Osteosarcoma

Osteosarcoma is a rare form of bone cancer, representing less than one percent of all cancers, but it is the most common form of bone cancer in children and young adults. It can also occur in older patients, usually 60 years old and older. Osteosarcoma frequently begins beside the knee, in either the femur or the tibia. It also commonly affects the shoulder, arising within the humerus.

Osteosarcoma tumors occur more frequently during periods of active bone growth, such as adolescence. Although many genetic mutations have been identified in these tumors, in most instances, the main cause of the disease remains unclear. There is no evidence that environmental, social or dietary factors contribute to its development. However, prior radiation, chronic bone disorders such as Paget’s disease and certain rare inherited conditions like Li-Fraumeni syndrome, Rothmund-Thomson syndrome and hereditary retinoblastoma can increase an individual’s risk of developing osteosarcoma.

Symptoms of osteosarcoma include a painful, swollen, firm area in or around a bone. This may be more visible in an arm or leg. If located on the pelvis or spine, it may be harder to see, and pain may be the main symptom. Patients may feel uncomfortable even while sitting or resting, and they may experience pain that wakes them from sleep. Pain may prevent normal range of motion, and patients may report stiffness, weakness or other subjective senses of discomfort. Rarely, the bone may break in the absence of major trauma or other obvious causes.

Osteosarcoma requires a comprehensive team approach, including the multidisciplinary expertise of orthopedic oncologists, pediatric oncologists, medical oncologists, radiation oncologists, musculoskeletal radiologists, bone and soft tissue pathologists, nuclear medicine specialists, surgical oncologists and plastic and reconstructive surgeons, among others.

Treatment includes both systemic chemotherapy and surgery, at a minimum. After a few months of chemotherapy, the tumor is surgically removed. Additional chemotherapy is administered thereafter. Treatment generally takes nine to 10 months. In some cases, other treatments, such as radiation, are also used.

Patients treated for osteosarcoma require close surveillance for a period of five years. This includes physical examinations and periodic imaging studies. Many patients continue to follow up even after five years, though at a reduced frequency.