Osteosarcoma

Answer 1

Definition

Osteosarcoma is a cancerous (malignant) bone tumor that usually develops during the period of rapid growth that occurs in adolescence, as a teenager matures into an adult.

Alternative Names

Osteogenic sarcoma

Causes, incidence, and risk factors

Osteosarcoma is the most common cancerous (malignant) bone tumor in youth. The average age at diagnosis is 15. Boys and girls have a similar incidenceof this tumor until late adolescence, at which time boys are more commonly affected.

The cause is not known. In some cases, osteosarcoma runs in families, and at least one gene has been linked to increased risk. This gene is also associated with familial retinoblastoma, 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)

This cancer occurs most commonly in larger bones and in the area of bone with the fastest growth rate. Osteosarcoma can occur in any bone, however.

Although it is rare, osteosarcoma can occur in adults.

Symptoms

• Bone fracture (may occur after what seems like 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

• 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 of the affected area
• Open biopsy (at time of surgery for diagnosis)
• X-ray of the affected area

Treatment

Treatment usually starts after a biopsy of the tumor.

Before major surgery to remove the tumor, chemotherapy is usually given. Chemotherapy is also used to kill or shrink any cancer cells that may have spread to other parts of the body.

Common chemotherapy medicines include:

• Cisplatin
• Carboplatin (Paraplatin)
• Cyclophosphamide (Cytoxan)
• Doxorubicin (Adriamycin)
• High-dose methotrexate with leucovorin
• Ifosfamide (Ifex)

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). Rarely, more radical surgery (such as amputation) may be necessary.

Support Groups

Association of Cancer Online Resources -- www.acor.org

Cure Search (formerly the National Childhood Cancer Foundation) --www.curesearch.org

Expectations (prognosis)

If the tumor has not spread to the lungs (pulmonary metastasis), long-term survival rates are very high. If the cancer has spread to other parts of the body, there is still a good 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

Skubitz KM, D'Adamo D. Sarcoma. Mayo Clin Proc. 2007;82:1409-1432.

Baker MH. Bone tumors: primary and metastatic bone lesions. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 212.

Answer 2

Definition

Osteosarcoma is a cancerous (malignant) bone tumor that usually develops during the period of rapid growth that occurs in adolescence, as a teenager matures into an adult.

Alternative Names

Osteogenic sarcoma

Causes, incidence, and risk factors

Osteosarcoma is the most common cancerous (malignant) bone tumor in kids. The average age at diagnosis is 15. Boys and girls are just as likely to get this tumor until the late teen years, when it is more often seenin boys. Osteosarcoma is also more commonly seen 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, 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)

This cancer occurs most commonly in larger bones and in the area of bone with the fastest growth rate. Osteosarcoma can occur in any bone, however.

Symptoms

• Bone fracture (may occur after what seems like 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 it makes 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). Rarely, more radical surgery (such as amputation) may be necessary.

Support Groups

Association of Cancer Online Resources -- www.acor.org

Cure Search for Children's Cancer --www.curesearch.org

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

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

National Cancer Institute. Osteosarcoma and malignant fibrous histiocytoma of bone treatment PDQ. Updated October 12, 2011.

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Bone Cancer. Version 2.2011.

Reviewed By

Review Date: 12/15/2011

David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.