Osteosarcoma is a type of bone sarcoma mostly diagnosed in teenagers and young people; however, it can also affect older adults.
It mostly affects the knee, thigh bone, shin bone or upper arm. They make up 30% of all bone sarcoma diagnoses.
Signs and symptoms
Symptoms of bone sarcoma can vary depending on the size and location of your tumour.
- Bone pain, particularly occurring at night
- A mass or swelling
- Restricted movement in a joint
Symptoms can sometimes be confused with more common problems such as a sports injury or in children and young people, growing pains.
Diagnosis
Your doctor will examine you. You may have one or more of these tests:
- MRI scan – uses magnets to create an image of the tissues of the body
- CT scan – The Computer Tomography (CT) scan takes a number of x-rays to make a 3D image of an affected area
- X-ray – uses x-radiation to take images of dense tissues inside the body such as bones or tumours
- Bone scan – shows up changes or abnormalities in the bones. A small amount of radioactive material is injected into your veins before having a scan
To read more about scans and tests, click here.
Treatment
Surgery
During surgery, the surgeon will remove the tumour and will aim to take out an area of normal tissue around it too. This is known as taking a margin. To achieve this margin of normal tissue, some patients will receive limb-sparing surgery. The aim of this surgery is to preserve the limb where the tumour is rather than amputating it.
Limb-sparing surgery involves taking out the affected bone and replacing it with a bone graft (bone taken from another part of the body). Unfortunately, it’s not always possible to use limb-sparing surgery. Sometimes the cancer may spread from the bone to the nerves and blood vessels around it. If this happens the only way to treat the cancer may be to remove part of the limb known as a partial amputation. Some people may need to have all of their limb removed. This is called a full amputation.
Tumours in the pelvis can sometimes be hard to remove with surgery. You may be given chemotherapy first, then surgery to get rid of all of the cancer. You may also receive radiotherapy after surgery to get rid of any cancer cells still in the area. Pelvic bones can sometimes be reconstructed after surgery, either by a bone graft or using a prosthesis. Unfortunately, in some cases pelvic bones and the leg they are attached to might need to be removed, this is called a hind-quarter amputation.
For a tumour in the lower jaw bone, the entire lower half of the jaw may be removed. This may be reconstructed using bones from other parts of the body. If the surgeon can’t remove all of the tumour, radiation therapy may be used as well.
If your tumour is in the spine or the skull, it may not be possible to remove all of the tumour safely. Sarcoma in these bones may require a combination of treatments such as chemotherapy, surgery, and radiation.
Chemotherapy
Chemotherapy uses anti-cancer drugs to destroy cancer cells. It is sometimes used before surgery to reduce the size of the tumour so it can be operated on and removed. This can be useful to treat large tumours and can prevent the need to have the limb either partially or fully amputated.
Chemotherapy is also sometimes used after surgery. In this case, the aim is to kill off any local cancer cells which remain in the area of the tumour. The main types of chemotherapy used to treat osteosarcoma are doxorubicin, cisplatin, high-dose methotrexate and ifosfamide.
Children, adolescents and young adults (aged 30 or under) may also be given a course of a new drug called mifamurtide (Mepact) which may help to reduce the risk of osteosarcoma coming back. This treatment is not relevant for everyone; however, children, adolescents and young adults should be able to have mifamurtide if:
- Their tumour is high grade and has not spread to another part of the body and
- They have had an operation to remove their tumour and
- They are also having chemotherapy with multiple drugs
Radiotherapy
Radiotherapy uses high-energy radiation beams to destroy cancer cells. Osteosarcoma is not usually sensitive to radiotherapy; however, this type of treatment may be used after surgery in some cases, if there is a risk that the cancer has spread to the surrounding soft tissue.
After treatment
After treatment for sarcoma you may benefit from rehabilitation services, such as occupational therapy, physiotherapy, dieticians, orthotics and prosthetics.
Rehabilitation usually starts after treatment. However, with bone sarcoma you may find that it helps to start rehabilitation earlier.
You may find that you are not automatically offered a referral to rehabilitation services by your medical team, so it is important to ask at the earliest opportunity for a referral.
You can read more about rehabilitation services here.
Living with
A recurrence of cancer may appear in other parts of the body. This is called a metastasis or secondary cancer.
In people with bone sarcoma, these secondary cancers may appear in the lungs. A chest x-ray is taken at follow-up appointments to look for secondary cancers in the lung.
