Osteosarcoma

• Alternative Names

  Osteogenic sarcoma

• 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.

  The cause is not known. In some cases, osteosarcoma runs in families, and at least one gene has been linked to 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.

  Although it is rare, osteosarcoma can occur in adults.

• 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
  • 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
  • Open biopsy (at time of surgery for diagnosis)
  • X-ray of the affected area
• Treatment

  Treatment usually starts after a biopsy of the tumor.

  Before major surgery to remove the tumor, chemotherapy is usually given. Chemotherapy is also used to kill or shrink any cancer cells that may 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 -- www.acor.org

  Cure Search (formerly the National Childhood Cancer Foundation) --www.curesearch.org

• 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

  Skubitz KM, D'Adamo D. Sarcoma. Mayo Clin Proc. 2007;82:1409-1432.

  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.

Review Date: 11/5/2009

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.