Osteosarcoma (also known as osteogenic sarcoma) is a tumor that almost always arises in a bone, most commonly near the growth plates around the knee, arms, legs and pelvis. It is the most common type of pediatric bone tumor. Osteosarcoma occurs more frequently in males than in females; and usually affects adolescents and young adults between the ages of 10 and 25. Like all sarcomas, the tumor is highly malignant and can metastasize (spread) rapidly to other bones and to the lungs. Accurate diagnosis and staging, and prompt, carefully orchestrated therapy are particularly critical when treating osteosarcoma.
The University of Chicago Medicine Comer Children’s Hospital has a multidisciplinary team of experts with the experience and advanced resources to diagnose, analyze and treat osteosarcoma and other less common types of bone sarcoma. Pediatric oncologists, radiation oncologists, orthopaedic surgeons, pathologists, nurse specialists and others at Comer Children’s work together as a team to strive for the best results for children with bone sarcomas.
What are the Symptoms of Osteosarcoma?
The most common symptoms of osteosarcoma are:
- Sharp or dull pain 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
Pain and swelling in arms and legs are not uncommon in teens and young adults, especially young athletes. When the pain and/or swelling persists, gets worse at night or during exercise, or begins to interfere with activity, a doctor should be consulted.
Getting the correct diagnosis is critical, but isn’t always simple. Multilevel, advanced diagnostics are necessary to detect, locate, identify and stage osteosarcoma. Once a tumor is suspected, your care team will perform state-of-the art imaging studies and procedures including:
- X-ray -- to confirm the presence of a tumor
- Magnetic Resonance Imaging (MRI) or Computed Tomography (CT) scan -- to determine the extent of the tumor
- Bone scan -- to identify any additional sites of bone involvement
- Positron Emission Tomography (PET) scan -- to find small tumors or check if treatment is working effectively
- Biopsy -- to remove tissue from the tumor for microscopic examination by an expert pathologist
Using extensive, specialized testing of the tissue, the pathologist is able to confirm the diagnosis and identify the type of sarcoma. The sarcoma team then assigns a stage to the tumor, defining whether the tumor is localized to only one site or has spread to other sites. Having the correct diagnosis and stage assignment is critical for optimal treatment planning.
There are several steps in the treatment of osteosarcoma. Most patients with osteosarcoma need to be treated with chemotherapy first. Even if the cancer appears to be localized to one place, we know that microscopic amounts of osteosarcoma cells may have spread around the body but are not detectable. Second, effective osteosarcoma therapy nearly always includes surgery to remove all visible tumor. Usually, our osteosarcoma team uses chemotherapy to shrink the tumor before surgery. This is done to have a better chance of removing the tumor without significantly interfering with function or needing an amputation. Chemotherapy is often used again after surgery to destroy any remaining cancer cells where the primary tumor had been and in other sites as mentioned above. If complete removal of the tumor is not possible or if we can still detect cancer in the tissue surrounding the tumor site after the surgery, radiation may also be necessary. At Comer Children's, we have the capability to provide all of these treatment options on-site, which enables the team to effectively coordinate each child's care and to readily modify treatment plans as the cancer responds to therapy.
Some patients may be eligible for studies of the very newest therapies through clinical trials being conducted at Comer Children's. Parents are closely involved in deciding whether or not to enroll their child in a clinical trial. Clinical trials are only considered by the sarcoma team if they are thought to provide the best chance to cure the osteosarcoma.
Innovative Surgery Saves Limbs, Protects Growth
At Comer Children's, we carefully balance the need to surgically treat bone cancer with the desire to keep kids active and functioning normally throughout their childhood and into adulthood. There are different types of surgery required during treatment for osteosarcoma. Surgeries are tailored to fit the needs of each patient:
- Resection -- removal of the original tumor
- Limb-sparing surgery -- removal of the affected bone, saving the limb from amputation. This is done in most cases.
- Articular-sparing surgery -- removal of the tumor and reconstructing the bone/limb while preserving the joints.
- Amputations -- removal of all or part of the limb. It is rarely done and used as a last resort, when it is the only option for cure.
- Metastases surgery -- removal of tumor that has spread to other places, usually to the lungs
Orthopaedic surgeons at Comer Children's have been leaders in less-extreme surgical treatment of bone cancers for more than 20 years. In the 1980s, our surgeons were among the first in the U.S. to perform limb-sparing surgery as an alternative to amputation. We use state-of-the-art prostheses to rebuild the involved cancerous bone and joint removed during surgery. With physical therapy, nearly all patients are able to walk soon after surgery.
Today, our surgeons are among the first worldwide performing "articular-sparing" (joint -sparing) resection to preserve the joint surfaces and long-term functioning for kids with bone cancer. This intricate technique preserves as much of the child's healthy bone as possible. In certain scenarios, they are also able to spare the growth plates, preserving bone growth as the child grows. Like matching together jagged pieces of a jigsaw puzzle, the orthopaedic surgeon removes cancerous bone and then fits together the child's own healthy bone with bone from a bone tissue bank (i.e. allograft bone). The result: a bone or joint that is strong, stable and has the best chance to grow normally.