side effects from treatment, such
- Shortness of breath
- Trouble eating or drinking
- Osteosarcoma is cancer of the
bone. It’s rare, but it's the most common type of bone cancer children and
- 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.
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
instructions 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
- 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. This is important if your child becomes ill and you have
questions or need advice.