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My Child's Cancer > Bone cancers > Osteosarcoma

Osteosarcoma

January 22, 2018

Childhood Cancer Name:

Bone tumor – Osteosarcoma; Osteosarcoma (OS); Osteogenic sarcoma (OGS); Aggressive Malignant Neoplasm of Mesenchymal origin; Malignant Osteoid; Conventional Osteosarcoma.

Explanation:

Osteosarcoma is the most common type of cancer that arises in bones, and typically found at the end of long bones. Most people diagnosed with osteosarcoma are between the ages of 10 to 25.

Characteristics:

Osteosarcoma is most often seen in teenage boys. Teens diagnosed with osteosarcoma tend to be tall for their age, suggesting that rapid bone growth may lead to the disease. Osteosarcoma is a type of cancer that produces immature bones. It is the most common histological form of malignancy of the bone, called Conventional Osteosarcoma when it affects teenagers or young adults.

Biology:

In most cases, it is found in the bones around the knee.  Located in the growing ends of the bone (metaphysis).

Causes: Although not very well defined, the cause of osteosarcoma is considered a combination of genetic changes. Together, they cause immature bone cells to become tumor cells instead of healthy bone. A gene known as RB may be associated with osteosarcoma, which is also the gene responsible for the eye cancer called retinoblastoma.
Some groups of people are more likely to develop osteosarcoma like; teenagers having a growth spurt, osteosarcoma is 50% more common in boys, radiation treatment or its high dose can increase the risk of the disease whereas several research groups are investigating cancer stem cells and their potential to cause tumors.
Most Osteosarcomas are not caused by inherited DNA mutations. They are the result of gene changes acquired during the person’s lifetime and these changes are most often present only in the cancer cells and are not passed on to children.

Main types:

There are two types of osteosarcoma.

  • Central tumor, also called a medullary tumor
  • Surfacetumor, also called a peripheral tumor

Each type of osteosarcoma has different subtypes. The type and subtype of osteosarcoma is determined by looking at the tumor cells through a microscope.

Subtypes of medullary osteosarcoma include:

  • Conventional central osteosarcoma, such as osteoblastic, chondroblastic, fibroblastic, and mixed types
  • Telangiectatic osteosarcoma
  • Intraosseous well-differentiated or low-grade central osteosarcoma
  • Small cell osteosarcoma

 Subtypes of peripheral osteosarcoma include:

  • Parosteal well-differentiated or low-grade osteosarcoma, also called juxtacortical osteosarcoma
  • Periosteal osteosarcoma that is low grade to intermediate grade
  • High-grade surface osteosarcoma

The most common subtype of osteosarcoma is conventional central osteosarcoma. The other subtypes are much less common. They each account for less than 5% of all osteosarcomas.

Grade is the most important factor in treatment decision-making. This is because low-grade tumors only recur in the same area, called locally. High-grade tumors metastasize, or spread, to other parts of the body and can recur anywhere in the body. Most osteosarcoma in children are high grade.

Childhood Cancer Localization:

Osteosarcoma occurs in large bones in the area of bone with the fastest growth rate, most commonly in the:

  • Shin (near the Knee)
  • Thigh (near the knee)
  • Upper Arm (near the shoulder)
    They typically occur at the metadiaphysis of tubular bones in the appendicular skeleton;
  • Long Bones: Femur 40%, Tibia 16%, Humerus 15%.
  • Less Common Sites(29%): Fibula, innominate bone, mandible (lower jaw), maxilla (jaw bone), vertebrae

Childhood Cancer Noticeable Symptoms:

The first symptom is usually bone pain near a joint, the pain may get worse at night, may be intermittent and of varying intensity. Other symptoms may include a sudden fracture, limitation of motion, Limping, pain when lifting, tenderness, swelling or redness at the site of tumor. Back pain or a loss of bowel or bladder control is also a symptom that can occur if the tumor is in the pelvis or at the base of the spine.

Parents tips:

The pain often considered to be related to muscle soreness or “growing pains”, but it does not go away with rest. The symptoms can also be misdiagnosed as Sports Injury, but if you are concerned about any changes your child experiences, please consult a doctor immediately.

Childhood Cancer Diagnostic Method:

An X-ray is the first diagnostic test. An experienced radiologist would recognize if bone cancer is the likely diagnosis. This is followed by MRI, which helps to rule out the metastases stage or spread of the tumor, a CT scan and a PET scan to detect metastases to other organs, bones, or other parts of the body. A bone scan is being done to rule out distant spread of the disease. A biopsy of the tumor provides a definite diagnosis to determine whether the tumor is malignant or benign.

Childhood Cancer Treatment:

  • Chemotherapy – Neo-adjuvant therapy
  • Surgery – to remove the tumor.
  • Surgery is also required in cases where an amputation or a rotationplasty is performed (limb-sparing surgery). This is followed by an implant surgery or an allograft for replacement of the tissue.
  • Radiation Therapy

Late effects of the treatments and follow-up:

Care for children diagnosed with cancer does not end when active treatment has finished. Your child’s health care team will continue to check that the cancer has not come back, manage any side effects, and monitor your child’s overall health. This is called follow-up care. All children and teens treated for cancer, including osteosarcoma, should have life-long follow-up care.

Your child’s follow-up care may include regular physical examinations and medical tests. Doctors want to keep track of your child’s recovery in the months and years ahead.

The main considerations for the long-term health of children and teens who have had osteosarcoma are:

  • Recurrence of osteosarcoma (Recurrence of osteosarcoma more than 5 years later is rare. The drugs used to treat osteosarcoma have a small chance, about 1.5%, of causing a blood cancer called leukemia. This is called secondary leukemia).
  • Appearance of a new type of cancer (called a secondary cancer)
  • Orthopedic complications and other late effects of the cancer treatment.

Cancer rehabilitation may be recommended, and this could mean any of a wide range of services such as physical therapy, family or individual counseling, nutritional planning, and/or educational assistance. The goal of rehabilitation is to help survivors and their families regain control over many aspects of their lives and remain as independent and productive as possible.

References:

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