Osteosarcoma, also called osteogenic sarcoma

Osteosarcoma is the most common type of cancer that begins in you or your teenager’s bones, usually in the arms or legs. Limited movement, bone pain, a lump and an unexplained broken bone are the most common symptoms. Many treatments are available. If the osteosarcoma doesn’t spread to other parts of the body, the survival rate is around 70%. Osteosarcoma is most often found in the long bones — more often the legs, but sometimes the arms — but it can start in any bone. In very rare instances, it occurs in soft tissue outside the bone.

Osteosarcoma tends to occur in teenagers and young adults, but it can also occur in younger children and older adults. Treatment usually involves chemotherapy, surgery and, sometimes, radiation therapy. Doctors select treatment options based on where the osteosarcoma starts, the size of the cancer, the type, and grade of the osteosarcoma, and whether the cancer has spread beyond the bone.

Treatment innovations for osteosarcoma have greatly improved the outlook (prognosis) for this cancer over the years. After completion of treatment, lifelong monitoring is recommended to watch for potential late effects of intense treatments.

Bone pain and swelling

Pain at the site of the tumor in the bone is the most common symptom of osteosarcoma. The most common sites for these tumors in younger people are around the knee or in the upper arm, but they can occur in other bones as well. At first, the pain might not be constant and might be worse at night. The pain often increases with activity and might result in a limp if the tumor is in a leg bone.

Swelling in the area is another common symptom, although it might not occur until later. Depending on where the tumor is, it might be possible to feel a lump or mass.

Limb pain and swelling are very common in normal, active children and teens. They are much more likely to be caused by normal bumps and bruises, so they might not prompt a doctor visit right away. This can delay a diagnosis. If your child has these symptoms, and they don’t go away within a few weeks (or they get worse), see a doctor so that the cause can be found and treated, if needed.

These symptoms are less common in adults, so they should be a sign to see a doctor even sooner.

While pain and swelling are often the earliest and most common signs of osteosarcoma, this malignancy can cause a number of other symptoms, including:

A bump, depending on where the tumor is located
Redness and warmth at the site of the tumor
Anemia
Fever
Exhaustion
Unexplained weight loss

Bone fractures (breaks)

Although osteosarcoma might weaken the bone it develops in, fractures (breaks) are not common. Exceptions are rare telangiectatic osteosarcomas, which tend to weaken bones more than other forms of osteosarcoma and are more likely to cause breaks where the tumor is.

People with a fracture next to or through an osteosarcoma often describe a limb that was sore for a few months and suddenly became very painful when the fracture occurred.

Osteosarcoma treatment

Surgery

The goal of surgery is to remove all the cancer. Even a few cells left behind can grow into a new tumor. Depending on your case, your doctor may do one of these procedures:

Limb-sparing surgery:

Your doctor takes out the tumor in an arm or leg and some of the tissue around it. A medical device, or prosthesis, will fill in part or all of the gap left in the bone. You might also have a bone graft, which uses a piece of bone from another part of your body or from a donor.

Amputation:

If the tumor is large and has gotten into nerves or blood vessels, your doctor may have to amputate, or remove, all or part of your leg or arm. You might choose to get fitted for an artificial or prosthetic limb.

Rotationplasty:

If your doctor has to take off your leg above your knee, they can reattach part of your lower leg and foot to your thigh-bone. With the help of a prosthesis, your ankle works as a new knee joint.

Osteosarcoma in your pelvis, jawbone, spine, or skull may be harder to remove completely with surgery. You might also need radiation therapy. If the cancer spreads to your lungs or other parts of your body, your doctor may need to take out those tumors.

Chemotherapy

“Chemo” uses strong medications to kill cancer cells or stop them from growing. You usually get them in your vein through an IV. Doctors treat most osteosarcomas with chemo. The drugs may shrink the tumor, which can make surgery easier. They also get rid of small clusters of cancer cells that doctors may not be able to see on medical scans.

Side effects include nausea and vomiting, diarrhea, and a loss of appetite. Children tend to have less severe side effects from chemo than adults, so they might get higher doses of medication.

Radiation therapy

High-energy X-rays can kill cancer cells.

Radiation doesn’t work as well on osteosarcoma cells as it may with other cancers. But your doctor might use a procedure called external beam radiation therapy if they can’t take out all of the cancer through surgery. That often happens when a tumor is in your hip or jawbone.

This type of therapy uses a machine to focus high-energy beams on the tumor to kill the remaining cancer cells.

New therapies

Scientists are studying the best mix of chemo medications to treat osteosarcoma and testing newer types of drugs. They’re also working on stronger and more targeted radiation therapies.

You may want to ask your doctor about clinical trials. These are how experts test new treatments before they’re made widely available. Your doctor can help you find one that might be a good match and help you understand what’s involved.

Complications

Complications of osteosarcoma and its treatment include:

Cancer that spreads (metastasizes)

Osteosarcoma can spread from where it started to other areas, making treatment and recovery more difficult. Osteosarcoma that spreads most often spreads to the lungs and to other bones.

Adapting to limb amputation

Surgery that removes the tumor and spares the limb is used whenever possible. But sometimes it’s necessary to remove part of the affected limb in order to remove all of the cancer. Learning to use an artificial limb (prosthesis) will take time, practice, and patience. Experts can help you adapt.

Long-term treatment side effects

The aggressive chemotherapy needed to control osteosarcoma can cause substantial side effects, both in the short and long term. Your health care team can help you manage the side effects that happen during treatment and provide you with a list of side effects to watch for in the years after treatment.