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Osteosarcoma
(Osteogenic
Sarcoma)
By Teddi Softley, Ph.D.
Osteosarcoma is a disease in which cancer cells are
found in the bone. It is the most common type of bone cancer in children.
It occurs most often in the bones on either side of the knee and in the
upper arm. Four in 1 million children are diagnosed with osteosarcoma each
year. Osteosarcoma is somewhat more likely to strike males than females.
It typically occurs during adolescent years. Unfortunately, the cause of
osteosarcoma is unknown. However genetic influences and irradiation have
been linked to its development. If a patient has symptoms such as pain or
swelling in a bone region, a physician may order x-rays and other tests.
If osteosarcoma is suspected, your doctor might
recommend seeing an orthopedic oncologist who specializes in bone cancers.
The orthopedic surgeon may obtain a biopsy (cut out a piece of tissue from
the affected area) under anesthesia in the hospital. The tissue would be
looked at under a microscope to see if there are cancerous cells. Once
osteosarcoma has been found, doctors may complete more tests to determine
the extent of the disease and whether it has spread to other parts of the
body. The chance of recovery, prognosis and choice of treatment depend on
the size, location, type and stage of the cancer, how much of the cancer
is taken out by surgery and or killed by chemotherapy, the patient’s age,
blood and other test results and general health.
The following staging groups are used for
osteosarcoma:
Localized The cancer cells are localized (not
spread beyond the bone or nearby tissue) in which the cancer began. In
young patients most tumors occur around the knee.
Metastatic The cancer cells have spread from
the original site (bone in which the cancer began) to other parts of the
body. Cancer most often spreads to the lungs. It can also spread to other
bones.
Recurrent Recurrent disease means that the
cancer has come back after treatment has been completed. It may come back
in the original location tissues where it was first started or it may
return in another part of the body. There are treatment options for all
patients with osteosarcoma. Surgery to remove the affected bone and
surrounding tissue, remains the treatment of choice. In patients with
osteosarcoma that has not spread beyond the bone, researchers are studying
whether surgery without amputation of the arm or leg (limb-sparing
procedures) can be done without the cancer coming back. Sometimes the
cancer can be removed without amputation, and artificial devices (i.e.
titanium rod or bones from other places in the body can be used to replace
the bone that was removed.
Chemotherapy in conjunction with surgery is
necessary to prevent recurrence or spread of the tumor in children with
localized disease and to control distant metastasis in those with
metastatic disease. Several courses of chemotherapy are usually given.
Treatment for localized osteosarcoma involves chemotherapy followed by
surgery followed by additional chemotherapy.
Treatment for metastatic osteosarcoma may include;
1) Chemotherapy followed by surgery to remove the cancer followed by
additional chemotherapy or 2) surgery to remove the cancer followed by
additional chemotherapy. One or more chemotherapy drugs may be
administered to kill cancer cells. Chemotherapy may be given by mouth in a
pill form or put into the body by a needle in a vein or muscle.
Chemotherapy is called systemic treatment because the drug enters the
blood stream, travels through the body, and can kill cancer cells
throughout the body.
Treatment for recurrent osteosarcoma depends on
where the cancer recurred, what kind of treatment was given before, as
well as other factors. If the cancer has only come back in the lungs,
treatment may involve surgery to remove the cancer in the lungs with or
without chemotherapy. If the cancer returns in other places, treatment may
involve combination chemotherapy. Survival rates for children with
localized osteosarcoma are at about 70 percent, compared to 15 percent in
the early 1960s. Survival rates for children with metastatic disease are
about 30 percent.
A large number of patients receive treatment at a
comprehensive, multidisciplinary, pediatric cancer facility like
Jonathan Jaques children’s Cancer Center. It is recommended that
patients receive treatment that is part of a clinical trial or treatment
that is considered standard based on its effectiveness in a number of
patients in previous studies. Clinical trials are designed to find the
best ways to treat cancer patients and are based on the most up to date
information. Clinical trials for osteosarcoma are ongoing in many parts of
the country. If additional information is needed, please contact Jonathan
Jaques Children’s Cancer Center at 562 933-8600. |
