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Osteosarcoma is a rare type of bone cancer that develops most often in growing children and teenagers. It typically occurs in the leg bones near the knee and the upper arm bones near the shoulder. Doctors treat osteosarcoma with a combination of chemotherapy and surgery.

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What Is Osteosarcoma? 

Doctors define osteosarcoma as a rare cancer of the bone. It happens when cells in the bone grow out of control and form tumors. Sometimes, the cancer spreads to other parts of the body, most often the lungs. 

Osteosarcoma often forms in the large bones of the body, where bone growth is the fastest in children and teens. But it can develop in any bone.

Osteosarcoma is aggressive. It’s important to seek treatment if you or your child have bone pain, swelling, or an abnormal growth on a bone.

How common is osteosarcoma?

Osteosarcoma isn't common. Doctors diagnose about 1,000 new cases of osteosarcoma each year in the U.S., according to the American Cancer Society.

Most cases are in people ages 10 to 30, although older people can develop osteosarcoma. About one in 10 cases of osteosarcoma occur in people older than 60.

Osteosarcoma is more common in males than females.

What are the types of osteosarcoma?

Doctors classify osteosarcoma by a grade that indicates if the tumor is likely to grow quickly and spread to other parts of the body. The grades are:

  • High-grade. The fastest-growing type of osteosarcoma. Many of the cancer cells are dividing into new cells. Most osteosarcoma tumors in children and teens are high-grade.
  • Intermediate-grade. The least common grade, it falls between high-grade and low-grade.
  • Low-grade. The slowest-growing osteosarcomas. These tumor cells look more like normal cells under a microscope and have few dividing cells.

What causes osteosarcoma?

Doctors don’t know what causes osteosarcoma. They haven't found any environmental or lifestyle-related causes of the disease.

What are osteosarcoma risk factors and complications?

Doctors are still learning about possible risk factors for osteosarcoma. Complications from osteosarcoma can be serious.

Osteosarcoma risk factors

Although the exact cause of osteosarcoma isn't known, some factors may increase your risk of getting the disease. You're more likely to develop osteosarcoma if you had: 

  • Bone infarct, a condition where a disruption of the blood supply leads to cell death in the bone.
  • Certain bone disorders. People who have Paget’s disease or fibrous dysplasia are more likely to develop osteosarcoma.
  • Certain inherited cancers, including familial retinoblastomas and Li-Fraumeni syndrome.
  • Radiation therapy.

Complications of osteosarcoma

The main complication of osteosarcoma is that the disease will metastasize (spread) through the bloodstream. Most often, osteosarcoma will spread to the lungs, but it can also move into the brain, other organs, and other bones. 

About 20% of osteosarcomas have already spread when doctors find them, according to the American Cancer Society. If cancer has spread, it's harder to treat. 

How can I prevent osteosarcoma?

Because there are no environmental or lifestyle causes associated with osteosarcoma, there are no known ways to prevent it.

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What Are the Signs and Symptoms of Osteosarcoma?

Symptoms of osteosarcoma include:

  • A fracture or break in a bone, sometimes after a minor injury or routine movement. Because osteosarcoma weakens the bone, it can break easily.
  • A limp, if the tumor is in the leg. You may have pain when lifting things if the tumor is in the arm.
  • Limited range of motion in the limb with the tumor.
  • Pain at or near a joint. This is the most common sign of osteosarcoma. The pain may come in waves, especially at first, but gradually becomes more constant.
  • Swelling or a lump around the tumor.
  • Tenderness or redness near the tumor.

When should I see a doctor about my osteosarcoma symptoms?

If you or your child have any of the bone cancer symptoms above, you should see a doctor as soon as possible. You may start by going to your primary care provider (PCP), your child’s pediatrician, or an orthopaedic specialist.

If you or your child are diagnosed with osteosarcoma, you may eventually see:

  • Medical or pediatric oncologists.
  • Orthopaedic surgeons.
  • Physical therapists.
  • Psychologists.
  • Radiation oncologists.
  • Social workers.

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How Do You Diagnose Osteosarcoma?

Your doctor will start by asking questions about you or your child’s overall health and medical history. They'll want to know if there's a family history of cancer.

The doctor will do a physical exam to look for:

  • A painful hard lump, mass, or tumor.
  • Any joint pain or tenderness.
  • Limited range of motion in an arm or leg.
  • Swelling in an arm or leg.  

Tests to diagnose osteosarcoma

If your doctor suspects osteosarcoma, they'll order tests, including:

  • Imaging tests. X-rays, MRIs, and CT scans help doctors get a clear picture of the size and spread of the tumor.
  • Lab tests. While blood tests can’t confirm the presence of osteosarcoma, they can give your doctor information to get you ready for treatment.
  • Biopsy. To confirm the diagnosis of osteosarcoma, doctors remove a small sample of tissue from the tumor and examine it under a microscope. They'll grade it during the biopsy.

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How Do You Treat Osteosarcoma?

Doctors usually treat osteosarcoma with a combination of chemotherapy and surgery. But the specific treatment your doctor recommends will depend on several factors, such as:

  • The grade of the tumor.
  • Where the tumor is.
  • Whether the cancer has spread.
  • Whether you have other health issues.
  • Your age.
  • Your overall health.

Medicine to treat osteosarcoma

Chemotherapy is medication to treat cancer. Doctors usually give it to people in the hospital through an IV. They use it to treat osteosarcoma:

  • Before surgery, to help stop the spread of cancer and shrink the tumor. A smaller tumor is easier to remove.
  • After surgery, to kill any remaining cancer cells and lower the risk of the cancer coming back.

What happens during chemotherapy for osteosarcoma?

Before chemotherapy, you or your child will have an ultrasound of the heart to check how it’s working. You may also have a baseline hearing test because hearing loss can be one of the side effects of chemo. 

Doctors will place a port under the skin below the collarbone to administer the medicine. Doctors may use two chemotherapy drugs together, so the treatment is more effective.

Most people have about 10 weeks of chemotherapy before surgery. Doctors give chemotherapy in cycles, with a rest period following each treatment period.

Surgery for osteosarcoma

Successful surgery for osteosarcoma means getting rid of all the cancer. To accomplish that, surgeons will need to remove some of the bone and surrounding tissue. They'll try to save and rebuild as much of the limb as possible.

The two types of surgery for osteosarcoma are:

  • Limb-salvage surgery, which removes the tumor with as little disruption to the limb as possible.
  • Amputation, when it’s not possible to save the limb while removing the tumor. There are many types of amputation, depending on where the tumor is.

What happens during osteosarcoma surgery?

During limb-salvage surgery, the doctor removes the tumor along with some of the healthy tissue around it. They try to save as many of the tendons, blood vessels, and nerves in the area as possible.

Then they rebuild the limb, using one or more of the following:

  • A prosthesis (artificial limb) made from metal, plastic, or ceramic.
  • Bone from a donor.
  • Bone from another part of your own body.
  • Combinations of bone grafts and prostheses.

Sometimes, doctors can’t save a limb. If the tumor is enmeshed in a major blood vessel, for instance, amputation may be the best course of action. Surgeons will replace the limb with a prosthesis.

Once doctors remove the tumor, they'll examine it under a microscope. Another round of chemotherapy — or a different chemotherapy drug — usually is the next line of treatment. If doctors determine that the entire tumor wasn't removed, you may need another surgery.

Physical therapy for osteosarcoma

Recovery from osteosarcoma treatment for you or your child will require rehabilitation and follow-up care. You may need to use crutches, a cane, or a walker for some time. 

A physical therapist can help you regain strength and flexibility after surgery. It may take months to learn to walk or perform basic tasks with a reconstructed limb. If you have a prosthesis, a physical therapist will help you learn how to function with it.   

How effective is treatment? 

With physical therapy and follow-up care, most people notice continued improvement in strength and mobility for one to two years after surgery for osteosarcoma. You'll need regular imaging tests and physical exams every few months for a couple of years, to make sure the cancer hasn’t spread or returned. After that, your doctor may see you less often.

In general, the bone cancer survival rate depends on many factors. Your prognosis may depend on:

  • How far the cancer had spread.
  • How your body responded to chemotherapy. 
  • If you had other health conditions.
  • The grade and stage of your cancer.
  • Your age.

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