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Osteosarcoma is a type of bone cancer that occurs in the cells that creates the bones, typically found in teenagers and young children, although, it may also show in younger or older people. It commonly occurs in the long bones like legs or sometimes the arms, but any bone in the body may have it as well.
Treatment for osteosarcoma is based on the size, the location where it begun, the type and grade of osteosarcoma and if the cancer has spread to other areas of the body. Chemotherapy, surgery and, sometimes, radiation therapy are the common treatment options for osteosarcoma.
The latest technologies in osteosarcoma treatment has helped with its prognosis. Once it has been treated, it should still be regularly checked because there may be a tendency for the effects of aggressive treatment to show at a later time.
Symptoms
The following signs and symptoms may occur with osteosarcoma:
- Bone fracture or injury with no cause
- Swollen area near a bone
- Pain in the bone or joint
If you constantly notice this signs and symptoms on your child and it worries you, consult a doctor. There are a lot of common diseases such as sports injuries that has the same symptoms with osteosarcoma.
Causes
The cause of osteosarcoma is unknown. This type of cancer begins when the cells that creates the bone undergo an unusual change.
Osteosarcoma starts with the changes in the DNA of the cells of the bone making them produce more bone uncontrollably and later on creates a tumor. This tumor is composed of abnormal cells that can damage other nearby tissues that are healthy or break and spread to other areas of the body (metastasis).
Risk factors
The following are the risk factors that may lead to osteosarcoma:
- Hereditary: Having hereditary disorders such as retinoblastoma, Werner syndrome, Bloom syndrome, Li-Fraumeni syndrome and Rothmund-Thomson syndrome.
- Other diseases: Having Paget’s disease or fibrous dysplasia which are other types of bone disorder.
- Radiation: Undergoing radiation treatment in the past.
Diagnosis
The doctor initially performs physical assessment to know the cause of the symptoms.
- Imaging tests: These are the diagnostic tests that may be performed to understand better what causes the symptoms, check for any signs of cancer and if the cancer has metastasized:
- X-ray
- Computerized Tomography (CT)
- Magnetic Resonance Imaging (MRI)
- Positron Emission Tomography (PET)
- Bone scan
- Biopsy: Biopsy if performed by removing a sample of the tumor which will be sent to the laboratory to determine the presence of cancer as well as its stage and its grade (how aggressive it is). Osteosarcoma may be diagnosed by using the following types of biopsy:
- Needle biopsy. A thin needle is inserted into the skin to reach for the tumor and get a small sample of tumor tissue.
- Surgical biopsy. An incision is made by a surgeon on the skin and takes out a part (incisional biopsy) or the whole tumor (excisional biopsy).
Talk to your doctor on which type of biopsy should be performed in order to avoid getting in the way of possible cancer removal surgery in the future. An expert surgeon in osteosarcoma treatment should see you first before undergoing the biopsy.
Treatment
Surgery and chemotherapy are the common treatment for osteosarcoma or in some cases, radiation may also be used.
Surgery
Surgery is mainly done to take out all the cancer cells but it also depends on many factors, such as the size and location of the sarcoma.
The following surgical techniques are done to treat osteosarcoma:
- Limb-sparing surgery. Surgery may be done to remove the cancer without affecting the limb’s functionality. However, it depends on the extent of cancer and if a lot of muscles and tissues are removed.
The doctor will do bone reconstruction if a portion of the bone is removed which may include bone grafting or prosthetics. - Amputation. The whole limb or only a part of the limb may be removed. A prosthetic joint may further aid in resuming the limb’s function.
- Rotationplasty. This surgery may be done on children who are still growing. The technique is removing the cancer and the tissues around it, as well as the knee joint. Then, the foot and ankle is rotated while the ankle plays the role of the knee. For the lower leg and foot, a prosthesis will be utilized and this whole process results to returning the patient to normal activities of daily living, including physical activities and sports.
Chemotherapy
Chemotherapy uses medications which is administered intravenously or orally, or both. It may be done before surgery (neoadjuvant therapy) in order to shrink the tumor and spare the limb from surgery.
If the cancer is very aggressive, chemotherapy might not work. So, the doctors may need to combine different chemotherapy regimen or recommend a surgery that is more extensive to remove all the cancer. After the surgery, chemotherapy may also be applied to ensure that all the cancer cells are destroyed.
If osteosarcoma recur or has metastasized, chemotherapy may be used to slow down the disease.
Radiation therapy
Radiation therapy utilizes high powered energy beams through X-rays and protons to destroy cancer. Radiation may be used in situations where surgery cannot be done or if cancer cannot be totally removed by the surgeon.
A machine is navigated through the patient’s body while lying on a table. The beam is focused on the osteosarcoma’s area to spare the health cells nearby.
