It is important to find this cancer as early as possible. The sooner it is found, the better the chance of a cure. At this time there are no special tests to find osteosarcoma in people without symptoms. The best course of action is to watch for any symptoms of this disease and get to a doctor quickly.

Signs and symptoms of osteosarcoma

Pain in a bone is the most common symptom of osteosarcoma. At first, the pain is may come and go. It may be worse at night. The pain gets worse with activity and may cause a limp if a leg is involved.

Swelling in the area of the pain may not happen until weeks later. Depending on where the tumor is, you may be able to feel a lump. Although the cancer may weaken the bone it is in, the bones do not usually break.

Because limb pain or swelling is fairly common in normal, active teenagers, it's easy to see why this cancer might not be found right away.

Imaging studies

Imaging studies are tests done to get pictures of the inside of the body and look for problems.

Bone x-rays: Doctors can often spot osteosarcoma on a regular x-ray, but only a biopsy (see below) can confirm that the cancer is really there.

CT (computed tomography) scans: In this test many x-rays of the body are taken from different angles. These images are combined by a computer to make cross-sectional pictures of your insides. A CT scan of the bone can show if the tumor has spread into nearby muscle, fat, etc. The scan can also help the surgeon pick the best place to do a biopsy. A chest CT scan can show whether the cancer has spread to the lungs.

MRI (magnetic resonance imaging): MRI scans use radio waves and strong magnets instead of x-rays to make pictures. Sometimes the MRI can help find small tumors several inches away from the main tumor. Finding these small tumors is important for planning the best type of surgery. MRI scans are also very helpful in looking at the brain and spinal cord.

MRI scans take longer than CT scans—often up to an hour. You have to be inside a tube-like machine which can be upsetting. The machine also makes a thumping noise that you may find disturbing. Some places will give you headphones with music to block out the noise.

Chest x-ray: This x-ray can spot tumors ½-inch or larger that have spread from the place where they started.

Radionuclide bone scan: During a bone scan, a radioactive tracer is put into a vein. The tumor absorbs this tracer, which can be spotted by a special type of camera. A computer puts together pictures showing all the bones of the body. Osteosarcoma will usually look like a darker spot in the scan, showing where there is more radioactivity. The bone scan can also show cancer that has spread to other bones or the lungs.

Blood tests

High levels of certain chemicals in the blood can suggest that the osteosarcoma is more advanced than it may look on imaging tests. The most important of these chemicals are called alkaline phosphatase and LDH. These chemicals are released into the blood by osteosarcoma cells. Higher levels indicate a worse outlook for cure.

Biopsy

A biopsy involves taking a sample of the tumor to be looked at under a microscope. In osteosarcoma it is very important that the biopsy be done right. If it isn't, it may be very hard to prevent the arm or leg with cancer from having to be removed (amputated).

The biopsy may be done with the area around the tumor numbed or with the patient in a deep sleep.

There are 2 different types of biopsies, the needle biopsy and the open biopsy. A needle biopsy can be done with a thin (fine) or a thick needle. The fine needle biopsy removes very small pieces of tissue. With the thick needle biopsy, the surgeon takes out a round core of tissue.

In the open biopsy, the surgeon cuts through the skin, exposes the tumor, and then cuts out a piece of tissue. This type of biopsy must be done by an expert in bone tumors.

Last Medical Review: 03/20/2007
Last Revised: 03/20/2007