What is osteosarcoma?
The most common type of bone cancer, osteosarcoma begins in the bone cells and gradually destroys bone tissue. Of the 2,500 new cases of bone cancer diagnosed each year in the United States, about 900 cases are osteosarcoma, according to the American Cancer Society. When osteosarcoma is treated effectively prior to spreading, the five-year survival rate is 60 to 80 percent.
Who is likely to have osteosarcoma?
Osteosarcoma most often affects males between 10 and 30 years old, but it can occur in females, as well as at any age. About 10 percent of osteosarcomas occur in people over age 60. Teenagers having a “growth spurt” have the highest risk of osteosarcoma due to a suspected link between rapid bone growth and bone tumor formation. Osteosarcoma is also slightly more common among African Americans. Others more susceptible to osteosarcoma include individuals, especially children, who have received radiation therapy or treatment with certain anti-cancer drugs; people with Paget disease of the bone; and people with hereditary bone defects. Children who have had hereditary cancer syndromes, such as retinoblastoma, Li-Fraumeni syndrome and Rothmund-Thompson syndrome, also are at higher risk.
What characterizes osteosarcoma?
In children and young adults, osteosarcoma often develops near the ends of long bones (shin, thigh and upper arm) and other areas of rapid bone growth. In older adults, common locations include the bones of the pelvis, shoulder, and jaw. If this cancer spreads, it usually spreads to the lungs.
Pain is the most common symptom. Pain may occur at night or with activity at first and then become gradually more severe over time. Also, sometimes swelling, a mass, or a lump may form either on the bone or in the tissue around the bone, and this swelling may inhibit joint function or movement. Osteosarcoma can weaken bones and cause them to fracture with little or no stress or trauma. Fever, chills, night sweats, and weight loss are less common but can occur, usually after the cancer spreads beyond its original location.
How does the pathologist make the diagnosis?
The pathologist reviews the results of a personal and family medical history, physical examination, and diagnostic tests performed or ordered by the primary care physician. Depending upon the symptoms and other factors, these diagnostic tests may include an x-ray, bone scan, computed tomography (CT) scan, magnetic resonance imaging (MRI) scan, or positron emission tomography (PET) scan. These tests allow the pathologist to review the clinical and radiological evidence to determine the source of pain or the presence of cancer cells.
What else does the pathologist look for?
If a tumor is found, the primary physician may arrange to obtain a biopsy specimen–a sample of the tumor’s cells–for the pathologist to examine under a microscope for the presence of cancer cells. The pathologist may also perform tests looking for chromosome or gene changes in the tumor cells to aid in treatment planning. A physician experienced in the treatment of bone cancer should obtain the biopsy. To obtain the biopsy sample, the physician uses either a small needle (needle biopsy) or makes a surgical incision (open biopsy) through the skin.
What is meant by the grade and stage of the cancer?
Osteosarcomas are classified as high-grade, intermediate-grade, or low-grade by the pathologist. High-grade tumors grow and spread faster than low-grade tumors. The pathologist and primary care doctor also determine the cancer’s stage to plan the best treatment. According to the Surgical Staging System, Stage I osteosarcomas are low-grade and localized, or confined to their original location. Stage II tumors are high-grade and localized. Metastatic tumors are more likely to be grade III.
How do doctors determine what treatment will be necessary?
The recommended treatment will depend on the grade and stage of the tumor, its size and location, and the patient’s age and general health. The pathologist consults with the primary care physician or specialist. Together, using their combined experience and knowledge, they determine treatment options most appropriate for the patient’s condition. It’s important to learn as much as possible about the treatment options and make the decision that’s right for you.
What kinds of treatments are available for osteosarcoma?
Treatment for osteosarcoma usually includes surgery and chemotherapy and sometimes radiation therapy.
The usual surgical treatment for osteosarcoma involves the surgeon removing the entire tumor along with a margin of cancer-free tissue surrounding the tumor. In most cases, surgeons are able to avoid the removal of an entire limb. In some cases, reconstructive surgery or limb-salvaging surgery is required for the patient to continue to have limb function. Depending on the amount of bone removed, the surgeon may use bone cement, a bone graft, or metal implants to maintain limb function.
Chemotherapy kills cancer cells through the use of anti-cancer drugs. Most patients with osteosarcoma receive a combination of these drugs, although some patients with low-grade osteosarmoma may not require chemotherapy. Physicians use chemotherapy before surgery to reduce the size of the bone tumor, as well as after surgery to kill cells remaining after surgery. People with high-grade osteosarcoma usually receive chemotherapy after surgery for several months.
Radiation therapy uses pinpointed, high-energy beams to kill cancer cells and can be used in addition to surgery or for patients who refuse or cannot have surgery. Radiation therapy can reduce the risk of cancer spreading to tissue surrounding the tumor and can relieve pain and other symptoms.
In addition, people with bone cancer may receive other treatments to control pain and other symptoms, to relieve side effects, or to ease emotional problems. Many patients also require rehabilitation to adapt to reconstructed or salvaged limbs or new prosthetic devices.
Osteosarcoma sometimes spreads or comes back, and people with bone cancer are also more likely to develop another type of cancer. For these reasons, follow-up treatment is necessary. The type of follow-up treatment depends on the grade and stage of osteosarcoma. Regular blood tests and x-rays or other imaging tests are usually necessary, and patients must be vigilant about reporting any unusual symptoms.
Clinical trials of new treatments for osteosarcoma may be found at www.cancer.gov/clinicaltrials. These treatments are highly experimental in nature but may be an option for advanced cancers. For more information about clinical trials, talk to your doctor or call the National Cancer Institute’s Cancer Information Service at 1–800–4–CANCER.
For more information, go to www.cancer.org (American Cancer Society) or http://www.nlm.nih.gov (U.S. National Library of Medicine and National Institutes of Health). Type the keywords osteosarcoma into the search box.
What kinds of questions should I ask my doctors?
Ask any question you want. There are no questions you should be reluctant to ask. Here are a few to consider:
DEFINITION OF TERMS
Metastatic: Spreading beyond the original tumor location to other parts of the body.
Pathologist: A physician who examines tissues and fluids to diagnose disease in order to assist in making treatment decisions.
Sarcoma: A cancer–usually malignant–arising from bone, muscle or other connective tissue.
This information was developed by the College of American Pathologists’ Public Affairs Committee in conjunction with the College’s Cancer Committee and Council on Scientific Affairs. The College is providing this information to help you better understand your health. Ultimately any decisions you make about your health, however, should be between you and your doctor.