Overview

Though rare, osteosarcoma is the most common type of bone cancer, which begins in cells that form bones. In very rare instances, it occurs in soft tissue outside the bone. Osteosarcoma is most often found in the long bones — more often the legs, but sometimes the arms — but it can start in any bone.

Osteosarcoma tends to occur in teenagers and young adults, but it can also occur in younger children and older adults. Treatment usually involves chemotherapy and surgery. Typically radiation therapy is not effective in treating osteosarcoma, though the use of new improved radiation techniques, such as proton beam therapy, is being studied.

Treatment for osteosarcoma has greatly improved over the years. The outlook (prognosis) and treatment decisions depend on where the osteosarcoma starts, tumor size, the type and grade of osteosarcoma, and whether the cancer has spread. After completion of treatment, people need lifelong monitoring for potential late effects of intense chemotherapy.

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Symptoms

Signs and symptoms of osteosarcoma may include, among others:

• Swelling near a bone
• Bone or joint pain
• Bone injury or bone break for no clear reason

Because these symptoms can be mistaken for other health issues, such as a sports injury, sometimes there is a delay in seeking medical help.

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Causes

The cause of osteosarcoma is not clear and most cases appear to occur sporadically, but some factors may increase the risk.

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Diagnosis

The first steps in seeking a diagnosis typically include a physical exam, discussion of medical history and lab tests.

The doctor may recommend one or more of these imaging tests to locate the cancer and find out if it has spread:

• X-ray
• Computerized tomography (CT)
• Magnetic resonance imaging (MRI)
• Positron emission tomography (PET)
• Bone scan

Biopsy

The doctor may recommend a procedure to remove a sample of tissue (biopsy) from the tumor for lab testing. Testing can show whether the tissue is cancerous and, if so, what type of cancer. Testing also reveals the cancer's grade, which helps doctors understand how aggressive the cancer may be.

Types of biopsy procedures used to diagnose osteosarcoma include:

• Needle biopsy. The doctor inserts a thin needle through the skin and guides it into the tumor. The needle is used to remove small pieces of tissue from the tumor.
• Surgical biopsy. The doctor makes an incision through the skin and removes either the entire tumor (excisional biopsy) or a portion of the tumor (incisional biopsy).

Determining the type of biopsy needed and the specifics of how it should be performed requires careful planning by the medical team. Doctors need to perform the biopsy in a way that won't interfere with future surgery to remove the cancer. For this reason, ask your doctor for a referral to a team of experts with extensive experience in treating osteosarcoma before the biopsy.

After the diagnosis, the extent (stage) of the cancer needs to be determined — whether and how far it has spread. Localized osteosarcoma has not spread beyond its origin or nearby tissues. Metastatic osteosarcoma has spread to other areas of the body. The cancer stage and other factors guide treatment options.

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Complications

Osteosarcoma can spread from where it started to other areas, making treatment and recovery more difficult. Surgery that removes the tumor and spares the limb is most often the norm. But certain patients may require amputation of the affected part of the limb and then need to learn to use an artificial limb (prosthesis).

As with other types of serious cancer, aggressive chemotherapy for osteosarcoma can cause substantial side effects, both in the short and long term. The health care team takes steps to treat and manage these effects as best as possible. And it's important for you to learn what to watch for and contact your team with any concerns.

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Prevention

There is no known way to prevent osteosarcoma, though certain factors, such as past radiation therapy or certain genetic conditions increase the risk. Still, having a risk factor doesn't necessarily mean that you'll get osteosarcoma. But any signs or symptoms should be checked out as soon as possible.

Coping and support

A diagnosis of osteosarcoma can be frightening. With time you'll find ways to cope with the distress and uncertainty of cancer. Until then, you may find it helps to:

• Learn enough about osteosarcoma to make decisions about care. Ask your doctor about this sarcoma, including treatment options. As you learn more, you may become more confident in understanding and making decisions about treatment options. If your child has cancer, ask the health care team for guidance on sharing this information in a caring and age-appropriate way.
• Keep friends and family close. Keeping your close relationships strong can help you deal with cancer. Friends and relatives can provide the practical and emotional support you'll need, especially when you feel overwhelmed.
• Ask about mental health support. The concern and understanding of a counselor, medical social worker, psychologist or other mental health professional also may help you. If your child has cancer, ask your health care team for advice on providing emotional and social support and options for professional mental health support. You can also check online for a cancer organization, such as the American Cancer Society, that lists support services.

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Risk factors

These factors increase the risk of osteosarcoma:

• Previous treatment with radiation therapy
• Certain inherited or genetic conditions, including hereditary retinoblastoma, Bloom syndrome, Li-Fraumeni syndrome, Rothmund-Thomson syndrome, Diamond-Blackfan anemia, Paget's disease and Werner syndrome

Source: http://www.mayoclinic.com