Osteosarcoma

Definition

Osteosarcoma is a cancerous (malignant) bone tumor that usually develops in teenagers. It occurs when a teen is growing rapidly.

Alternative Names

Osteogenic sarcoma

Causes, incidence, and risk factors

Osteosarcoma is the most common bone cancer in children. Age at diagnosis is around 15. Boys and girls are just as likely to get this tumor until the late teen years, when it occurs more often in boys. Osteosarcoma is also common in people over age 60.

The cause is not known. In some cases, osteosarcoma runs in families. At least one gene has been linked to an increased risk. This gene is also associated with familial retinoblastoma. This is a cancer of the eye that occurs in children.

Osteosarcoma tends to occur in the bones of the:

• Shin (near the knee)
• Thigh (near the knee)
• Upper arm (near the shoulder)

Osteosarcoma can occur in any bone. It occurs most commonly in large bones and in the area of bone with the fastest growth rate.

Symptoms

• Bone fracture (may occur after a routine movement)
• Bone pain
• Limitation of motion
• Limping (if the tumor is in the leg)
• Pain when lifting (if the tumor is in the arm)
• Tenderness, swelling, or redness at the site of the tumor

Signs and tests

• Biopsy (at time of surgery for diagnosis)
• Blood tests
• Bone scan to see if the cancer has spread to other bones
• CT scan of the chest to see if the cancer has spread to the lungs
• CT scan
• MRI scan
• PET scan
• X-ray

Treatment

Treatment usually starts after a biopsy of the tumor is done.

Before major surgery to remove the tumor, chemotherapy is usually given. This can shrink the tumor and make surgery easier. It also may kill any cancer cells that have spread to other parts of the body.

Chemotherapy medicines include:

• Carboplatin (Paraplatin)
• Cisplatin
• Cyclophosphamide (Cytoxan)
• Doxorubicin (Adriamycin)
• Epirubicin
• Etoposide
• Ifosfamide (Ifex)
• Methotrexate (high dose) with leucovorin

Surgery is used after chemotherapy to remove any remaining tumor. In most cases, surgery can remove the tumor while saving the affected limb. This is called limb-salvage surgery. In rare cases, more involved surgery (such as amputation) is necessary.

Support Groups

You can ease the stress of illness by joining a cancer support group. Sharing with others who have common experiences and problems can help you and your family not feel alone.

Expectations (prognosis)

If the tumor has not spread to the lungs (pulmonary metastasis), long-term survival rates are better. If the cancer has spread to other parts of the body, the outlook is worse. However, there is still a chance of cure with effective treatment.

Complications

• Limb removal
• Spread of cancer to the lungs
• Side effects of chemotherapy

Calling your health care provider

Call your health care provider if you have persistent bone pain, tenderness, or swelling.

References

 GebhardtMA, Springfield D, Neff JR. Sarcomas of bone. In: Abeloff MD, Armitage JO, Niederhuber JE et al., eds. Abeloff’s Clinical Oncology. 4th ed. Phildelphia, PA: Elsevier Churchill-Livingstone; 2008:chap96.

Lerner A, Antman KH. Primary and metastatic malignant bone lesions. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 208.

National Cancer Institute. PDQ Osteosarcoma and malignant fibrous histiocytoma or bone treatment. Bethesda, MD: National Cancer Institute. Date last modified 8/9/2012. Available at: http://www.cancer.gov/cancertopics/pdq/treatment/osteosarcoma/HealthProfessional. Accessed November 16, 2012.

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Bone Cancer. Version 2.2012. Available at: http://www.nccn.org/professionals/physician_glspdf/bone.pdf. Accessed November 16, 2012.

Review Date: 11/17/2012

Reviewed by: Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, Stephanie Slon, and Nissi Wang.