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The University of Chicago Medicine - Comer Children's Hospital
At the Forefront of Kids' Medicine

Osteosarcoma: Frequently Asked Questions

Here are answers to some questions frequently asked by parents of children with osteosarcoma:

Although osteosarcoma is not completely understood, we know it occurs when there is uncontrolled dividing among bone cells. It is associated with genetic mutations in the cells that form the bones. Most often, osteosarcoma is diagnosed during adolescence, when the bones are growing the most. The reason for this association is not clear; it is possible that growing bone cells are more likely to become “transformed” into cancerous osteosarcoma cells.

Most of the time, we do not know why osteosarcoma develops in an individual child. However, osteosarcoma has been linked to certain hereditary conditions in which children are at an increased risk for developing the disease. Osteosarcoma has also been linked to previous radiation therapy given earlier in life for other types of cancer.

It’s very rare for other family members to be affected. We always analyze family history for each new patient. Occasionally a genetic problem is suspected. In that case, the patient and certain family members are sometimes referred to our Pediatric Familial Cancer to be tested for inherited defects that might predispose them to cancer.

Once the diagnosis has been confirmed, your oncologist will assign a stage to the tumor. Osteosarcomas are staged as either localized or metastatic (spread to other parts of the body - typically to the lungs).

If the tumor cells have metastasized they are most often found in the lungs, in other bones, or both.

Osteosarcoma requires surgery for the initial biopsy and for removal of all visible tumor tissue. This is often accomplished using bone grafts, limb-sparing procedures and reconstruction. Only rarely is amputation required. In the past, amputation of the involved limb was the first line of treatment for tumor removal. At the University of Chicago Medicine Comer Children’s Hospital, our orthopaedic surgeons and sarcoma team avoid amputation whenever possible. In fact, in the 1980s, the University of Chicago was among the first institutions in the US to perform limb-sparing surgery. We continue to be innovators in using surgical techniques that remove cancerous bone and tissue while leaving as much of the child's healthy bone and tissue intact as possible.

Chemotherapy, before and after surgery, is a critical part of the comprehensive and multidimensional treatment of osteosarcoma. It is given before surgery in order to shrink the tumor, and in an attempt to prevent or control spread of the tumor. Chemotherapy after surgery targets potential tumor sites not removed completely by surgery. It is important to know that chemotherapy is nearly always needed even if the osteosarcoma is only visible at one site and can be removed. In the past, when osteosarcoma was only treated with surgery, it often came back and was even harder to eradicate. Chemotherapy is usually given intravenously (IV) through a temporary central line. Other medications that control the side effects of chemotherapy are given orally.

Because osteosarcoma cells are not easily killed by radiation, it is not typically used in the initial treatment phase. But, if complete removal of the tumor is not possible or if there is still visible cancer in the tissue surrounding the tumor site after the surgery, radiation may be necessary.

Chemotherapy drugs not only attack the cancer cells, they can injure normal tissue and blood-forming cells. For this reason, your child may experience some of the common side effects of chemotherapy including low blood counts (causing anemia), nausea, vomiting, hair loss, mouth sores, irregular periods (girls) and inability to produce sperm (boys). Your treatment team will do everything they can to reduce or prevent side effects of treatment.

Patients and their parents should talk to their doctor about the reproductive risks associated with cancer treatment. In certain situations, there are options available to try to preserve fertility, such as with sperm banking. These programs are available at Comer Children’s.

Scientists and researchers are continually making progress in the fight against cancer. At any given time, many clinical trials of new drugs and protocols for childhood cancers are being tested. Across North America, most children with cancer are treated on a clinical research trial. Your physician only recommends a clinical trial when your care team believes it offers the best chance for a cure. Even if your treating physician recommends treatment on a clinical trial, you always have the option to choose the “standard of care” treatment that does not involve research.

The length of stay will vary from patient to patient. In general, the first phase of treatment lasts 10 to 15 weeks, during which time chemotherapy is given to begin to shrink the tumor. During this phase, you should anticipate being in the hospital only for periods of 3 to 5 days every three weeks when the chemotherapy is actually administered. Surgery typically takes place immediately following this first chemotherapy phase and requires some inpatient stay. After surgery, treatment continues for about 18 more weeks, with inpatient stays lasting a few days every few weeks to administer the chemotherapy.

The prognosis for survival varies depending on the stage of the tumor when it is detected and treated and other factors. The survival rate for osteosarcoma patients who undergo chemotherapy and surgery, and who have no metastases, is approximately 70 percent. Survival rates for patients who have metastases to the lungs or other bones are 30 to 50 percent, if the affected tissues are successfully removed.

Unfortunately, osteosarcoma can come back after treatment. The lungs are the most common sites for recurrence. Sometimes, multiple resections (partial surgical removals) of recurrent tumors are necessary. Additional chemotherapy or experimental therapy is recommended in some cases.

Behind the scenes, University of Chicago physicians and scientists are studying the biological and genetic basis of sarcomas and other cancers. Their findings may contribute to more effective ways to diagnose and treat osteosarcoma and to prevent the recurrence of this and other cancers that affect children and adults.  Read more about sarcoma research under way at the University of Chicago.