What is osteogenic sarcoma?
Also called osteosarcoma, osteogenic sarcoma is one of the most common types of bone cancer in children.
The disease usually occurs in the long bones, such as the arms (humerus), legs (femur/tibia), and pelvis. It rarely occurs in the jaw and fingers, but often occurs at the ends of these bones near growth plates. Osteosarcoma affects adolescents and young adults.
This cancer is also more prevalent in males than in females, possibly because of the rapid growth rate at this age. Prior to adolescence, the percentage of affected males and females is equal.
Osteogenic sarcoma cancer cells can also spread (metastasize) to other areas of the body. Most commonly, these cells spread to the lungs. However, bones, kidneys, the adrenal gland, the brain, and the heart can also be sites of metastasis.
What causes osteogenic sarcoma?
It has been suggested that repeated trauma to an area may be a risk factor for developing this type of cancer. It is uncertain whether trauma is a cause or effect of the disease. Cancer lesions in the bone can make that area of the bone weaker, thus, making injury more likely. However, repeated injuries to a certain area of the bone may lead to an increased production of osteoid tissue to repair the damaged area. The rapid production of osteoid tissue may lead to the malignancy. It is thought, most often, that injury simply brings the condition to attention and has no causal relationship.
Genetics may play an important role in developing osteosarcoma. Children and adults with other hereditary abnormalities, including exostoses (bony growths), retinoblastoma, Ollier's disease, osteogenesis imperfecta, polyostotic fibrous dysplasia, and Paget's disease, have an increased risk for developing osteosarcoma.
This form of cancer has also been linked to exposure to ionizing irradiation associated with radiation therapy for other types of cancer (i.e., Hodgkin's and non-Hodgkin's disease).
What are the symptoms of osteogenic sarcoma?
The following are the most common symptoms of osteogenic sarcoma. However, each child may experience symptoms differently. Symptoms may include, but are not limited to, the following:
- pain (sharp or dull) at the site of the tumor
- swelling and/or redness at the site of the tumor
- increased pain with activity or lifting
- decreased movement of the affected limb
The symptoms may have been present over a short period of time or may have been occurring for six months or more. Often, an injury brings a child into a medical facility, where an x-ray may indicate suspicious bone lesions.
The symptoms of osteogenic sarcoma may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.
How is osteogenic sarcoma diagnosed?
In addition to a complete medical history and physical examination of your child, diagnostic procedures for osteogenic sarcoma may include:
- multiple imaging studies of the tumor and sites of possible metastasis, such as:
- x-rays - a diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
- bone scans - a nuclear imaging method to evaluate any degenerative and/or arthritic changes in the joints; to detect bone diseases and tumors; to determine the cause of bone pain or inflammation. This test is to rule out any infection or fractures.
- magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body. This test is done to rule out any associated abnormalities of the spinal cord and nerves.
- computed tomography scan (Also called a CT or CAT scan.) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.
- complete blood count (CBC) - a measurement of size, number, and maturity of different blood cells in a specific volume of blood.
- blood tests (including blood chemistries)
- biopsy of the tumor - a tissue sample of the tumor or cancerous area must be taken for study under a microscope to confirm that the diagnosis is cancer, and not another bone disease.
Stages of Osteosarcoma:
Once osteosarcoma is found, more tests will be done to determine if the cancer cells have spread to others parts of the body. This is called staging. Currently, there is no staging system for osteosarcoma. Instead, most patients are grouped depending on whether cancer is found in only one part of the body (localized disease) or whether the cancer has spread from one part of the body to another (metastatic disease). Treatment is tailored to where the cancer is located and how far the disease has spread.
The following groups are used for osteosarcoma:
- Localized osteosarcoma – The cancer cells have not spread beyond the bone or nearby tissue in which the cancer began.
- Metastatic osteosarcoma – The cancer cells have spread from the bone in which the cancer began to other parts of the body. The cancer most often spreads to the lungs and it may also spread to other bones.
- Recurrent – Recurrent disease means that the cancer has come back (recurred ) after it has been treated. It may come back in the tissues where it first started or it may come back in another part of the body. Click here for more information about CHOC's Recurrent Cancer program.
Treatment for osteogenic sarcoma:
Specific treatment for osteogenic sarcoma will be determined by your child's physician based on:
- your child's age, overall health, and medical history
- extent of the disease
- your child's tolerance for specific medications, procedures, or therapies
- expectations for the course of the disease
- your opinion or preference
At CHOC, the most common treatments for osteosarcoma are surgery, chemotherapy and radiation therapy.
- Surgery – Surgery is a common treatment for osteosarcoma. The surgeon may remove the cancer and some of the healthy tissue around the cancer. If cancer has spread to the lymph nodes, the lymph nodes will be removed.
- Chemotherapy – This uses drugs to kill cancer cells. Chemotherapy may be taken by pill or put into the body by a needle in a vein or muscle. Chemotherapy is called systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells throughout the body. Chemotherapy with more than one drug is called combination chemotherapy. Sometimes chemotherapy is injected directly into the area where the cancer is found. In osteosarcoma, surgery is often used to remove the local tumor and chemotherapy is then given to kill any cancer cells that remain in the body. Chemotherapy given after surgery has removed the cancer is called adjuvant chemotherapy. Chemotherapy can also be given before surgery to shrink the cancer so that it can be removed during surgery. This is called neoadjuvant chemotherapy.
- Radiation therapy – This approach uses high-energy X-rays or other types of radiation to kill cancer cells and shrink tumors. Radiation for osteosarcoma usually comes from a machine outside the body (external beam radiation therapy).
Treatment may also include one or more of the following:
- resections of metastases (spreading of the tumor to other locations)
- rehabilitation including physical and occupational therapy and psychosocial adapting
- prosthesis fitting and training
- supportive care (for the side effects of treatment)
- antibiotics (to prevent and treat infections)
- continued follow-up care (to determine response to treatment, detect recurrent disease, and manage the side effects of treatment)
Long-term outlook for a child with osteogenic sarcoma:
Prognosis for osteogenic sarcoma greatly depends on:
- the extent of the disease.
- the size and location of the tumor.
- presence or absence of metastasis.
- the tumor's response to therapy.
- the age and overall health of your child.
- your child's tolerance of specific medications, procedures, or therapies.
- new developments in treatment.
As with any cancer, prognosis and long-term survival can vary greatly from child to child. Every child is unique and treatment and prognosis is structured around the child's needs. Prompt medical attention and aggressive therapy are important for the best prognosis. Continuous follow-up care is essential for a child diagnosed with osteogenic sarcoma. Side effects of radiation and chemotherapy, as well as second malignancies, can occur in survivors of osteogenic sarcoma. New methods are continually being discovered to improve treatment and to decrease side effects.
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Online Resources of Oncology