Overview
Osteosarcoma is a type of bone cancer that originates in the cells that form bones. It most commonly affects the long bones, such as those in the legs or arms, but can develop in any bone. Osteosarcoma is typically found in teenagers and young adults, but can also occur in younger children and older adults. Treatment options include chemotherapy, surgery, and sometimes radiation therapy, and the choice of treatment depends on various factors such as the location, size, and grade of the cancer, as well as whether it has spread beyond the bone. Despite the improvements in treatment, lifelong monitoring is necessary to detect potential late effects of treatments.
Understanding the disease
Symptoms
Symptoms of osteosarcoma may include swelling near a bone, bone or joint pain, and bone injury or bone break for no clear reason. If you notice any persistent signs and symptoms that worry you, it's important to make an appointment with your child's doctor. Osteosarcoma symptoms can be similar to more common conditions, such as sports injuries, so your doctor may investigate those causes first.
Risk Factors
Risk factors for developing osteosarcoma include previous treatment with radiation therapy, other bone disorders such as Paget's disease of bone and fibrous dysplasia, and certain inherited or genetic conditions including hereditary retinoblastoma, Bloom syndrome, Li-Fraumeni syndrome, Rothmund-Thomson syndrome, and Werner syndrome. It's not clear what causes bone cancer, but certain factors associated with an increased risk include inherited genetic syndromes, Paget's disease of bone, and radiation therapy for cancer.
Development
Osteosarcoma develops when healthy bone cells undergo genetic changes in their DNA, causing them to grow and multiply abnormally. These changes instruct the cells to produce new bone tissue when it is not needed. The result is a tumor made up of poorly formed bone cells that can invade and destroy surrounding healthy tissue. In rare instances, osteosarcoma can originate in soft tissue outside the bone. The exact cause of these genetic changes is not yet clear.
Assessment and Diagnosis
Triage
You should see a doctor if your child has any persistent signs and symptoms of osteosarcoma, such as swelling near a bone, bone or joint pain, or an unexplained bone injury or break. These symptoms may resemble more common conditions like sports injuries, so your doctor will likely investigate those possibilities first. If osteosarcoma is suspected, your doctor may refer you to a specialist for further evaluation and treatment.
Diagnosis
To diagnose osteosarcoma, the doctor may start with a physical exam to understand the symptoms. Imaging tests are used to investigate bone symptoms, look for cancer, and determine if the cancer has spread. Imaging tests may include X-ray, computerized tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), and bone scan. To confirm the diagnosis, a sample of suspicious cells is collected for laboratory testing through a biopsy procedure, such as a needle biopsy or surgical biopsy.
Management and Treatment
Complications
Complications of osteosarcoma and its treatment include:
- Cancer that spreads (metastasizes): Osteosarcoma can spread from where it started to other areas, making treatment and recovery more difficult. Osteosarcoma most commonly spreads to the lungs and other bones.
- Adapting to limb amputation: Surgery that removes the tumor and spares the limb is used whenever possible. However, sometimes it's necessary to remove part of the affected limb in order to remove all of the cancer. Learning to use an artificial limb (prosthesis) will take time, practice, and patience. Experts can help with the adaptation process.
Treatment
Treatment for osteosarcoma typically involves a combination of chemotherapy, surgery, and sometimes radiation therapy. The specific treatment plan depends on factors such as the location of the cancer, the size of the tumor, the type and grade of the osteosarcoma, and whether the cancer has spread beyond the bone. Treatment innovations have improved the prognosis for osteosarcoma in recent years, but lifelong monitoring is still recommended to watch for potential late effects of the intense treatments.
Preparing for medical consultation
To prepare for an appointment for osteosarcoma, which is a type of bone cancer, you should:
- Be aware of any pre-appointment restrictions: Ask your healthcare provider if there are any specific instructions you need to follow before the appointment, such as restricting your diet.
- Write down symptoms: Note down any symptoms you're experiencing, including those that may seem unrelated to osteosarcoma.
- Record personal information: Jot down key personal information, such as major stresses or recent life changes.
- Make a list of medications: Include all medications, vitamins, or supplements you're taking.
- Bring previous scans or X-rays: Bring previous imaging studies, reports, and any other medical records relevant to your situation.
- Consider bringing a support person: Having someone with you can help remember important details and provide emotional support. At the appointment, be sure to ask your doctor about the type, stage, and grade of your osteosarcoma, treatment options, potential side effects and risks, and any effects on your other health conditions. Prepare a list of questions to make the most of your time with the doctor.