If You (or Your Child) Have Osteosarcoma

How does the doctor know it is an osteosarcoma?

Pain or swelling in the bone is the most common symptom. Pain might come and go at first, but after a while it may become worse or constant. Of course, pain and swelling can have other causes as well.

The doctor will ask questions about the symptoms you (or your child) are having and do a physical exam. If the doctor thinks it might be a bone tumor, they may send you (or your child) for an imaging test or to an orthopedic surgeon. This is a doctor who treats problems in the bones, muscles, and joints.

If signs are pointing to a bone tumor such as an osteosarcoma, here are some of the tests that you or your child might need:

Imaging tests

Bone x-ray: This is often the first test done if a doctor suspects a bone tumor.

MRI scan: MRIs use radio waves and strong magnets instead of x-rays to take pictures. MRIs can show details about the bone and nearby areas. This helps the doctor plan for a biopsy (see below) and surgery.

CT scan: This test uses x-rays to make detailed pictures of a person's insides. A CT scan of the chest may be done to see if cancer has spread to the lungs.

PET scan: PET scans use a special kind of sugar that can be seen inside the body with a special camera. If there is cancer, this sugar shows up as “hot spots” where the cancer is found. This test can help show if the cancer has spread, as well as if the cancer is being helped by treatment. PET scans are sometimes done at the same time as a CT scan (known as a PET/CT scan).

Bone scan: A bone scan can help show if cancer has spread to other bones. This test is useful because it can show all of the bones in the body at once.

Biopsies

Surgical biopsy: In a surgical biopsy, the doctor takes out a piece of bone through a cut in the skin to look at under a microscope for cancer cells.

Needle biopsy: For this type of biopsy, a thin, hollow needle is inserted through the skin and into the tumor to remove a small sample. If the tumor is deep, CT scans or an ultrasound may be used to help guide the needle into the tumor.

A biopsy is the only way to tell for sure if a person has a bone cancer like osteosarcoma.

For tumors in a bone, the biopsy should be done by doctors who often treat bone tumors. The biopsy and surgery to remove the tumor should be planned at the same time, and the same doctors should do both. This can help prevent problems later.

How serious is osteosarcoma?

Doctors describe how serious osteosarcoma is by using stages and grades. The stage describes the growth or spread of the cancer within the bone or into nearby areas. It also tells if the cancer has spread to other parts of the body that are farther away. The lower the stage number, the less the cancer has spread. A higher number means the cancer has spread more.

The cancer cells in the biopsy sample will be given a grade, based on how they look. This helps doctors know how fast cancer is likely to grow and spread. Higher-grade cancers tend to grow faster. Low-grade cancer cells usually grow slowly and are less likely to spread.

Be sure to ask the doctor about the cancer stage and grade and what it means.

How is osteosarcoma treated?

The main treatments for osteosarcoma are surgery and chemotherapy (chemo). Radiation might be used as well.

The treatment plan that is best will depend on:

• The grade and stage of the cancer
• The chance that a type of treatment will cure the cancer or help in some other way
• A person's age and overall health
• Your feelings about the treatment and the side effects that come with it

Surgery

Surgery is a major part of treating nearly all osteosarcomas. This includes both the biopsy to tell for sure that it is an osteosarcoma and the surgery to take out the tumor(s). The type of surgery done depends on where the tumor is. Ask the doctor what kind of surgery will be done and what to expect.

A specialist called an orthopedic surgeon usually does the surgery.

Chemo

Chemo is short for chemotherapy. It is the use of drugs to kill cancer cells. Chemo drugs go into the blood and spread all over the body. Chemo is often given both before surgery (for about 10 weeks) and then again after surgery. Chemo is given in cycles or rounds. Each round of treatment is followed by a break. Most of the time, 2 or more chemo drugs are given.

Possible side effects

Chemo can have side effects like:

• Hair loss
• Mouth sores
• Loss of appetite
• Diarrhea
• Nausea and vomiting
• Increased risk of infections (because of low white blood cell counts)
• Bruising and bleeding easily (from low platelet counts)
• Tiredness (caused by low red blood cell counts)

These problems tend to go away after treatment ends. There are ways to treat many chemo side effects, so be sure to talk to your child’s cancer care team so they can help.

Targeted therapy

Targeted therapies, such as tyrosine kinase inhibitors, are treatments that target cancer cells more specifically than standard chemo drugs. Depending on the type of tumor, targeted treatments may be recommended as part of the treatment plan for osteosarcoma.

Radiation treatments

Radiation uses high-energy rays (like x-rays) to kill cancer cells. For the most part, radiation is not a main treatment of osteosarcoma. Sometimes it may be used when surgery cannot get rid of all the cancer. Radiation can also help treat symptoms like pain and swelling if the cancer has come back and more surgery cannot be done.

Possible side effects

If the doctor suggests radiation treatment, talk about what side effects might happen. Side effects depend on the type of radiation that is used and the area being treated. The most common side effects of radiation are:

• Skin changes where the radiation is given
• Feeling very tired

Most side effects get better after treatment ends. Some might last longer.

Side effects can be more serious in children, who are more likely to be affected by radiation. For example, it might slow the growth of bones or increase the risk of cancer later in life. Talk to the cancer care team about what to expect.

Clinical trials

Clinical trials are research studies that test new drugs or other treatments in people. They compare standard treatments with others that may be better. Clinical trials are one way to get the newest cancer treatment. They are the best way for doctors to find better ways to treat cancer. If the doctor can find one that might be a good fit, it is up to you whether to take part. And if you do sign up for a clinical trial, you can always stop at any time.

If you would like to learn more about clinical trials that might be right for you (or your child), start by asking your doctor if the clinic or hospital conducts clinical trials. See Clinical Trials to learn more.

What about other treatments we hear about?

You might hear about other ways to treat the cancer or manage symptoms and side effects. These may not always be standard medical treatments. These treatments may be vitamins, herbs, special diets, and other things. You may wonder about these treatments.

Some of these are known to help, but many have not been tested. Some have been shown not to help. A few have even been found to be harmful. Talk to your doctor about anything you are thinking about using, whether it is a vitamin, a diet or anything else.

What will happen after treatment?

You will be glad when treatment is over. But it is hard not to worry about cancer coming back. Even when cancer never comes back, people still worry about it. For years after treatment ends, it is still important to see the cancer doctor. Be sure to go to all these follow-up visits. Exams and maybe other tests will be done to see if the cancer has come back and check for late effects of cancer treatments.

These doctor visits may be very frequent at first. Then, the longer you or your child is cancer-free, the less often the visits are needed.