What is osteosarcoma in children?
Osteosarcoma in children is bone cancer. Cancer (malignant) cells produce immature bone cells (osteoid). Osteosarcoma is very rare, but it is the most common type of bone cancer in children and adolescents. It is of utmost common in teens and young adults.
Cancer most often grows at the ends of long bones, especially the lower thigh bone (femur) and the upper part of the largest shin (tibia). The upper part of the arm bone (humerus) is another common place where it grows.
Types of osteosarcoma include:
- High grade: This is fast-growing cancer. Most osteosarcomas in children are high-grade. There are several subtypes of high-grade osteosarcoma.
- Intermediate grade: This type is rare. It is between high and low grade.
- Low grade: This is slow-growing cancer. There are two subtypes of low grade.
Causes of osteosarcoma in children
The exact cause is unknown. Cancer can be caused by changes in the DNA of cells. In most cases, these changes are not passed down from parent to child. They happen by chance.
A child with one of the certain rare genetic cancer syndromes may be at increased risk for osteosarcoma. Being treated with radiation or chemotherapy for other cancers also increases the risk.
Other risk factors for osteosarcoma in children include:
- Age between 10 and 30 years
- High height
- Male gender
- African American race
- Certain bone diseases
Symptoms of osteosarcoma in children
Symptoms can occur a little differently in each child. They may include:
- Pain at the tumor site
- Swelling at the tumor site
- Lump (mass) in the area
- Increased pain with activity or at night
- A bone that breaks for no identified reason
The symptoms of osteosarcoma in children may resemble other conditions. Make sure your child sees a healthcare supplier for a diagnosis.
Diagnosis of osteosarcoma in children
Your child’s healthcare provider will ask about your child’s medical history and symptoms. He or she will examine your child. Your child can be referred to a specialist. This can be a bone specialist (orthopedic surgeon) or a bone cancer specialist (orthopedic oncologist). Your child may have tests like:
- Bone scan: An X-ray uses a small quantity of radiation to take pictures of bones and other body tissues.
- Blood test: Some test results may be abnormal with osteosarcoma. For example, liver tests and erythrocyte sedimentation rate (ESR) may be higher than normal.
- Computed tomography: This test uses a series of X-rays and a computer to make detailed pictures of the body.
- MRI: This test uses large magnets, radio waves, and a computer to make detailed pictures of the inside of the body.
- Bone scan: A small amount of radioactive dye is inserted into a vein. The whole body is scanned. The dye appears in areas of the bone where there may be cancer.
- Positron emission tomography (PET) scan: For this test, a radioactive sugar is inserted into the bloodstream. Cancer cells use more sugar than normal cells, so the sugar accumulates in cancer cells. An exceptional camera is used to see where the radioactive sugar is in the body. Sometimes a positron emission tomography scan can find cancer cells in different areas of the body, even when they cannot be seen with other tests. This test is often used in combination with a CT scan. This is called a PET / CT scan.
- Biopsy of the tumor: A sample of the tumor is taken and looked at under a microscope to look for cancer cells. A biopsy is needed to diagnose osteosarcoma. The biopsy can be done with a needle or with surgery. It is very important that the biopsy be performed by a doctor with experience and knowledge of bone tumors.
Subsequently a diagnosis of osteosarcoma, other tests will be done. These help your child’s healthcare providers learn more about cancer. They will show you how much and how much cancer has spread (metastasized) in your child’s body. Then a grouping of stages is assigned.
The most commonly used system uses groupings of stages with a value of 1 to 3. They are written with Roman numerals I, II, and III. Some staging systems add stage 4 (IV). The higher the number, the more progressive the cancer is. Letters and numbers can be used after the Roman numeral to give more details.
Staging of osteosarcoma also takes into account the grade of cancer. This is a measure of how much cancer cells look like normal cells. A 1 or 2 is used. In grade 1 tumors, cancer cells look a lot like normal cells and tend to grow and spread more slowly than grade 2. This may also be called a low-grade tumor. Grade 2 can be called high grade and the cells look very different from normal cells.
The phase of cancer is one of the most important things to know when determining how to treat cancer. Be sure to ask your child’s healthcare provider to explain the stage of your child’s cancer in a way that you can understand.
Treatment for osteosarcoma in children
Osteosarcoma in children treatment will rest on the stage and other factors. Cancer can be treated with any of the following:
- Surgery: Surgery may be done to try to protect the arm or leg. This is known as limb-salvage or limb preservation surgery. Or, surgery may be done to eliminate an arm or leg (amputation). Surgery may be done to eliminate tumors in other parts of the body.
- Chemotherapy: These are drugs that kill cancer cells. They are usually given before surgery. They can also be given after surgery. Your child may have a port or catheter inserted to get the medicine into a vein (IV). Chemotherapy is given in series with periods of rest.
- Radiation therapy: These are high-energy X-rays or other kinds of radiation. Radiation is used to kill cancer cells or break them from growing. It is not used often to treat osteosarcoma. It can be used when a tumor cannot be completely removed with surgery. Or it can be used to slow the growth of a tumor and control symptoms. Radioactive drugs can also be given intravenously (IV).
- Clinical trials: Ask your child’s healthcare provider if treatments that may work well for your child are being tested.
- Supportive care: The growth factor can be given to help the bone marrow make blood cells. Other medications may be given for the side effects of treatment. Pain relievers can also be given.
With any cancer, the expected recovery (prognosis) of a child varies. Keep in mind:
- Getting medical treatment right missing is important for the best prognosis. Cancer that has a range is more difficult to treat.
- Continuing follow-up care is desirable during and after treatment.
- New treatments are being tested to improve results and reduce side effects.
Complications of osteosarcoma in children
A child may have complications from osteosarcoma in children or from treatment, such as:
- Infection or bleeding from surgery
- Loose or broken grafts or rods from surgery to save a limb
- Hair loss, mouth sores, nausea, vomiting, diarrhoea, increased infections, easy bruising and bleeding, and fatigue from chemotherapy
- Skin frustration, hair loss, nausea, diarrhea, poor bone growth, organ damage, and new cancers from radiation
- Physical and emotional challenges of the tumor, surgery, or other treatments
- Heart and lung problems
- Growth and development problems
- Learning problems
- Changes in sexual development
- Problems with the ability to have children (fertility) in the future
- Return of cancer
- Growth of other cancers
Prevention of osteosarcoma in children
The risk of many adult cancers can be reduced with certain lifestyle changes (such as maintaining a healthy weight or quitting smoking), but at this time there are no known ways to prevent osteosarcoma in children. Most of the recognized risk factors for osteosarcoma cannot be different.