Children's Hospital Colorado

Osteosarcoma in Children

What is osteosarcoma?

An osteosarcoma is a tumor made up of cancer cells that occurs in and/or around bone. It is the most common type of bone cancer in children and adolescents and is the sixth most common type of cancer in this age group.

Osteosarcoma usually occurs in school-age children and adolescents at the time when their bones are growing very rapidly. The most common tumor locations include the lower end of the thigh bone (femur) around the knee, the upper end of the shin bone (tibia) and the upper end of the arm (humerus), all of which are the fastest growing ends of our long bones. The tumor most often begins inside the bone but occasionally occurs on the surface of the bone or in the soft tissue area next to the bone.

When most osteosarcomas are diagnosed they are localized, meaning the cancer cells have not spread beyond the bone or nearby tissues to other parts of the body. Sometimes at diagnosis, however, the tumor can be found to have metastasized, or spread to other parts of the body. The most common locations for osteosarcoma to spread are the lungs or other bones in the body.

Who gets osteosarcoma?

Osteosarcoma usually occurs in school-age children (ages 8-12) and adolescents at the time when their bones are growing very rapidly. Osteosarcoma occurs in both boys and girls. The majority of osteosarcomas have no known cause and there is no known method of prevention. There has been no association between osteosarcoma and trauma or environmental exposure.

What are symptoms of osteosarcoma?

Symptoms can vary widely between patients. The most common symptoms of osteosarcoma include:

  • Recurring pain, which may be with activity or at rest
  • Swelling or a palpable mass (bump)
  • Possible unexplained fever with no symptoms
  • Unexplained weight loss
  • Poor appetite
  • Fatigue

Patients may also have a limp on the affected leg or may be unable to move the affected extremity (limb) without discomfort.

It is common for the child to complain about pain for a month or two before any of the other symptoms are noticed. If your child or teen has any of these symptoms, it is important to see a doctor because early treatment is more likely to be successful.

How is osteosarcoma diagnosed?

To ensure your child receives the most accurate diagnosis and the best treatment possible, it is important to choose a doctor who specializes in pediatric bone tumors.

Learn more about our Orthopedic Tumor Program.

A bone tumor specialist will begin by getting a detailed medical and family history and performing a comprehensive physical exam. Radiographic studies are usually performed and may include X-rays, magnetic resource imaging (MRI), bone scan or a CT scan of the lungs.

The ultimate diagnosis is always based on a biopsy of the tumor and examination of the biopsy specimen. Often times, a preliminary diagnosis is available on the day of biopsy; however, it may take up to a week to get a permanent diagnosis depending on what additional studies need to be done.

Determining the stage of the tumor

After the diagnosis of osteosarcoma is made, your child's bone tumor specialist will evaluate the extent of the disease by performing several different tests. This is known as staging. These tests may include a bone scan, a PET scan, a CT scan or an MRI. The doctor will also order blood tests. The studies are done to look for any evidence that the tumor has spread from the original site and are necessary in order to provide the most definitive treatment for the disease.

How is osteosarcoma treated?

Osteosarcoma treatment is determined by your child’s doctor and is based on the extent and location of the disease. Treatment recommendations will include a combination of the following:

Chemotherapy refers to a type of medicine that acts to help shrink the size of the tumor and kill cancer cells. It is administered through a special type of IV known as a port, which goes into a large vein in the upper chest. The port is placed surgically in the operating room.

Chemotherapy drugs are given to treat the tumor (mass in the bone) and other potential cancer cells throughout the body. When treating osteosarcoma, chemotherapy is also typically given before and after the surgical procedure to remove the tumor.

The osteosarcoma tumor will be removed by surgery. The kind of surgery that your child will have depends on the size of the tumor, where the tumor is located and if the cancer cells have spread. Surgical options may include:

  • Limb-sparing surgery: This type of surgery removes the tumor and the tissues surrounding it that contain cancer cells, while leaving the surrounding muscles, nerves and blood vessels. A bone graft or metal implant will replace the bone and soft tissues that have been removed, thereby preserving the patient’s extremity.​
  • Rotationplasty: In rotationplasty, the tumor and parts of the lower leg are removed, the ankle joint is rotated 180 degrees and used as a knee joint improving the function of and artificial leg (prosthesis). This allows the child to participate in any running or jumping activities and sports.​
  • Amputation: Sometimes, to remove the tumor, the affected limb also has to be removed. Amputation is an option when the tumor is too big to be treated with limb-sparing surgery, or when the risk of a recurring tumor is high. Children tend to be good at using and adapting to an artificial limb (known as prosthetics). Experts in our Amputee Program help many kids and young adults become active and participate in sports.

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