OSTEOSARCOMA

Osteosarcoma
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Featured Topics:
· What is Osteosarcoma?
· Treating Osteosarcoma
· Potential Osteosarcoma Symptoms
· Osteosarcoma Risk Factors
· Osteosarcoma Treatment at CTCA
From the initial shock of an osteosarcoma diagnosis to evaluating your treatment options, at Cancer Treatment Centers of America (CTCA) we understand how overwhelming this time can be. If you or a loved one has received an osteosarcoma diagnosis, it is important that you learn about the treatment options available to you so you can evaluate your situation and individual needs. At CTCA we know that everyone is different, and that cancer will impact each person in different ways. Not everyone will experience the same symptoms, side effects, or respond to treatment the same way. That is why we work with all of our patients to ensure that they not only understand their options, but can participate in creating an individualized treatment plan based on their needs.
If you would like to learn more about CTCA and our approach to treating osteosarcoma, call 800-615-3055 to speak with an Oncology Information Specialist. They can tell you more about our innovative approach to cancer treatment and help you decide of CTCA may be the right treatment facility for you. You can also Discuss Your Treatment Options Online through our live chat feature.
What is Osteosarcoma?
Osteosarcoma is the most common type of bone cancer. Usually found in people between the ages of 10-25, osteosarcoma generally develops in new tissue within growing bones and is often found in the bones around the knee. Another related type of cancer, chondrosarcoma, arises in cartilage, usually in the pelvis, upper legs and shoulders.
How is Osteosarcoma Treated?
Osteosarcoma treatment depends on a number of factors, including the stage of the disease. However, because osteosarcoma can spread to other parts of the body, even if the tumor is detected when it is very small, osteosarcoma treatment requires treatment to the whole body. The most common forms of treatment include chemotherapy and surgery.
At CTCA, you will find comprehensive care delivered in a welcoming environment of compassion and support, helping you to relax and focus on your healing. We are much more that a network of cancer hospitals and facilities. We understand that you are fighting for your life, and will do everything we can to provide you with every choice, offer you every chance, and empower you to victory. We battle this disease with many weapons and we never give up. At Cancer Treatment Centers of America, we fight to win.
If you are exploring your treatment options, we encourage you to call 800-615-3055 and learn more about CTCA and our innovative and comprehensive approach to treating cancer. Our dedicated Oncology Information Specialists can help you explore your treatment options and determine if CTCA may be the right facility for you.

Potential Osteosarcoma Symptoms
Although the symptoms of osteosarcoma will vary from person to person depending on a number of factors, including the size and stage of the cancer, the most common symptoms associated with osteosarcoma are pain, swelling, and tenderness in the affected bone or the area around it. Other potential symptoms may include anemia, fever, weight loss, restricted movement and prolonged increased pain around the affected area. In addition, because osteosarcoma can weaken bones, fractures may occur. If you experience any of these potential symptoms of osteosarcoma, it is important that you see a medical professional. Only they can tell you if your symptoms are the result of osteosarcoma.
Risk Factors for Developing Osteosarcoma
Although the exact causes of osteosarcoma are not known, there are risk factors that may increase the likelihood of developing the disease. Younger people who have been treated with radiation or chemotherapy for other conditions develop osteosarcoma more frequently than those who have not. Paget's disease of the bone may also increase an individual's risk for developing the disease. Genetics may also play a role in increasing your chances of developing osteosarcoma.
Treating Cancer at CTCA
At CTCA, we understand that cancer affects every aspect of your life - not just part of it. So that is how we treat it. Top to bottom, inside and out, it’s total care for your mind, body and spirit. We assemble a team of dedicated experts who will work with you to understand how your cancer affects you, and create a plan based on your unique needs. We will make sure that you not only understand the treatment options available to you, but that you also have the opportunity to be as involved as you want in creating your treatment plan.
To learn more about the treatment options available at CTCA, visit our Cancer Treatment Options Page.
At CTCA, fighting cancer is all we do. We know that you are fighting for your life, and we are committed to helping you overcome cancer. By offering long-established conventional treatments, combined with complementary therapies, such as nutritional, psychological and physical support options, we fight your cancer on many fronts. We will never stop searching for and providing powerful and innovative treatment options designed to fight cancer, improve your quality of life and restore hope.
At CTCA, you and your healing are at the center of our actions everyday. We will rally our team around you to deliver compassionate, integrative cancer care for your body, mind and spirit - designed around your needs. Whether you are exploring your treatment options for the first time, or are unhappy with the treatment you are currently receiving, call us today at 800-615-3500 or Discuss Your Osteosarcoma Treatment Options Online with an Oncology Information Specialist. They can help you explore treatment options and determine if CTCA may be the right facility for you.





(Cáncer infantil: Osteosarcoma)
Osteosarcoma is the most common type of bone cancer, and the sixth most common type of cancer in children. Although other types of cancer can eventually spread to parts of the skeleton, osteosarcoma is one of the few that actually begin in bones and sometimes spread (or metastasize) elsewhere, usually to the lungs or other bones.
Because osteosarcoma usually develops from osteoblasts (the cells that make growing bone), it most commonly affects teens who are experiencing a growth spurt. Boys are more likely to have osteosarcoma than girls, and most cases of osteosarcoma involve the knee.
Most osteosarcomas arise from random and unpredictable errors in the DNA of growing bone cells during times of intense bone growth. There currently isn't an effective way to prevent this type of cancer. But with the proper diagnosis and treatment, most kids with osteosarcoma do recover.
Risk for Childhood Osteosarcoma
Osteosarcoma is most often seen in teenage boys, and evidence shows that teens who are taller than average have an added risk for developing the disease.
Kids who have inherited one of the rare cancer syndromes also are at higher risk for osteosarcoma. These syndromes include retinoblastoma (a malignant tumor that develops in the retina, usually in children younger than age 2) and Li-Fraumeni syndrome (a kind of inherited genetic mutation). Because exposure to radiation is another trigger for DNA mutations, children who have received radiation treatments for a prior episode of cancer are also at increased risk for osteosarcoma.
Symptoms of Osteosarcoma
The most common symptoms of osteosarcoma are pain and swelling in a child's leg or arm. It occurs most often in the longer bones of the body — such as above or below the knee or in the upper arm near the shoulder. Pain may be worse during exercise or at night, and a lump or swelling may develop in the affected area up to several weeks after the pain starts. Pain that persistently wakes the child up at night or pain at rest are of particular concern. In osteosarcoma of the leg, the child may also develop an unexplained limp. In some cases, the first sign of the disease is a broken arm or leg, because the cancer has weakened the bone to make it vulnerable to a break.
If your child or teen has any of the above symptoms, it's important to see a doctor.
Diagnosing Osteosarcoma
To diagnose osteosarcoma, the doctor will likely perform a physical exam, obtain a detailed medical history, and order X-rays to detect any changes in bone structure. The doctor may also order a magnetic resolution imaging (MRI) scan of the affected area, which will find the best area to biopsy and show whether the osteosarcoma has spread from the bone into nearby muscles and fat. The doctor will also order a bone biopsy to obtain a sample of the tumor for examination in the lab. This is best done by an orthopedic surgeon experienced in the treatment of osteosarcoma (orthopedic oncologist).
Sometimes the doctor does a needle biopsy, using a long hollow needle to take a sample of the tumor. A local anesthesia is typically used in the area that's being biopsied. Alternatively, the doctor may order an open biopsy, in which a portion of the tumor is removed in the operating room by a surgeon while the child is under general anesthesia.
If a diagnosis of osteosarcoma is made, the doctor will order CT chest scans as well as a bone scan and, sometimes, additional MRI studies. These will show if the cancer has spread to any part of the body beyond the original tumor. These tests will be repeated after treatment starts to determine how well it is working and whether the cancer is continuing to spread.
Treating Osteosarcoma
Treatment of osteosarcoma in children includes chemotherapy (the use of medical drugs to kill cancer cells and shrink the cancer) followed by surgery (to remove cancerous cells or tumors) and then more chemotherapy (to kill any remaining cancer cells and minimize chances of the cancer coming back). Surgery often can effectively remove bone cancer, while chemotherapy can help eliminate remaining cancer cells in the body.
Surgical Treatment
Surgical treatments for osteosarcoma consist of either amputation or limb-salvage surgery.
Currently, most teens with osteosarcomas involving an arm or leg can be treated with limb-salvage surgery rather than amputation. In limb-salvage surgery, the bone and muscle affected by the osteosarcoma are removed, leaving a gap in the bone that is filled by either a bone graft (usually from the bone bank) or more often a special metal prosthesis. These can be appropriately matched to the size of the bone defect. The risk of infection and fracture is higher with bank bone replacement and therefore metal prostheses are more commonly used for reconstruction of the bone after removal of the tumor.
If the cancer has spread to the nerves and blood vessels surrounding the original tumor on the bone, amputation (removing part of a limb along with the osteosarcoma) is often the only choice.
When osteosarcoma has spread to the lungs or elsewhere, surgery may also be performed to remove tumors in these distant locations.
Chemotherapy
Chemotherapy is usually given both before and after surgery. It eliminates small pockets of cancer cells in the body, even those too small to appear on medical scans. A child or teen with osteosarcoma is given the chemotherapy drugs intravenously (through a vein) or orally (by mouth). The drugs enter the bloodstream and work to kill cancer in parts of the body where the disease has spread, such as the lungs or other organs.
Short-Term and Long-Term Side Effects
Amputation carries its own short-term and long-term side effects. It usually takes at least 3 to 6 months until a young person learns to use a prosthetic (artificial) leg or arm, and this is just the beginning of long-term psychological and social rehabilitation.
With a limb salvage surgery, one usually starts bending the knee or the affected body part almost immediately. A continuous passive motion (CPM) machine, that continuously bends and straightens the knee may be used to improve motion for tumors around the knee. Physical therapy and rehabilitation for 6 to 12 months following surgery usually enables the child to walk initially with a walker or crutches and then without any assistive devices. Early complications after surgery include infection and slow healing of the surgical wound, and the metal prosthetic device or the bank bone may need to be replaced in the long term. Other late problems might include fracture of the bank bone or failure of the bank bone to heal to the child's bone, which might require more surgery.
Many of the medications used in chemotherapy also carry the risk of both short-term and long-term problems. Short-term effects include anemia, abnormal bleeding, and increased risk of infection due to destruction of the bone marrow, as well as kidney damage and menstrual irregularities. Some drugs carry a risk of bladder inflammation and bleeding into the urine, hearing loss, and liver damage. Others may cause heart and skin problems. Years after chemotherapy for osteosarcoma, patients have an increased risk of developing other cancers.
Chances for a Cure
Recent studies have reported that survival rates of 60% to 80% are possible for osteosarcoma that hasn't spread beyond the tumor, depending on the success of chemotherapy.
Osteosarcoma that has spread cannot always be treated as successfully. Also, a child whose osteosarcoma is located in an arm or leg generally has a better prognosis than one whose disease involves the ribs, shoulder blades, spine, or pelvic bones.
New Treatments
Treatments are being developed and researched with new chemotherapy drugs. Other research is focused on the role certain growth factors might play in the development of osteosarcoma. This research may be used to develop new medications to slow these growth factors as a way to treat the cancer.
For osteosarcomas that cannot be removed surgically, studies are now underway to test treatments that use new combinations of chemotherapy and localized, high-dose radiation.
Reviewed by: Mihir Thacker, MDDate reviewed: January 2008Originally reviewed by: Donna Patton, MD

Osteosarcoma in Children
This information is about osteosarcoma (also called osteogenic sarcoma) in children. It is helpful to read it alongside our general information on children's cancer, which contains more information about cancers in children, their diagnosis and treatment, and the support services available.
Osteosarcoma
Causes of osteosarcoma
Signs and symptoms
How it is diagnosed
Grading
Staging
Treatment
Side effects of treatment
Clinical trials
Follow-up
Your feelings
References
Osteosarcoma
Around 30 children develop osteosarcomas in the UK each year. These tumours occur more commonly in older children and teenagers, and are very rarely seen in children under five. They are more common in boys than girls.
Osteosarcoma is a cancer that starts in the bone. It often starts at the ends of the bones, where new bone tissue forms as a young person grows. Any bone in the body can be affected, but the most common sites are the arms or legs, particularly around the knee joint.
There are several different types of osteosarcoma. Most occur in the centre of the bone. There are also rare subtypes, such as parosteal, periosteal telangiectatic, and small cell osteosarcoma.

Causes of osteosarcoma
As with most cancers, the cause of osteosarcoma is unknown. Children who have hereditary retinoblastoma (a rare tumour of the eye) have an increased risk of developing osteosarcoma. Children who have had previous radiotherapy and chemotherapy also have an increased risk of developing osteosarcoma.
It is not caused by injuries or damage to the bone, although an injury may draw attention to a bone tumour.

Signs and symptoms
Pain in the affected bone is the most common symptom. This pain may initially come and go, and then gradually become more severe and constant. There may also be swelling around the affected bone.

How it is diagnosed
A variety of tests and investigations may be needed to diagnose an osteosarcoma. An x-ray of the painful part of the bone will usually identify a tumour, although sometimes they can be difficult to see. A small piece of the tumour will be removed and looked at under a microscope (biopsy). This is done during a small operation, under a general anaesthetic.
Other tests are taken to check whether the cancer has spread elsewhere in the body. These include a chest x-ray, blood tests, a bone scan, a bone marrow aspirate and an MRI or CT scan.
Any tests and investigations that your child needs will be explained to you. Our general information on children’s cancers gives details of what the tests and scans involve.

Grading
Grading refers to the appearance of the cancer cells under the microscope, and gives an idea of how quickly the cancer may develop. Low-grade cancer cells look very like normal cells, and are usually slow-growing and less likely to spread. In high-grade tumours, the cells look very abnormal, are likely to grow quickly, and are more likely to spread.
Most osteosarcomas are high-grade, but a type known as parosteal osteosarcoma is usually low-grade. A further subtype (periosteal osteosarcoma) is usually treated as though it was high-grade.

Staging
The 'stage' of a cancer is a term used to describe its size and whether it has spread beyond its original site. Knowing the particular type, and stage, of the cancer helps the doctors to decide on the most appropriate treatment.
Most patients are grouped depending on whether cancer is found in only one part of the body (localised disease), or whether the cancer has spread from one part of the body to another (metastatic disease).
A commonly-used staging system for osteosarcomas is described below:
Stage 1A The cancer is low-grade and is found only within the hard coating of the bone.
Stage 1B The cancer is low-grade, extending outside the bone and into the soft tissue spaces that contain nerves and blood vessels.
Stage 2A The cancer is high-grade and is completely contained within the hard coating of the bone.
Stage 2B The cancer is high-grade and has spread outside the bone and into surrounding soft tissue spaces that contain nerves and blood vessels. Most osteosarcomas are stage 2B.
Stage 3 The cancer can be low- or high-grade and it is found either within the bone or extends outside the bone. The cancer has spread to other parts of the body, or to other bones not directly connected to the bone where the tumour started.
If the cancer comes back after initial treatment, this is known as recurrent or relapsed cancer.

Treatment
Treatment will depend on a number of factors including the size, position, and stage of the tumour.
Surgery is a very important part of treatment for osteosarcoma. Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells, and is usually given to shrink the main tumour before surgery. It is also given after the tumour has been removed by surgery, to help reduce the risk of the cancer coming back (recurring). It is common for a combination of drugs to be used.
Radiotherapy may occasionally be given. Radiotherapy treats cancer by using high-energy rays to destroy the cancer cells, while doing as little harm as possible to normal cells.
Surgery
The type and extent of surgery depends on the position and size of the tumour in the body. This surgery may need to be carried out at a specialist orthopaedic centre, and your child may be referred to one.
Surgery may include removing the whole limb (amputation) or part of the affected bone, which is then replaced by some form of false limb (prosthesis). If only part of the affected bone is removed, this is known as limb-sparing surgery.
Amputation of the limb is sometimes unavoidable if the cancer is affecting the surrounding blood vessels and nerves. After amputation, a false limb will be fitted and will be regularly adjusted as your child grows. False limbs can work very well. It should be possible for them to join in with normal activities and even sport.
Limb-sparing surgery preserves the limb. There are two ways in which this may be done:
replacing the bone with a prosthesis (a specially designed artificial part)
replacing the affected bone with bone taken from another part of the body.
After this type of surgery, children will usually be able to use their limbs almost normally. However, they are advised not to participate in any contact sports, as, if the bone graft or prosthesis is damaged, another major operation might be needed to repair or replace it. If your child is growing, the limb prosthesis will need to be lengthened as the bone grows. This will mean further short stays in hospital.

Side effects of treatment
Treatment often causes side effects, and your child’s doctor will discuss these with you before treatment starts. Possible side effects will depend upon the particular treatment being used and the part of the body that is being treated. Side effects can include feeling sick (nausea) and being sick (vomiting), hair loss, an increased risk of infection, bruising and bleeding, tiredness and diarrhoea.
Late side effects
A small number of children may develop late side effects, sometimes many years later, caused by their treatment for an osteosarcoma. These include reduction in bone growth, infertility, a change in the way the heart and lungs work, and a slight increase in the risk of developing another cancer in later life. Your child’s doctor or nurse will explain more about any possible late side effects. There is more detailed information about these late side effects in the general information on children’s cancers.

Clinical trials
Many children have their treatment as part of a clinical research trial. Trials aim to improve our understanding of the best way to treat an illness (usually by comparing the standard treatment with a new or modified version of the standard treatment). Specialist doctors carry out trials for children's cancer. Your child's medical team will talk to you about taking part in a clinical trial (if appropriate) and will answer any questions you may have. Written information is often provided to help explain things. Taking part in a research trial is completely voluntary, and you'll be given plenty of time to decide if it is right for your child. Currently, the main trial for osteosarcoma is the EURAMOS 1 trial. Your child's doctor or specialist nurse can tell you more about this.

Follow-up
Many children with osteosarcoma are cured. However, the child may need to have surgery to lengthen the affected limb from time to time. Your child will have regular check-ups, both in the paediatric or adolescent oncology clinic, and at the orthopaedic centre.
If you have specific concerns about your child’s condition and treatment, it is best to discuss them with your child’s doctor, who knows the situation.

Your feelings
As a parent, the fact that your child has cancer is one of the worst situations you can be faced with. You may have many different emotions, such as fear, guilt, sadness, anger and uncertainty. These are all normal reactions, and are part of the process that many parents go through at such a difficult time.
Your child may have a range of powerful emotions throughout their experience of cancer. Our booklet, Peppermint Ward, is a storybook for younger children with cancer. It looks at the issues that they and their family may face, and helps them to explore their feelings. You can order the booklet online.

References
This section has been compiled using information from a number of reliable sources, including:
Cancer in Children: Clinical Management (5th ed). Eds PA Voute et al. Oxford University Press, 2005.
For further references, please see the general bibliography.