What is osteosarcoma in children?

Osteosarcoma is cancer of the bone. The cancer (malignant) cells make immature bone cells (osteoid). Osteosarcoma is rare, but it is the most common type of bone cancer in children and teens. It is most common when teens have growth spurts. That is between the ages of 13 and 16. 

The cancer most often grows in the ends of long bones, especially the bottom of the thigh bone (femur) and the top of the larger shin bone (tibia). The top of the upper arm bone (humerus) is another common place it grows.

The types of osteosarcoma include:

• High-grade. This is fast-growing cancer. Most osteosarcoma in children is high-grade. There are several sub-types of high-grade osteosarcoma.

• Intermediate-grade. This type is uncommon. It is between high- and low-grade.

• Low-grade. This is slow-growing cancer. There are two sub-types of low-grade.

What causes osteosarcoma in a child?

Which children are at risk for osteosarcoma?

A child with one of certain rare genetic cancer syndromes may be at higher risk of osteosarcoma. Having radiation or chemotherapy treatment for other cancers also increases the risk.

Other risk factors for osteosarcoma include:

• Age between 10 and 30 years

• Tall height

• Male sex

• African-American race

• Certain bone diseases         

What are the symptoms of osteosarcoma in a child?

Symptoms can occur a bit differently in each child. They can include:

• Pain at the site of the tumor

• Swelling  at the site of the tumor

• Lump (mass) in the area

• Increased pain with activity or at night

The symptoms of osteosarcoma can be like other health conditions. Make sure your child sees a healthcare provider for a diagnosis.

How is osteosarcoma diagnosed in a child?

Your child's healthcare provider will ask about your child's health history and symptoms. He or she will examine your child.  Your child may be referred to a specialist. This may be a bone specialist (orthopedic surgeon) or a bone cancer specialist (orthopedic oncologist). Your child may have tests such as:

• X-ray. An X-ray uses a small amount of radiation to take pictures of bones and other body tissues.

• Blood tests. Some test results may be abnormal with osteosarcoma. For example, liver tests and the erythrocyte sedimentation rate (ESR) may be higher than normal.

• CT scan. This test uses a series of X-rays and a computer to make detailed images of the body.

• MRI. This test uses large magnets, radio waves, and a computer to make detailed images of the inside of the body.

• Bone scan. A small amount of dye is injected into a vein. The whole body is scanned. The dye shows up in areas where there may be cancer.

• Positron emission tomography (PET) scan. For this test, a radioactive sugar is injected into the bloodstream. Cancer cells use more sugar than normal cells, so the sugar will collect in cancer cells. A special camera is used to see where the radioactive sugar is in the body. A PET scan can sometimes spot cancer cells in different areas of the body, even when they can’t be seen by 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 checked under a microscope for cancer cells. A biopsy is needed to diagnose osteosarcoma. The biopsy may be done with a needle or with surgery.

Part of diagnosing cancer is called staging. Staging checks the size and location of the main tumor, if it has spread, and where it has spread. Osteosarcoma may be stage 1, 2, or 3 with sub-stages. Or it may be stage 1, 2, 3, or 4. Talk with your child's oncologist about your child's stage and what it means. Staging also helps to decide the treatment.

How is osteosarcoma treated in a child?

Treatment will depend on the stage and other factors. The cancer can be treated with any of the below:

• Surgery. Surgery may be done to try to save the arm or leg. This is known as limb-salvage or limb-sparing surgery. Or surgery may be done to remove an arm or leg (amputation). Surgery may be done to remove tumors in other parts of the body.

• Chemotherapy. These are medicines that kill cancer cells. They are usually given before surgery. They may also be given after surgery. Your child may have a port or catheter inserted in order to receive the medicines into a vein (IV). Chemotherapy is given in cycles with periods of rest.

• Radiation therapy. These are high-energy X-rays or other types of radiation. Radiation is used to kill cancer cells or stop them from growing. It is not often used to treat osteosarcoma. It may be used when a tumor can’t be fully removed with surgery. Or it may be used to slow the growth of a tumor and control symptoms. Radioactive medicines may also be given into a vein (IV).

• Clinical trials. Ask your child's healthcare provider if there are any treatments being tested that may work well for your child. 

• Supportive care. Growth factor may be given to help the bone marrow make blood cells. Other medicines may be given for side effects of treatment. Pain medicines may also be given.

With any cancer, how well a child is expected to recover (prognosis) varies. Keep in mind:

• Getting medical treatment right away is important for the best prognosis. Cancer that has spread is harder to treat.

• Ongoing follow-up care during and after treatment is needed.

• New treatments are being tested to improve outcome and to lessen side effects.

What are the possible complications of osteosarcoma in a child?

A child may have complications from the osteosarcoma or from treatment, such as:

• Infection or bleeding from surgery

• Loose or broken grafts or rods from limb-salvage surgery

• Hair loss, mouth sores, nausea, vomiting, diarrhea, increased infections, easy bruising and bleeding, and feeling tired from chemotherapy

• Burns, hair loss, nausea, diarrhea, poor bone growth, organ damage, and new cancers from radiation

• Emotional and physical challenges from amputation

• Heart and lung problems

• Problems with growth and development

• Learning problems

• Changes in sexual development

• Problems with the ability to have children (fertility) in the future

• Return of the cancer

• Growth of other cancers

How can I help my child live with osteosarcoma?

A child with osteosarcoma needs ongoing care. Your child will be seen by oncologists and other healthcare providers to treat any late effects of treatment and to watch for signs or symptoms of the tumor returning. Your child will be checked with imaging tests and other tests. And your child may see other healthcare providers for problems from the tumor or from treatment. Your child may need therapy to help with movement and muscle strength. This may be done by physical and occupational therapists.

You can help your child manage his or her treatment in many ways. For example:

• Your child may have trouble eating. A dietitian may be able to help.

• Your child may be very tired. He or she will need to balance rest and activity. Encourage your child to get some exercise. This is good for overall health. And it may help to lessen tiredness.

• If your child smokes, help him or her quit. If your child doesn’t smoke, make sure he or she knows the danger of smoking.

• Get emotional support for your child. Find a counselor or child support group can help.

• Make sure your child attends all follow-up appointments.

When should I call my child’s healthcare provider?

Call the healthcare provider if your child has:

• Symptoms that get worse

• New symptoms

• Side effects from treatment

Key points about osteosarcoma in children

• Osteosarcoma is cancer of the bone. It’s rare, but it is the most common type of bone cancer children and teens.

• Symptoms can include bone pain, swelling, or a lump (mass).

• The cancer may show up on an X-ray or on other imaging tests. It is diagnosed with a biopsy.

• The biopsy and surgery should be done by an orthopedic surgeon with experience treating osteosarcoma.

• Treatment is usually chemotherapy and surgery. Surgery may be limb-sparing or amputation.

• Ongoing follow-up care during and after treatment is needed.

Next steps

• Before your visit, write down questions you want answered.

• At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you for your child.

• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.