Osteosarcoma is the most common cancer that originates in the bones, typically affecting teenagers and often found in the arms or legs. Common symptoms include limited movement, bone pain, a noticeable lump, and unexpected bone fractures. Various treatment options are available, and if the cancer has not spread, the survival rate is around 70%.
Osteosarcoma, or osteogenic sarcoma, is a type of bone cancer where initially normal-appearing bone cells become cancerous, forming tumors that produce irregular and diseased bone. It most commonly affects teenagers, with the average diagnosis age being 15. Sarcoma is a type of cancer found in connective tissues like bone, cartilage, or muscle, with “osteo” referring to bones.
Osteosarcoma usually affects long bones, such as those near the knee (femur, tibia) or shoulder (humerus). Less common locations include the pelvis, skull, jaw, and rarely, soft tissues or organs in the chest or abdomen.
Types of Osteosarcoma
Osteosarcoma tumors are classified as low-grade, intermediate-grade, or high-grade. Low-grade tumors grow slowly and are often localized, while high-grade tumors spread quickly and metastasize. Most osteosarcoma tumors in children and teenagers are high-grade, characterized by cells that look abnormal under a microscope.
There are nine types of high-grade osteosarcoma, including osteoblastic, chondroblastic, and small cell types. Intermediate-grade osteosarcoma includes periosteal, while low-grade types include parosteal and intramedullary well-differentiated forms. Understanding the grade is crucial for determining treatment options and prognosis.
Who Gets Osteosarcoma? Risk Factors Explained
Osteosarcoma most commonly affects pre-teens and teenagers, with an average diagnosis age of 15, and over 75% of cases occur in people under 25. This may be linked to growth spurts during adolescence. The cancer is slightly more prevalent in African Americans, and occurs equally in boys and girls before adolescence but is more frequent in boys afterward.
Risk factors include previous radiation treatment, certain anticancer drugs, genetic mutations like RB1, and specific conditions such as Li-Fraumeni syndrome, Paget disease, hereditary retinoblastoma, and Werner syndrome.
How Common Is Osteosarcoma?
Each year, between 400 and 1,000 new cases of osteosarcoma are diagnosed in the United States. It accounts for about 3% of all childhood cancers, making it the most common primary bone tumor in children and the third most common cancer in adolescence after lymphomas and brain tumors.
Does Osteosarcoma Cause Pain?
Osteosarcomas can cause pain, especially when affecting limbs. The pain is often reported as worse during activity and at night, though the reason is unclear.
Is Osteosarcoma Deadly?
If osteosarcoma doesn’t spread, the survival rate is around 70%. However, if it metastasizes, survival rates may drop to 30-50%.
What Causes Osteosarcoma?
The exact cause of osteosarcoma is unknown, but several risk factors are associated with it:
- Rapid Bone Growth: Occurs during growth spurts in childhood or adolescence.
- Radiation Exposure: Often from prior cancer treatment.
- Genetic Factors: Includes certain inherited conditions or gene mutations (like retinoblastoma and p53).
- Bone Infarction: Caused by a lack of blood supply to bone tissue, leading to cell death.
Symptoms of Osteosarcoma
- Bone pain or tenderness
- Mass or lump that’s warm to the touch
- Swelling and redness at the tumor site
- Pain with lifting (arm tumors) or limping (leg tumors)
- Limited joint movement
- Unexplained fever
- Fractures from minor activity
Diagnosis and Tests
Diagnosis typically begins with a physical exam and involves several tests:
- Blood Tests to assess organ function.
- X-ray, CT Scan, MRI, Bone Scan, and PET-CT to locate tumors and evaluate spread.
- Biopsy to confirm cancer presence.
Treatment Options
- Surgery: Removal of the tumor, often with limb-sparing techniques.
- Chemotherapy: Given before and after surgery.
- Radiation Therapy: Used when surgery isn’t possible.
- Targeted Therapy: Uses drugs that attack cancer-specific proteins.
- Cryosurgery: Freezes and destroys cancer cells.
- Amputation and Rotationplasty: For some severe cases.
Treatment Team
A pediatric oncologist typically leads the treatment, supported by specialists such as orthopedic surgeons, radiation oncologists, and psychologists.
Side Effects and Complications
Side effects can include:
- Heart, lung, kidney issues
- Fertility problems
- Neurological and psychological effects
- Risk of secondary cancers
Prevention and Outlook
Currently, there’s no known way to prevent osteosarcoma. Survival rates are around 70% if the cancer hasn’t spread. Recurrence is possible, often within 18 months of treatment.
Living With Osteosarcoma
Regular follow-ups are vital for early detection of complications or recurrence. Family and social support are crucial for mental health and adjustment after surgery, especially if a limb has been amputated or altered.
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