Osteosarcoma

X-rays are a form of ionizing radiation that can penetrate the body to form an image on film. Structures that are dense (such as bone) will appear white, air will be black, and other structures will be shades of gray depending on density. X-rays can provide information about obstructions, tumors, and other diseases, especially when coupled with the use of barium and air contrast within the bowel.

Also known as: Osteogenic sarcoma

Definition

Osteosarcoma is a cancerous (malignant) bone tumor that usually develops during the period of rapid growth that occurs in adolescence, as a teenager matures into an adult.

Causes, incidence, and risk factors

Osteosarcoma is the most common cancerous (malignant) bone tumor in youth. The average age at diagnosis is 15. Boys and girls have a similar incidence of this tumor until late adolescence, at which time boys are more commonly affected. There is another peak in incidence among adults in their 60s and 70s.

The cause is not known. In some cases, osteosarcoma runs in families. At least one gene has been linked to an increased risk. This gene is also associated with familial retinoblastoma, a cancer of the eye that occurs in children.

Osteosarcoma tends to occur in the bones of the:

Shin (near the knee)
Thigh (near the knee)
Upper arm (near the shoulder)

This cancer occurs most commonly in larger bones and in the area of bone with the fastest growth rate. Osteosarcoma can occur in any bone, however.

Symptoms

Bone fracture (may occur after what seems like a routine movement)
Bone pain
Limitation of motion
Limping (if the tumor is in the leg)
Pain when lifting (if the tumor is in the arm)
Tenderness, swelling, or redness at the site of the tumor

Signs and tests

Biopsy (at time of surgery for diagnosis)
Blood tests
Bone scan to see if the cancer has spread to other bones
CT scan of the chest to see if the cancer has spread to the lungs
CT scan of the affected area
X-ray of the affected area

Treatment

Treatment usually starts after a biopsy of the tumor is done.

Before major surgery to remove the tumor, chemotherapy is usually given. This can shrink the tumopr and it makes surgery easier. It also may kill any cancer cells that have spread to other parts of the body.

Common chemotherapy medicines include:

Cisplatin
Carboplatin (Paraplatin)
Cyclophosphamide (Cytoxan)
Doxorubicin (Adriamycin)
High-dose methotrexate with leucovorin
Ifosfamide (Ifex)

Surgery is used after chemotherapy to remove any remaining tumor. In most cases, surgery can remove the tumor while saving the affected limb (this is called limb-salvage surgery). Rarely, more radical surgery (such as amputation) may be necessary.

Support Groups

Association of Cancer Online Resources --

Cure Search for Children's Cancer --

Expectations (prognosis)

If the tumor has not spread to the lungs (pulmonary metastasis), long-term survival rates are very high. If the cancer has spread to other parts of the body, there is still a good chance of cure with effective treatment.

Complications

Limb removal
Spread of cancer to the lungs
Side effects of chemotherapy

Calling your health care provider

Call your health care provider if you have persistent bone pain, tenderness, or swelling.

References

Baker MH. Bone tumors: primary and metastatic bone lesions. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 212.

Gebhardt MC, Springfield D, Neff JR. Sarcomas of the bone. In: Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKenna WG, eds. Abeloff's Clinical Oncology. 4th ed. Philadelphia, Pa: Elsevier Churchill Livingstone, 2008;chap 96.

Disease

Metastatic cancer to the lung

Metastatic cancer to the lung is cancer that starts somewhere else in the body and spreads to the lungs. See also:
Symptoms

Swelling

Swelling is the enlargement of organs, skin, or other body parts. It is caused by a buildup of fluid in the tissues. The extra fluid can lead to a rapid increase in weight over a short period of time (days to weeks). Swelling can occur all over the body (generalized) or only in one part of the ...
Special Topic

Distal

Distal refers to sites located away from a reference point. When used in medicine, it refers to parts of the body further away from the center. For example, the hand is distal to the shoulder. The thumb is distal to the wrist. Usually, that reference point is the center or midline of the body. ...
Disease

Tumor

A tumor is an abnormal growth of body tissue. Tumors can be cancerous (malignant) or noncancerous (benign).
Disease

Bone tumors

A bone is an abnormal growth of cells within the bone that may be noncancerous () or cancerous (malignant).
Disease

Retinoblastoma

Retinoblastoma is a rare, cancerous tumor of a part of the eye called the retina.
Special Topic

Incidence

Incidence is the number of new cases of a condition, symptom, death, or injury that develop during a specific time period, such as a year. The number is often expressed as a percentage of a population. For example, 25% of Americans were diagnosed with the flu in 2002. Incidence shows the ...
Special Topic

Proximal

Proximal means nearer to the center (trunk of the body) or to the point of attachment to the body. If another reference point is given, such as the heart, the proximal point of another organ or extremity is the point closest to the heart — central rather than . Proximal is the opposite of ...

Review date:: December 28, 2010
Reviewed by:: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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