Osteosarcoma

A sign is a presentation that can be seen or felt by someone else such as a lump or mass, depending where the tumour is located.

A symptom is a feeling or something unusual you notice, such as pain and swelling in the affected bone area (usually the knee or upper arm). The pain may be worse at night, or after use/activity.

At a time of growth and development, these symptoms are quite common in active children and teenagers, and so symptoms should be treated with care. Please consult your GP if you are concerned with any unusual pain or swelling.

Bone breakages can occur, however these are not as common as one might think, considering the osteosarcoma is weakening the bone.

When symptoms of osteosarcoma are present, a full physical examination will be conducted, often in conjunction with an imaging test (x-ray, bone scan, MRI or PET). Any of these imaging tests will help determine whether the area in question is cancerous, and whether it might have started in, or spread to, another part of the body.

A biopsy will then be needed to confirm whether the cancer is primary (started in the bone) or secondary (spread from elsewhere in the body). This information is very important in defining treatment schedules.

In most cases, both chemotherapy and surgery are needed. The aim of surgery will be to remove the bone tumour, as well as surrounding bone and muscle to ensure no traces are left behind.

When operating to remove bone tumours, surgeons will always aim to preserve the limb and maintain functionality; however, depending on the location and extent of the tumour, there will be instances where this is not possible. ‘Limb-salvaging’ surgery is very complex as it involves removing the tumour without harming nearby tendons, nerves and blood vessels. If the cancer has grown into these structures, they will need to be removed together with the tumour. In such cases, amputation may sometimes be the best option.

A bone graft (a piece of bone from another part of the body, or from another person) or an internal prosthesis will replace the section of bone that has been removed. Each of these solutions can be problematic, as they carry a risk of infection or loosening of the graft or of the prosthetic rod. Using an internal prosthesis in growing children can be especially challenging as the artificial structure needs replacing as the child ages. More modern prostheses can be made longer without extra surgery, however still need to be replaced with a stronger adult prosthesis once the child’s body stops growing.

For both adults and children, specialists working on the treatment schedule will include a surgeon, a pathologist, a medical oncologist and possibly a radiation oncologist. Depending on the extent of the surgery, there will most likely be a need for a rehabilitation or physical therapy specialist.

Following surgery, chemotherapy will often be used to further eliminate residual cancers, especially cancerous bone cells that have spread to other areas of the body.