Osteosarcoma is the most common cancer of the bone and the sixth most common cancer in children. Osteosarcoma is one of the few cancers that begins in the bones, usually the leg or knee. Osteosarcoma is produced by defective osteoblasts – the cells that are responsible for growing bones. This disease affects boys more than girls and affects the knees in most patients. Defective and unpredictable errors in the DNA of osteoblasts occur during intense bone growth. With correct diagnosis and treatment, most children recover from this disease.
Pain and swelling in the joints are the most common symptoms of Osteosarcoma. The cancer most often is present in longer bones – such as the thigh bone and upper arm bone. Pain can be worse at night or after athletic activity. Swelling or a mass may grow several weeks after the pain begins. Children can develop and unpredictable limp with osteosarcoma. Often the disease is first diagnosed after an unusual break in the bone. The bone becomes weakened by the cancer and a simple injury can cause it to shatter.
Diagnosis of this disease begins with a complete physical exam and a detailed medical history of the patient. X-rays will detect any bone abnormalities. A bone biopsy can provide tissue from the tumor for laboratory examination.
A CT scan of the bone will determine where a biopsy should be performed and what the extent of the cancer is. Sometimes an MRI can be used to obtain this same information.
A needle biopsy involves removing a piece of the tumor with a long hollow needle. Local anesthesia and sedation are used for the comfort of the patient. An open biopsy involves surgery, the patient is under general anesthesia and a larger portion of the tumor is removed. A pathologist will examine the biopsy tissues for cancer cells.
Once a diagnosis of osteosarcoma is determined, a CT scan of MRI will be used to determine the stage of the cancer. The stage of the cancer is defined by the size of the tumor, whether it has spread and to where the cancer has spread in the body. The scans will be repeated during and after treatment to monitor the success of the treatment and response of the cancer to treatment.
Treatment for this disease involves surgery and chemotherapy. The surgery can remove the tumor and chemotherapy is used to kill of any remaining cancer cells in the body.
Surgical treatment involves amputation or limb-salvage surgery. Most patients with osteosarcoma in the arm or leg can receive limb-salvage surgery instead of the amputation procedure. Limb salvage surgery will involve removing the tumor from the bone and grafting bone to the empty spots. The donated graft usually comes from the patient him or herself and is from the hip bone.
If the cancer has spread, most likely it spreads to blood vessels and nerves around the tumor, amputation is the only choice. When osteosarcoma has spread to other parts of the body, such as the lungs, surgery to remove cancerous tissue from these locations is also performed.
Chemotherapy is usually started before surgery. It can kill of small areas of cancer that do not appear on scans. Chemotherapy is administered orally or intravenously. Drugs kill off cancer in the body where the disease may have spread.
Amputation involves healing for up to six months before learning to work with a prosthetic leg or arm. Psychological and social support, therapy and rehabilitation are necessary to help patients adjust to their new bodies.
Chemotherapy medications carry long and short term side effects. Short term side effects are abnormal bleeding, increased risk of infection (the bone marrow is usually damages – decreasing immune functioning), abnormal menstrual cycles, kidney damage and/or anemia. Bladder inflammation, hearing loss, nausea are also side effects of chemotherapy.
Patients have a sixty to eighty percent survival rate, if osteosarcoma has not spread beyond the tumor. Osteosarcoma in the leg or arm has a better prognosis than osteosarcoma in other bones of the body.
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