What is Osteosarcoma in Children

Osteosarcoma is a type of bone cancer. It often affects the ends of the long bones of the arms and legs.

It can also develop in the hip, shoulder, jaw, or other bones. Osteosarcoma often affects teenagers during times when their bones are growing quickly.

What are the causes?

Osteosarcoma may be caused by genetic changes (mutations) that cause immature bone cells to become tumor cells. Most osteosarcomas are the result of mutations that occur after a person is born.

What increases the risk?

Your child is more likely to develop this condition if your child:

• Is male.
• Is a teenager.
• Is of African American or Hispanic descent.
• Is tall for his or her age.
• Had X-ray treatment (radiation therapy) for another type of cancer.
• Has a certain condition that is passed from parent to child (inherited), such as:
  • A genetic defect that increases the risk of rare cancers (Li–Fraumeni syndrome).
  • A rare eye cancer that develops in the immature cells of the retina (retinoblastoma).
  • A change in the retinoblastoma gene.

What are the signs or symptoms?

Symptoms of this condition depend on where the tumor is located. The most common symptom is a dull or sharp bone pain that gets worse with activity or increases over time. Other symptoms include:

• Swelling, redness, or a lump over a bone.
• Loss of movement of the arm or leg.
• A limp.
• A broken bone (fracture) from a minor injury or for no known reason.
• Back pain, or loss of bowel or bladder control. This happens if the tumor is in the pelvis or at the base of the spine.

How is this diagnosed?

This condition may be diagnosed based on:

• Your child’s symptoms and medical history.
• A physical exam.

Your child may also have other tests, including:

• Imaging tests, such as:
  • X-ray.
  • CT scan.
  • MRI.
  • Bone scan.
  • PET scan.
• A procedure in which a sample of the tumor is removed (biopsy). This lets your child’s health care provider:
  • See how the tumor cells look under a microscope. This will determine the grade of the tumor.
  • Determine how big the tumor is and how much it has spread. This will determine the stage of the tumor.

To plan for treatment, your child’s health care provider will stage your child’s cancer. Osteosarcoma is staged from stage I to stage III. Stage III is the most advanced. Staging depends on many factors, including the size of the tumor and whether it has spread to other parts of the body (metastasized).

Your child may see a health care provider who specializes in treating childhood cancers (pediatric oncologist).

How is this treated?

Treatment for osteosarcoma depends on the location and stage of the cancer, and whether the cancer has come back after treatment (recurrent). Treatment may include:

• Chemotherapy. This is the use of medicines to kill cancer cells. This may be done:
  • Before surgery to shrink the tumor in order to avoid the amputation of a limb.
  • After surgery to destroy any tumor cells that may remain within the body.
• Surgery. This may be done to remove the tumor and some normal tissue around the tumor (wide excision). In some cases, a tumor in the arm or leg can be removed without having to remove the entire arm or leg (amputation).
• Radiation therapy. This is the use of high-energy X-rays or gamma rays to kill cancer cells in a specific location in the body. Radiation may be applied from a source outside the body (external beam radiation), or from radioactive chemicals that are injected into the body.
• Participating in clinical trials to find out if new (experimental) treatments are effective.
• Physical therapy. This is done to restore strength and movement after surgery.
• Occupational therapy. This is done to help your child learn to function after surgery.
• Assistive devices. Your child may be given an assistive device, such as a brace or a prosthetic (artificial limb).

The most common treatment is a combination of surgery and chemotherapy.

Follow these instructions at home:

Medicines

• Give your child over-the-counter and prescription medicines only as told by your child’s health care providers.
• Do not give your child aspirin because of the association with Reye syndrome.
• Do not give your child dietary supplements or herbal medicines unless your health care provider tells you to give them. Some supplements can interfere with how well the treatment works.

General instructions

• Learn as much as you can about your child’s condition. Work closely with your child’s team of health care providers, and take an active role in treatment decisions. Dealing with childhood cancer is stressful for the whole family. Ask your child’s treatment team about resources for support.
• Know what side effects of treatment to watch for. Surgery, chemotherapy, and radiation can all have side effects.
• Keep records of all your child’s treatments.
• After treatment, know what symptoms may mean that the cancer has come back.
• Do any physical or occupational therapies at home as told by your child’s health care provider.
• Have your child avoid contact sports or other rough activities. Ask your health care provider what activities are safe for your child.
• Keep all follow-up visits as told by your child’s health care providers. This is important.

Where to find more information

• American Cancer Society: www.cancer.org  
• National Cancer Institute (NCI): www.cancer.gov  

Contact a health care provider if your child has:

• Any new or worsening symptoms.
• Side effects from treatment.
• Pain that is not controlled with medicine.

Get help right away if your child has:

• A fever or chills.
• Trouble breathing.

Summary

• Osteosarcoma is a type of bone cancer. It often affects the ends of the long bones of the arms and legs.
• The most common symptom is a dull or sharp bone pain that gets worse with activity or increases over time.
• The most common treatment is a combination of surgery and chemotherapy.
• Keep all follow-up visits as told by your child’s health care providers. This is important.