Osteosarcoma - Childhood and Adolescence

Osteosarcoma - Childhood and Adolescence

Osteosarcoma is a bone cancer that arises from immature bone cells. It is the most common type of bone cancer in children and adolescents. The cancer typically begins in areas where the bones grow rapidly, such as around the knee (femur or tibia) or in the upper arm bone (humerus). However, it can develop in any bone of the body.

Types of Osteosarcoma

1. Central or Medullary Tumor:

• Conventional central osteosarcoma

• Telangiectatic osteosarcoma

• Intraosseous well-differentiated or low-grade central osteosarcoma

• Small cell osteosarcoma

2. Surface or Peripheral Tumor:

• Parosteal well-differentiated or low-grade osteosarcoma

• Periosteal osteosarcoma (low to intermediate grade)

• High-grade surface osteosarcoma

The most common subtype is Conventional central osteosarcoma.

Statistics

• In 2023, 1,000 cases of osteosarcoma were estimated in the United States, with nearly half of these cases occurring in children and adolescents.

• Osteosarcoma accounts for 2% of all childhood cancers.

Survival Rate

• 5-year survival rate for children under 14 years in the United States is 69%.

Risk Factors

A risk factor increases the likelihood of developing cancer. Some individuals with multiple risk factors may never develop the disease, while others with no known risk factors might develop it.

• Genetic Mutations: Certain genetic changes can trigger osteosarcoma.

• Previous Radiation Therapy: Children who received radiation therapy for other cancers are at higher risk.

• Inherited Disorders: Conditions like retinoblastoma, Li-Fraumeni syndrome, Werner syndrome, and Rothmund-Thomson syndrome can increase the risk.

Symptoms

• Pain in bones or joints: The pain may worsen over time and interfere with sleep.

• Swelling or a lump: Often seen around the knee or shoulder.

• Bone fractures without trauma: Bones may weaken and break easily.

• Back pain: May indicate spinal involvement.

• Loss of bladder or bowel control: If the tumor compresses the spinal cord.

Diagnosis

• X-ray

• CT Scan

• MRI

• PET-CT Scan

• Bone Scan

• Biopsy: A small sample of tissue is removed and examined under a microscope to confirm the presence of cancer. Biopsies for bone tumors are usually done by a specialist to avoid complications.

Treatment Options

1. Surgery

• Limb-sparing Surgery: The tumor and surrounding tissue are removed while preserving the limb’s function. This may involve bone grafting or reconstructive surgery.

• Bone Allograft: A bone from another person may be used in reconstruction.

• Amputation: In severe cases, the affected limb may need to be removed. Rehabilitation helps children regain mobility after surgery.

2. Chemotherapy

• Chemotherapy involves powerful drugs to kill cancer cells and may be administered before or after surgery.

• Most children receive chemotherapy through an infusaport or port-a-cath implanted under the skin, which allows easy access to veins for administering drugs.

• Chemotherapy typically lasts 6 months.

• Side Effects: Infections, nausea, vomiting, hair loss, loss of appetite, and fatigue are common. These effects usually subside after treatment ends.

3. Radiation Therapy

• Radiation is not commonly used for osteosarcoma since the cancer is less responsive to it.

• However, it may be used if surgery is not possible or if some tumor remains after surgery.

Follow-up Care

• After completing treatment, regular follow-up tests are essential to monitor recovery and detect any recurrence.

• Follow-up care includes physical exams, blood tests, and imaging tests to manage side effects and ensure the cancer does not return.

Osteosarcoma is a challenging cancer, but advancements in surgery and chemotherapy have improved outcomes for many children and adolescents. Early detection and appropriate treatment play a crucial role in achieving the best possible prognosis.

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