Author: Cecilia Belzarena, MD, MPH, MBA
Description
Osteosarcoma is a cancer often found in the long bones of teenagers and young adults, although other locations and age ranges are possible. This tumor is more frequent in males and Black or Hispanic population. The most common location is around the knee. At times, this condition can be associated with gene mutations.
Symptoms
Patients commonly present with pain and swelling. A mass can sometimes be felt at the pain site. More rarely, patients can suffer a fracture through the affected bone.
Examination
Your doctor will examine the limb where the pain and/or mass is, trying to feel if the mass is hard or soft, if it moves in relation to the surrounding tissues or if it is tender. The physician will also feel for lymph nodes. You might also be asked if you have pain with weightbearing of that limb.
Tests
Your doctor will order radiographs of the entire bone as well as an MRI with and without contrast (Figure 1). Additionally, since this is a malignant tumor we need to know if the osteosarcoma has spread to other locations. To assess this, CT scans and/or PET scans may be ordered as well. A biopsy will be done to obtain a small tissue sample for assessment under the microscope and confirmation of the diagnosis. Only then can the treatment begin. It is important that the biopsy be performed by a physician with experience in bone tumors.
Figure 1. Radiograph and MRI
Osteosarcoma of the distal part of the femur on radiographic images and MRI. (Tumor outlined in red)
Treatment Options
The most common treatment protocol involves undergoing chemotherapy as the first step. This will be followed by surgery to remove the tumor (Figure 2). More chemotherapy will then follow once you have healed from your surgery. Changes to this protocol can potentially be made on specific circumstances.
Figure 2. Reconstruction after tumor resection.
Upper part of the femur (left) and lower part of the femur and upper part of the tibia (right) showing one way of creating a new knee joint after the bone involved by cancer is removed. This is called a distal femur replacement.
Prognosis
Localized disease (tumor in only one spot) has a better prognosis. The overall outcome will depend on many factors, for example, response to chemotherapy or if the tumor was completely removed (negative margins). Due to its complexity and rarity, it is highly recommended that patients are treated by an orthopaedic oncologist with experience treating these tumors.
More Information:
https://orthoinfo.aaos.org/en/diseases--conditions/osteosarcoma/
https://www.cancer.org/cancer/types/osteosarcoma.html
This is not intended as a substitute for professional medical advice and does not provide advice on treatments or conditions for individual patients. All health and treatment decisions must be made in consultation with your physician(s), utilizing your specific medical information. Inclusion in this is not a recommendation of any product, treatment, physician or hospital.