Osteosarcoma (patient information)

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Overview
Bone cancer is a malignant (cancerous) tumor of the bone that destroys normal bone tissue (1). Not all bone tumors are malignant. In fact, benign (noncancerous) bone tumors are more common than malignant ones. Both malignant and benign bone tumors may grow and compress healthy bone tissue, but benign tumors do not spread, do not destroy bone tissue, and are rarely a threat to life.

Malignant tumors that begin in bone tissue are called primary bone cancer. Cancer that metastasizes (spreads) to the bones from other parts of the body, such as the breast, lung, or prostate, is called metastatic cancer, and is named for the organ or tissue in which it began. Primary bone cancer is far less common than cancer that spreads to the bones.

There are three types of bone cancer:
 * Osteosarcoma - develops in growing bones, usually between ages 10 and 25
 * Chondrosarcoma - starts in cartilage, usually after age 50
 * Ewing's sarcoma - begins in nerve tissue in bone marrow of young people, often after treatment of another condition with radiation or chemotherapy

Osteosarcoma is the most common type of malignant bone cancer, accounting for 35% of primary bone malignancies. There is a preference for the metaphyseal region of tubular long bones. 50% of cases occur around the knee. It is a malignant connective (soft) tissue tumor whose neoplastic cells present osteoblastic differentiation and form tumoral bone.







What are the symptoms of Bone cancer (Osteosarcoma)?
Many patients first complain of pain that may be worse at night, and may have been occurring for some time. If the tumour is large, it can appear as a swelling. The affected bone is not as strong as normal bones and may fracture with minor trauma (a pathological fracture).
 * Bone fracture (may occur after what seems like a routine movement)
 * Bone pain
 * Limitation of motion
 * Limping (if the tumor is in the leg)
 * Pain when lifting (if the tumor is in the arm)
 * Tenderness, swelling, or redness at the site of the tumor

Who is at highest risk?

 * Age and height: Data suggest that the risk of osteosarcoma is highest during the teenage "growth spurt." Children with osteosarcoma are usually tall for their age.
 * Radiation to bones: People who were treated with radiation for another cancer have a higher risk of later developing post-radiation (after radiation) osteosarcoma.
 * Certain bone diseases: Some bone diseases such as Paget disease of bone and multiple hereditary osteochondromas may be risk factors of osteosarcoma.
 * Inherited cancer syndromes: Syndromes such as Li-Fraumeni syndrome and retinoblastoma may increase the risk of developing osteosarcoma.

Diagnosis
To help diagnose bone cancer, the doctor asks about the patient’s personal and family medical history. The doctor also performs a physical examination and may order laboratory and other diagnostic tests. These tests may include (1):


 * X-rays, which can show the location, size, and shape of a bone tumor. If x-rays suggest that an abnormal area may be cancer, the doctor is likely to recommend special imaging tests. Even if x-rays suggest that an abnormal area is benign, the doctor may want to do further tests, especially if the patient is experiencing unusual or persistent pain.


 * A bone scan, which is a test in which a small amount of radioactive material is injected into a blood vessel and travels through the bloodstream; it then collects in the bones and is detected by a scanner.


 * A computed tomography (CT or CAT) scan, which is a series of detailed pictures of areas inside the body, taken from different angles, that are created by a computer linked to an x-ray machine.


 * A magnetic resonance imaging (MRI) procedure, which uses a powerful magnet linked to a computer to create detailed pictures of areas inside the body without using x-rays.


 * A positron emission tomography (PET) scan, in which a small amount of radioactive glucose (sugar) is injected into a vein, and a scanner is used to make detailed, computerized pictures of areas inside the body where the glucose is used. Because cancer cells often use more glucose than normal cells, the pictures can be used to find cancer cells in the body.


 * An angiogram, which is an x-ray of blood vessels.


 * Biopsy (removal of a tissue sample from the bone tumor) to determine whether cancer is present. The surgeon may perform a needle biopsy or an incisional biopsy. During a needle biopsy, the surgeon makes a small hole in the bone and removes a sample of tissue from the tumor with a needle-like instrument. In an incisional biopsy, the surgeon cuts into the tumor and removes a sample of tissue.


 * Blood tests to determine the level of an enzyme called alkaline phosphatase.

When to seek urgent medical care?
Speak to your doctor immediately if you are experiencing any of the above mentioned symptoms.

Treatment options
Treatment options depend on the type, size, location, and stage of the cancer, as well as the person’s age and general health. Treatment options for bone cancer include surgery, chemotherapy, radiation therapy, and cryosurgery.


 * Surgery is the usual treatment for bone cancer. The surgeon removes the entire tumor with negative margins (no cancer cells are found at the edge or border of the tissue removed during surgery). The surgeon may also use special surgical techniques to minimize the amount of healthy tissue removed with the tumor.


 * Dramatic improvements in surgical techniques and preoperative tumor treatment have made it possible for most patients with bone cancer in an arm or leg to avoid radical surgical procedures (removal of the entire limb). However, most patients who undergo limb-sparing surgery need reconstructive surgery to maximize limb function.


 * Chemotherapy is the use of anticancer drugs to kill cancer cells. Patients who have bone cancer usually receive a combination of anticancer drugs. However, chemotherapy is not currently used to treat chondrosarcoma.


 * Radiation therapy, also called radiotherapy, involves the use of high-energy x-rays to kill cancer cells. This treatment may be used in combination with surgery. It is often used to treat chondrosarcoma, which cannot be treated with chemotherapy, as well as ESFTs . It may also be used for patients who refuse surgery.


 * Cryosurgery is the use of liquid nitrogen to freeze and kill cancer cells. This technique can sometimes be used instead of conventional surgery to destroy the tumor.

Diseases with similar symptoms

 * Malignant fibrous histiocytoma
 * Fibrosarcoma
 * Giant cell tumors
 * Osteosarcoma with diaphyseal location may suggest Ewing's sarcoma
 * Lymphoma
 * Malignant fibrous histiocytoma
 * Poorly differentiated fibrosarcoma
 * Osteoblastoma
 * Aneurysmal bone cyst

Where to find medical care for Osteosarcoma?
Directions to Hospitals Treating Bone cancer

Prevention of Osteosarcoma
Currently, there are no known modifications to one's lifestyle that will help prevent bone cancer.

What to expect (Outlook/Prognosis)?
The prognosis for bone cancer varies immensely based on how far the cancer has spread in the body and what specific type of cancer it is. You should talk to your doctor about your specific condition and outlook to gain a better sense of your prognosis.