Osteosarcoma

You probably have a lot of questions: How dangerous is osteosarcoma? What is the very best treatment? What do we do next?

We’ve tried to provide some answers to those questions in the following pages, and Boston Children's Hospital's expert specialists can explain your child’s condition fully when we meet with you.

What is osteosarcoma?

Osteosarcoma is a type of bone cancer that usually occurs in the long bones, such as the arms and legs. It can also occur in the pelvis and spine. In rare cases, it can occur in the jaw or other locations in the body.

Osteosarcoma cancer cells can spread (metastasize) to other areas of the body. If this happens, it most often spreads to the lungs. It can also spread to other bones and, much less commonly, to the kidneys, the adrenal gland, the brain and the heart.

Types of osteosarcoma

Most commonly, the disease begins in the marrow cavity of the bone. However, some types of osteosarcoma can start just outside of or at the surface of the bone. These include:

Parosteal osteosarcoma

• originates in a layer of soft tissue next to the bone
• tends to grow slowly, eventually invading the bone
• tends to occur in people between the ages of 20 and 40
• most commonly forms in the back and the lower end of the thighbone

Periosteal osteosarcoma

• originates in the tough outer covering that surrounds the bone and contains the blood vessels and nerves
• more aggressive than parosteal osteosarcoma
• usually located in the (upper end) of the leg bone

What causes osteosarcoma?

As a parent, you undoubtedly want to know what may have caused your child’s tumor. In most cases, there is no clear cause for osteosarcoma. Genetics, abnormal bone metabolism or environmental exposures play an important role in some people.

• Inherited conditions that increase the risk of osteosarcoma are hereditary retinoblastoma, Li-Fraumeni syndrome and Rothmund-Thomson, Bloom and Werner syndromes.
   
• Bone diseases associated with an increased risk of osteosarcoma include Ollier's disease, osteogenesis imperfecta, polyostotic fibrous dysplasia and Paget's disease.
   
• The environmental exposure known to increase the risk of osteosarcoma is exposure to ionizing irradiation associated with radiation therapy for other types of cancer (such as Hodgkin disease and non-Hodgkin lymphoma).

It’s important to understand that osteosarcoma most often occurs with no known cause. There’s nothing that you could have done or avoided doing that would have prevented the tumor from developing.

Is osteosarcoma common?

Osteosarcoma is the most common type of bone cancer among children, adolescents and young adults.

There are about 600 new cases of osteosarcoma diagnosed each year in the United States. Osteosarcoma occurs most commonly in teenagers, when the rate of bone growth is the fastest. However, it can affect younger children and adults as well.

What are the symptoms of osteosarcoma?

Each child may experience symptoms differently. The symptoms of osteosarcoma can vary depending on the size and location of the tumor and whether it has spread.

Often, an injury brings your child into a medical facility, where an x-ray may indicate suspicious bone lesions. Usually, your child does not appear to be ill. While symptoms may vary child-to-child, the most common include:

• pain (sharp or dull) at the site of the tumor
• swelling (mass) and/or redness at the site of the tumor
• increased pain with activity or lifting
• limping
• decreased movement of the affected limb

Keep in mind that the symptoms of osteosarcoma may resemble other, more common conditions or medical problems, so if you suspect that your child may have osteosarcoma, always consult your child's physician for a diagnosis.

Glossary

FAQ

Q: Will my child have physical limitations after surgery for osteosarcoma?

A: Depending on the type of surgery your child receives, your child may have to avoid certain physical activities following treatment. Limb-salvage surgery can leave an arm or leg fragile and increase the risk of fracture. As a result, patients will need to avoid high-stress physical activities such as skiing, skate-boarding or bike riding. Children that require partial or complete limb amputations will be fitted with a prosthesis and will need to undergo physical therapy to adapt to using it.

Q: Will my child need physical therapy?

A: Rehabilitation is an extremely important part of your child’s osteosarcoma care. This includes both physical and occupational therapy and help adapting to social situations. Your child’s physician will discuss what types of lifestyle changes may be necessary, and our experienced physical and occupational therapists will work to optimize his mobility after surgery.

Q: Will my child require an amputation?

A: Limb-sparing techniques such as limb-salvage surgery and rotationplasty allow our orthopedic surgeons to avoid amputation in many cases. However, if the tumor is very large or limb function cannot be preserved, your child’s physician may recommend amputation. If your child’s physician believes amputation is the best course of action, it is because other types of surgery may put your child at risk of relapse or leave her with a poorly functioning limb.

If amputation is necessary, your child will be fitted with a prosthesis through our NOPCO Brace Shop and will receive physical therapy to help her adjust.

Q: What kind of follow-up care will my child require?

A: In order to monitor recovery, check for relapse and receive physical therapy, your child will need frequent follow-up care. Get more information on our long-term follow-up services.

Questions to ask your child’s doctor

After your child is diagnosed with osteosarcoma, you may feel overwhelmed with information. It can be easy to lose track of the questions that occur to you. Lots of parents find it helpful to jot down questions as they arise—that way, when you talk to your child’s doctors, you can be sure that all of your concerns are addressed.

If your child is old enough, you may want to suggest that she write down what she wants to ask her health care provider, too.

Some of the questions you may want to ask include:

• How long will my child need to be in the hospital?
• What are the possible short and long-term complications of treatment? How will they be addressed?
• What is the likelihood of cure?
• What services are available to help my child and my family cope?