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What is osteosarcoma in children?
Osteosarcoma is very rare, but it's the most common kind of bone cancer in children and
teens. It's most common in teens and young adults.
Osteosarcoma is cancer that starts in the bone. The cancer (malignant) cells look
like immature bone cells. The bone they form is not strong.
The cancer most often grows in the ends of long bones, most often the bottom of the
thigh bone (femur) and the top of the larger shin bone (tibia). The top of the upper
arm bone (humerus) close to the shoulder is another common place it starts.
Your child's treatment team can explain the type your child has and what it means.
What causes osteosarcoma in a child?
The exact cause is not known. Cancer is caused by changes in the DNA of the cells.
In most cases of osteosarcoma, these changes are not passed on from parents to children.
They happen by chance.
Which children are at risk for osteosarcoma?
A child with certain rare genetic cancer syndromes may be at higher risk of osteosarcoma.
Having radiation or chemotherapy treatment for other cancers also increases the risk.
Other risk factors for osteosarcoma include:
What are the symptoms of osteosarcoma in a child?
Symptoms can be different in each child. They can include:
Bone or joint pain at the tumor
Swelling at the tumor
Lump (mass) in the affected bone
Increased pain with activity or at night
A bone that breaks for no known reason
The symptoms of osteosarcoma can be a lot like other, more common health conditions.
Make sure your child sees a healthcare provider for a diagnosis.
How is osteosarcoma diagnosed in a child?
Your child's healthcare provider will ask about your child's health history and symptoms.
They will examine your child. Your child may be referred to a specialist. This may
be a bone specialist (orthopedic surgeon) or a bone cancer specialist (orthopedic
oncologist). Your child may need tests, such as:
X-ray. An X-ray uses a small amount of radiation to take pictures of bones and other body
Blood tests. Osteosarcoma can cause changes in some blood tests. For instance, liver tests and
the erythrocyte sedimentation rate may be higher than normal. Blood tests also give
an idea of your child's overall health.
CT scan. This test uses a series of X-rays and a computer to make detailed images of the inside
of the body.
MRI. This test uses large magnets, radio waves, and a computer to make detailed images
of the inside of the body.
Bone scan. A small amount of radioactive tracer is put into a vein. It travels through the blood.
Then the whole body is scanned. The tracer collects in parts of bone where there may
Positron emission tomography (PET) scan. For this test, a radioactive sugar is put into the bloodstream. Cancer cells use
more sugar than normal cells, so the sugar will collect in cancer cells. A special
camera is used to see where the radioactive sugar is in the body. A PET scan can sometimes
spot cancer cells in different parts of the body, even when they can’t be seen on
other tests. This test is often used along with a CT scan. This is called a PET/CT
Biopsy of the tumor. A small piece (sample) of the tumor is taken and tested for cancer cells. A biopsy
is needed to diagnose osteosarcoma. The biopsy may be done with a needle or with surgery.
It’s very important that a biopsy be done by a healthcare provider with experience
and knowledge about bone tumors.
After a diagnosis of osteosarcoma, other tests might be done. These help your child's
healthcare providers learn more about the cancer. They can show how much and how far
the cancer has spread (metastasized) in your child's body. A stage grouping is then
A commonly used staging system uses stage groupings with a value of 1 to 3. They are
written as Roman numerals I, II, and III. Some staging systems add a stage 4 (IV).
The higher the number, the more cancer there is and the more it has spread. Letters
and numbers can be used after the Roman numeral to give more details.
Staging for osteosarcoma also takes into account the grade of the cancer. This is
a measure of how much the cancer cells look like normal cells. A 1 or 2 is used. In
grade 1 (G1) tumors, the cancer cells look a lot like normal cells and tend to grow
and spread slower than grade 2. This may also be called a low-grade tumor. Grade 2
(G2) is called high grade, and the cells look very different from normal cells. They
tend to grow and spread quickly.
When working on a treatment plan, some healthcare providers use a simpler way describe
Localized means the cancer is only in the bone and nearby tissues. Most osteosarcomas
are localized when they're first found.
Advanced or metastatic means the cancer has spread to other parts of the body, like
other bones or the lungs.
Localized osteosarcoma then falls in 1 of these groups:
The stage of a cancer is 1 of the most important things to know when deciding how
to treat the cancer. Be sure to ask your child's healthcare provider to explain the
stage of your child's cancer to you in a way you can understand.
How is osteosarcoma treated in a child?
Treatment will depend on the stage and other factors. Osteosarcoma can be treated
with any of these:
Surgery. Surgery may be done to try to save the arm or leg. This is called limb-salvage or
limb-sparing surgery. Or surgery may be done to remove an arm or leg (amputation).
Surgery may also be done to remove tumors in other parts of the body.
Chemotherapy. This is treatment with strong medicines that kill cancer cells. They're usually given
before surgery to help shrink the tumor. This may also be given after surgery to help
kill any cancer cells still in the body. Chemotherapy is given in cycles with periods
Radiation therapy. These are high-energy X-rays or other types of radiation used to kill cancer cells
or stop them from growing. Radiation is not often used to treat osteosarcoma. It may
be used when a tumor can’t be fully removed with surgery. Or it may be used to slow
the growth of a tumor and control symptoms. A radioactive medicine may also be given
into a vein (IV). It collects in the cancer cells and kills them.
Targeted therapy. These medicines target changes that are mostly in or on cancer cells. This allows
them to kill cancer cells and limits damage to normal cells.
Clinical trials. Ask your child's healthcare provider if there are any treatments being tested that
may work well for your child. Clinical trials are a good way to get the best treatment
available along with new treatment that might be better.
With any cancer, how well a child is expected to recover (prognosis) varies. Keep
Getting medical treatment right away is important for the best prognosis. Cancer that
has spread is harder to treat.
Ongoing follow-up care during and after treatment is needed.
New treatments are being tested to improve outcomes and lessen side effects.
What are possible complications of osteosarcoma in a child?
Some problems linked to osteosarcoma or its treatment include:
Infection or bleeding from surgery
Loose or broken grafts or rods after limb-salvage surgery
Hair loss, mouth sores, nausea, vomiting, diarrhea, increased risk of infection, easy
bruising and bleeding, and feeling tired from chemotherapy
Skin irritation, hair loss, nausea, diarrhea, poor bone growth, organ damage, and
new cancers from radiation
Emotional and physical challenges from the tumor, surgery, or other treatments
Heart and lung problems from chemotherapy or targeted therapy
Problems with growth and development
Problems with the ability to have children (fertility) in the future
Return of the cancer (recurrence)
Growth of other cancers later in life (secondary cancers)
How can I help my child live with osteosarcoma?
A child with osteosarcoma needs ongoing care. Your child will be seen by oncologists
and other healthcare providers to treat any late effects of treatment and to watch
for signs or symptoms of the tumor returning. Your child will be checked with imaging
tests and other tests. Your child may need to see other healthcare providers for problems
from the tumor or from treatment. Your child may need therapy to help with movement
and muscle strength. This may be done by physical and occupational therapists.
You can help your child manage treatment in many ways. For instance:
Your child may have trouble eating. A dietitian may be able to help.
Your child may be very tired. They will need to balance rest and activity. Encourage
your child to get some exercise. This is good for overall health. And it may help
to lessen tiredness.
Get emotional support for your child. A counselor, therapist, or child support group
Make sure your child attends all follow-up appointments.
When should I call my child’s healthcare provider?
Your child's treatment team will talk with you about problems you should watch for
and what changes they need to be called about right away. Be sure you know what number
to call if you have questions or concerns after office hours or on weekends or holidays.
You might be told to call the healthcare provider if your child has:
Symptoms that get worse or don't get better with treatment, like vomiting even though
you've been using anti-nausea medicines.
Side effects from treatment, such as:
Key points about osteosarcoma in children
Osteosarcoma is cancer of the bone. It is rare, but it is the most common type of
bone cancer children and teens.
Symptoms can include bone pain, swelling, or a lump (mass).
The cancer may show up on an X-ray or on other imaging tests. It's diagnosed with
The biopsy and surgery should be done by an orthopedic surgeon with experience treating
Treatment is usually chemotherapy and surgery. Surgery may be limb-sparing or amputation.
Ongoing follow-up care during and after treatment is needed.
Tips to help you get the most from a visit to your child’s healthcare provider:
Know the reason for the visit and what you want to happen.
Before your visit, write down questions you want answered.
At the visit, write down the name of a new diagnosis, and any new medicines, treatments,
or tests. Also write down any new directions your provider gives you for your child.
Know why a new medicine or treatment is prescribed and how it will help your child.
Also know what the side effects are.
Ask if your child’s condition can be treated in other ways.
Know why a test or procedure is recommended and what the results could mean.
Know what to expect if your child doesn't take the medicine or have the test or procedure.
If your child has a follow-up appointment, write down the date, time, and purpose
for that visit.
Know how you can contact your child’s provider after office hours and on weekends
and holidays. This is important if your child becomes ill and you have questions or
Online Medical Reviewers:
- Jessica Gotwals RN BSN MPH
- Liora C Adler MD
- Sabrina Felson MD