Older children and adolescents might experience pain around both knees especially in the evening and/or before bedtime, a condition which is known as ‘Growing Pain’. This usually manifests as benign, self-limiting and a non-severe pain around the knees and sometimes on the ankles. However, if the pain is severe, present while asleep, or associated with a lump on the legs or ankles, the condition is unlikely to be ‘Growing Pain’ and can be the symptoms of Malignant Bone Tumor.

The enlarged lump on the extremities and bony areas is the second most common presenting symptom of bone tumor, especially after injury to primary lesion of tumor through minor sports injury or fall injury. The two most common malignant bone tumors in children are osteosarcoma and Ewing Sarcoma, respectively.

The most common symptoms of osteosarcoma are progressive pain around the knees commonly involving two sites such as the distal femur and proximal tibia. Its treatment depends on the site and size of the primary tumor as well as how far the tumor cells have spread through other sites (metastasis) including the lungs, bones, and brain.

The treatment modalities for osteosarcoma are surgery and chemotherapy. The prognosis of osteosarcoma depends on the completion of surgery at the primary tumor site, the response to chemotherapy and the metastatic status upon diagnosis and during treatment. Nonmetastatic osteosarcoma is associated with good prognosis, and up to 80% 5-years survival rate. Osteosarcoma is radio-resistant, and therefore radiation is not an option as the first-line of treatment.

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