Osteosarcoma (Osteogenic Sarcoma) in Children
What is osteosarcoma in children?
Osteosarcoma is cancer of the bone. The cancer (malignant) cells make immature bone
cells (osteoid). Osteosarcoma is rare, but it is the most common type of bone cancer in children and
teens. It is most common when teens have growth spurts. That is between the ages of
13 and 16.
The cancer most often grows in the ends of long bones, especially the bottom of the
thigh bone (femur) and the top of the larger shin bone (tibia). The top of the upper
arm bone (humerus) is another common place it grows.
The types of osteosarcoma include:
- High-grade. This is fast-growing cancer. Most osteosarcoma in children is high-grade. There are
several sub-types of high-grade osteosarcoma.
- Intermediate-grade. This type is uncommon. It is between high- and low-grade.
- Low-grade. This is slow-growing cancer. There are two sub-types of low-grade.
What causes osteosarcoma in a child?
The exact cause is not known. The cancer may be caused by changes in the DNA of the
cells. In most cases, these changes are not passed on from parents to children. They
happen by chance.
Which children are at risk for osteosarcoma?
A child with one of certain rare genetic cancer syndromes may be at higher risk of
osteosarcoma. Having radiation or chemotherapy treatment for other cancers also increases
Other risk factors for osteosarcoma include:
- Age between 10 and 30 years
- Tall height
- Male sex
- African-American race
- Certain bone diseases
What are the symptoms of osteosarcoma in a child?
Symptoms can occur a bit differently in each child. They can include:
- Pain at the site of the tumor
- Swelling at the site of the tumor
- Lump (mass) in the area
- Increased pain with activity or at night
The symptoms of osteosarcoma can be like other 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.
He or she 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 have tests such as:
- X-ray. An X-ray uses a small amount of radiation to take pictures of bones and other body
- Blood tests. Some test results may be abnormal with osteosarcoma. For example, liver tests and
the erythrocyte sedimentation rate (ESR) may be higher than normal.
- CT scan. This test uses a series of X-rays and a computer to make detailed images 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 dye is injected into a vein. The whole body is scanned. The dye
shows up in areas where there may be cancer.
- Positron emission tomography (PET) scan. For this test, a radioactive sugar is injected 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 areas of the body, even when they can’t be seen by
other tests. This test is often used in combination with a CT scan. This is called
a PET/CT scan.
- Biopsy of the tumor. A sample of the tumor is taken and checked under a microscope for cancer cells. A
biopsy is needed to diagnose osteosarcoma. The biopsy may be done with a needle or
Part of diagnosing cancer is called staging. Staging checks the size and location
of the main tumor, if it has spread, and where it has spread. Osteosarcoma may be
stage 1, 2, or 3 with sub-stages. Or it may be stage 1, 2, 3, or 4. Talk with your
child's oncologist about your child's stage and what it means. Staging also helps
to decide the treatment.
How is osteosarcoma treated in a child?
Treatment will depend on the stage and other factors. The cancer can be treated with
any of the below:
- Surgery. Surgery may be done to try to save the arm or leg. This is known as limb-salvage
or limb-sparing surgery. Or surgery may be done to remove an arm or leg (amputation).
Surgery may be done to remove tumors in other parts of the body.
- Chemotherapy. These are medicines that kill cancer cells. They are usually given before surgery.
They may also be given after surgery. Your child may have a port or catheter inserted
in order to receive the medicines into a vein (IV). Chemotherapy is given in cycles
with periods of rest.
- Radiation therapy. These are high-energy X-rays or other types of radiation. Radiation is used to kill
cancer cells or stop them from growing. It 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. Radioactive medicines may also
be given into a vein (IV).
- Clinical trials. Ask your child's healthcare provider if there are any treatments being tested that
may work well for your child.
- Supportive care. Growth factor may be given to help the bone marrow make blood cells. Other medicines
may be given for side effects of treatment. Pain medicines may also be given.
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 outcome and to lessen side effects.
What are the possible complications of osteosarcoma in a child?
A child may have complications from the osteosarcoma or from treatment, such as:
- Infection or bleeding from surgery
- Loose or broken grafts or rods from limb-salvage surgery
- Hair loss, mouth sores, nausea, vomiting, diarrhea, increased infections, easy bruising
and bleeding, and feeling tired from chemotherapy
- Burns, hair loss, nausea, diarrhea, poor bone growth, organ damage, and new cancers
- Emotional and physical challenges from amputation
- Heart and lung problems
- Problems with growth and development
- Learning problems
- Changes in sexual development
- Problems with the ability to have children (fertility) in the future
- Return of the cancer
- Growth of other 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. And your child may 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 his or her treatment in many ways. For example:
- Your child may have trouble eating. A dietitian may be able to help.
- Your child may be very tired. He or she 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.
- If your child smokes, help him or her quit. If your child doesn’t smoke, make sure
he or she knows the danger of smoking.
- Get emotional support for your child. Find a counselor or child support group can
- Make sure your child attends all follow-up appointments.
When should I call my child’s healthcare provider?
Call the healthcare provider if your child has:
- Symptoms that get worse
- New symptoms
- Side effects from treatment
Key points about osteosarcoma in children
- Osteosarcoma is cancer of the bone. It’s 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 is 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:
- Before your visit, write down questions you want answered.
- At the visit, write down the names of new medicines, treatments, or tests, and any
new instructions your provider gives you for your child.
- 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. This is important
if your child becomes ill and you have questions or need advice.