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Osteosarcoma

January 23, 2022

Osteosarcoma is a rare cancer and is the most common type of cancer that arises in bones, distinguished by the production of unhealthy or immature bone by malignant cells. It most commonly develops in long bones like the femur (thigh), and its origin is still not clear to this day. It is usually found at the end of long bones.  

Great advances have been made in treating osteosarcoma over the past few decades, but more research is needed to learn how best to manage hard-to-treat osteosarcomas. Since osteosarcoma is uncommon, only a few specialists are available, it may be best to seek specialized care by a major oncology (cancer) center or academic (university-affiliated) hospital. 

Endocrine Connection 

Cancer is the growth of cells with no limit or control. Some cancers have a known trigger for this uncontrolled growth, but in other cases, the cause is unknown. The innate or natural mechanism for cell regulation is affected in the cancer cells, and that is what makes it a disease. The cancer cells can spread to a distant organ through the blood stream or the lymphatic system. 

Depending on the cells affected, osteosarcomas could be “conventional,” “osteoblastic,” “chondroblastic,” and “fibroblastic.” The most commonly used staging system for osteosarcoma is the Musculoskeletal Tumor Society (MSTS) that divides them into Stage I (low grade) and stage II (high-grade) and sub-staging depending on the bone sites affected (within the bone compartment or not). The grade of the tumor plays a role in determining its stage and the type of treatment used.  

There is nothing that can be done to prevent osteosarcoma. Minimizing exposure to radiation might be a strategy to decrease the chances of osteosarcoma appearing. 

Although the causes are unknown some risk factors include rapid bone growth with an increased risk during a child’s growth spurts. Genetic factors linked to osteosarcoma by a mutation of the retinoblastoma gene or TP53 gene. In adults, Paget’s disease (increased activity of the osteoclasts, the cells that “chew” bone during normal bone remodeling (reshaping) and exposure to radiation increase the chances of osteosarcoma.  

Children are more likely to develop osteosarcoma, especially adolescents between the ages of 13 and 16. These tumors are also more common in boys compared to girls, as well as in African Americans. 

Symptoms include: 

  • Decreased joint motion 
  • A lump or swelling depending on the location of the tumor 
  • Redness or a warm sensation near the site of the tumor 
  • Bone injury or “bone breaks” with no cause 

Local (the affected bone) pain is the most common symptoms reported by patients. The doctor may feel a mass or tumor that is usually tender to touch. There is usually no fever, chills, malaise or weight loss. A plain radiograph of the affected area commonly shows a very distinctive pattern. Some blood tests specific to bone might help in the diagnosis. 

The spread of the malignant cell to other bones (metastasizes) is the most common complication. It is thought that at the initial presentation, there are already multiple spread cells that are not detectable by current diagnostic testing. Limb amputation during surgery and chemotherapy to slow the growth of the disease may have long-term side effects. 

Treatment usually includes chemotherapy, surgery, and sometimes radiation therapy. Your healthcare team will determine treatment plan based on where the osteosarcoma started, the size of the tumor, if the cancer has spread and the “grade” or type of osteosarcoma. Before chemotherapy existed 80-90% of patient died from this disease. Now with chemotherapy treatment available, in addition to surgery, 25-75% of patient survive in 5 years.

  • What tests are needed to determine my prognosis? And stage? 
  • How can I prevent my symptoms from worsening? 
  • What are my treatment options and what are the potential risks? 
  • Should I be concerned about my bone health after treatment? 
  • Should I see a bone specialist or endocrinologist? 

 

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