Overview
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.
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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.
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.
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.
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