Symptoms of osteosarcoma

Osteosarcoma damages and weakens the bone. Symptoms depend on where the tumor is located. They may be hard to notice at first. They can also be like symptoms of other conditions.

Symptoms of osteosarcoma include:

• Pain in a bone or joint
• Problems moving the joint
• A lump or swelling over a bone
• Limping or problems walking
• A bone that breaks

Pain may worsen over weeks or months. The pain may cause your child to wake up in the middle of the night. Over-the-counter pain medicines such as ibuprofen or acetaminophen may not relieve pain over time.

Risk factors for osteosarcoma

Osteosarcoma typically develops after age 10. It is rare before the age of 5.

These factors may increase risk for osteosarcoma:

• Osteosarcoma is slightly more common in males than females.
• Black children have a higher risk of osteosarcoma than white children.
• Cancer survivors who were treated with radiation therapy have a higher risk for developing osteosarcoma.
• Genetic factors may increase risk for osteosarcoma. A small number of children have changes in genes that put them at higher risk for some cancers. People at a higher risk include those with:
  
  
• Retinoblastoma that is passed down through families 
• A history of multiple cancers
• A strong family history of 
• Breast cancer
• Leukemia
• Brain tumors
• Tumors in bones or soft tissues
• Other rare, conditions that are passed through families may also increase risk for osteosarcoma. These include:
• Li-Fraumeni syndrome
• Rothmund-Thomson syndrome
• Bloom syndrome
• Werner syndrome

Diagnosis of osteosarcoma

Several tests are used to diagnose osteosarcoma. They include:

• Health history and physical exam 
• Blood tests to learn about symptoms, general health, past illnesses, and risk factors.
• Imaging tests to look for tumors and help determine other tests that are needed.
• An x-ray to see if osteosarcoma has spread to other parts of the bone.
• A CT scan of the chest to see if osteosarcoma has spread to the lungs.
• An MRI is used to assess the tumor and assist in planning surgery.
• Full body imaging using bone scans or PET scans to look for spread of osteosarcoma to other areas of bone.
• A biopsy. In a biopsy, the doctor removes a small amount of tissue from the tumor. Doctors will look at the cells with a microscope to find signs of cancer.
• CT scan of the chest is used to see if osteosarcoma has spread to the lungs.

Staging of osteosarcoma

Osteosarcoma is usually described as either localized or metastatic. 

• Localized osteosarcoma means that there is a tumor in only 1 place. 
• Metastatic osteosarcoma means that the cancer has spread to other places.

Metastatic osteosarcoma means that the cancer has spread to other places, such as the lungs or other bones. The most common place for osteosarcoma to spread is the lungs.

Treatment of osteosarcoma

Osteosarcoma is usually treated with chemotherapy followed by surgery.

Surgery is used to remove the cancer when possible. The doctor removes a small amount of tissue around the tumor to make sure that no cancer is left behind. Most osteosarcoma can be treated with limb-sparing surgery. In this surgery, the doctor removes the piece of bone with the tumor. The doctor replaces the bone with a metal prosthesis or another piece of bone. The care team might suggest amputation if it is not possible to remove the entire tumor with limb-sparing surgery. Patients who have disease that has spread may have surgery to remove lung nodules. This usually happens after limb-sparing surgery between cycles of chemotherapy. Or it can happen after chemotherapy is finished.

Other treatments such as radiation therapy may be needed if the tumor cannot be removed or if any disease is left behind after surgery.

Prognosis for osteosarcoma

Prognosis depends on several factors:

• Whether the cancer has spread to other parts of the body
• The ability of surgery to completely remove the tumor
• Response of the tumor to chemotherapy
• If the cancer has come back

Patients with a single, localized osteosarcoma that can be completely removed with surgery have a 65–70% chance of long-term cure.

If osteosarcoma has already spread at diagnosis, the chance of survival is about 30%.

Life after osteosarcoma

Monitoring for return of cancer

Your child needs follow-up care every few months to see if cancer has returned. These visits occur for several years after treatment ends.

Screening tests usually include:

• Blood tests
• CT scans of the lungs
• X-rays of the affected bone

Patients with certain inherited syndromes or genetic conditions may be at risk for future cancers. They may need other follow-up care.

Life after limb-sparing surgery or amputation

Most osteosarcoma patients who have amputation or limb-sparing surgery do well over time.

They report good physical function and quality of life. Follow-up care is important.

Your child should have an annual exam to check muscle and bone function. It is important to make sure that there are no ongoing problems. Uneven limb length, changes in the way your child walks, joint issues, or other problems can cause chronic pain or disability.

• If your child had an amputation, they should also have an annual exam to maintain the function of the prosthetic limb.
• An orthopedic surgeon should check your child once a year if they have a bone graft and/or metal implant.
• If your child had limb-sparing surgery, they may need other surgeries for limb lengthening until they reach adult size.

Health after osteosarcoma

All survivors should continue to have regular checkups and screenings by a primary health care provider. Your child is encouraged to be physically active, eat healthy, and get enough sleep. These lifestyle habits promote general health and help prevent diseases.

Survivors of bone cancer tend to be less active. Regular exercise is important to maintain health, fitness, and physical function. This is quite important for patients who have had limb-sparing surgery or amputation.

Survivors treated with chemotherapy or radiation should be monitored for late effects of therapy.

Your child’s care team should give you a survivorship care plan after treatment ends. This report will include needed screening tests and tips for a healthful lifestyle.

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Diagnostics of Osteosarcoma

The program includes:

• Initial presentation in the clinic
• clinical history taking
• review of medical records
• physical examination
• laboratory tests:

• complete blood count
• biochemical analysis of blood
• inflammation markers (CRP, ESR)
• indicators of blood coagulation
• tumor markers

• CT/MRI local
• high-resolution computed tomography (HR-CT)  of chest
• Renal scan
• Bone Scan
• Audiometry
• biopsy with histological and immunohistochemical study 
• nursing services
• consultation of related specialists
• treatment by chief physician and all leading experts
• explanation of individual treatment plan (the cost of medicines is not included)

Required documents

• Medical records
• MRI/CT scan (not older than 3 months)
• Biopsy results (if available)

Type of program : Outpatient

Expected duration of the program: 15 days

Chemotherapy of osteosarcoma

The program includes:

• Initial presentation in the clinic
• clinical history taking
• review of medical records
• physical examination
• laboratory tests:

• complete blood count
• general urine analysis
• biochemical analysis of blood
• TSH-basal, fT3, fT4
• tumor markers
• inflammation indicators
• indicators of blood coagulation

• courses of chemotherapy
• nursing services
• consultations of related specialists
• treatment by head doctor and leading experts
• explanation of individual treatment plan

How program is carried out

During the first visit, the doctor will conduct a clinical examination and go through the results of previous laboratory tests and instrumental examinations. After that, you will undergo an additional examination, including laboratory assessment of liver and kidney function, ultrasound scan. Based on the received results, the doctor will elaborate the chemotherapy regimen. If necessary, related medical specialists will be involved in the elaboration of a treatment regimen (tumor board).

Chemotherapy is carried out as the inpatient procedure, with mandatory admission to the hospital. After the placement of a venous catheter, you will stay in a comfortable ward. An infusion system will be connected to the catheter, through which the required drug or a drug combination will be administered. All drugs are administered by intravenous drip, slowly, so the total duration of the infusion can be up to several hours. All this time, doctors and nurses will monitor your health condition closely.

After the course of chemotherapy, you will stay under medical supervision in the ward for a few more hours. After the completion of the chemotherapy course you will receive the medical report with detailed recommendations regarding further treatment. In the future, you will be able to have a distant consultation with your attending physician and schedule the next course of chemotherapy, if necessary.

Required documents

• Medical records
• MRI/CT scan (not older than 3 months)
• Biopsy results (if available)

Type of program : Inpatient

Duration: 7 days

Surgical intervention (Limb salvage surgery )

The program includes:

• Initial presentation in the clinic
• clinical history taking
• physical examination
• review of medical records
• laboratory tests:

• complete blood count
• general urine analysis
• biochemical analysis of blood
• tumor markers
• indicators of inflammation
• indicators blood coagulation

• CT/MRI scan of the local tumor
• CT Chest with contrast
• preoperative care
• tumor resection
• histologically and immunohistochemically examination
  of the remote tissues
• symptomatic treatment
• control examinations
• the cost of essential medicines and materials
• nursing services
• full hospital accommodation
• explanation of future recommendations

Required documents

• Medical records
• MRI/CT scan (not older than 3 months)
• Biopsy results (if available)

Type of program : Inpatient

Expected duration of the program: 10 days