Osteosarcoma Facts

Osteosarcoma is the most common type of bone cancer in children and adolescents. It is a malignant tumor that arises from bone cells, typically occurring in the wide ends of long bones such as the femur (thigh bone) and tibia (shin bone) in the lower limbs, as well as the humerus (upper arm bone) in the upper limbs.

One of the significant challenges with osteosarcoma is that it can metastasize, or spread, to other parts of the body. Approximately 15-20% of patients have metastatic disease at the time of diagnosis. The most common site of metastasis for osteosarcoma is the lungs, but it can also spread to other bones beyond the initial site of the tumor. 

Early detection and prompt treatment are essential to improve outcomes and reduce the risk of metastasis.

Osteosarcoma primarily affects children and young adults, typically occurring after the age of 10. 

  • It is slightly more common in males than females. 
  • African-American children have been found to have a higher risk of developing osteosarcoma compared to other racial groups.
  • Each year in the United States, approximately 400 children and teenagers under the age of 20 are diagnosed with osteosarcoma. It ranks as the third most common cancer in teens, following lymphomas and brain tumors. However, it is extremely rare in children before the age of 5.
  • Genetics can play a role in the development of osteosarcoma. Around 3-4% of children with osteosarcoma carry mutations in certain genes. Factors that may increase the risk of osteosarcoma include a history of retinoblastoma (eye cancer), a history of multiple cancers, and a strong family history of various cancers, including breast cancer, leukemia, brain tumors and tumors of the bones or soft tissues. 
  • These genetic predispositions highlight the complex interplay between genetic factors and environmental influences in the development of osteosarcoma.

Osteosarcoma typically presents several symptoms centered around the affected area. These can include:

  • Persistent, localized pain is one of the hallmark symptoms of osteosarcoma. The pain may initially be intermittent and worsen over time.
  • Swelling or a noticeable lump may develop at the site of the tumor. This swelling can be accompanied by tenderness to touch.
  • As the tumor grows, it can restrict the movement of nearby joints. This can lead to stiffness or decreased range of motion in the affected limb.
  • In some cases, osteosarcoma weakens the bone to the point where it may fracture easily, even with minimal trauma. This symptom tends to occur later in the disease progression.

The combination of surgery and chemotherapy has significantly improved outcomes for patients with osteosarcoma. Limb-sparing surgeries have become increasingly successful, allowing many patients to retain full or partial use of their affected limbs while effectively treating the cancer. 

Additionally, the use of chemotherapy has helped reduce the risk of recurrence and metastasis, improving long-term survival rates. Early diagnosis, multidisciplinary treatment planning and ongoing monitoring are essential components of comprehensive care for individuals with osteosarcoma.

  • Surgery is a primary treatment for osteosarcoma and aims to remove the cancerous tumor while preserving as much function and mobility as possible. The goal of surgery is complete removal of the tumor with a margin of healthy tissue (margin-negative resection) to reduce the risk of recurrence. In cases where the tumor has not spread, limb-sparing surgery, also known as limb-salvage surgery, is often possible. This approach involves removing the tumor while preserving the affected limb’s function. 
    • Before the 1970s, amputation was the standard surgical treatment, but advances in surgical techniques and prosthetics have made limb-sparing surgeries more common.
  • Chemotherapy plays a crucial role in the treatment of osteosarcoma and is often administered before and after surgery. The primary goals of chemotherapy are to shrink the tumor, making it easier to remove surgically and to eradicate any remaining cancer cells that may have spread beyond the primary tumor site. 

When the cancer is localized, meaning it has not spread to other areas of the body, the long-term survival rate is typically around 70-75%. 

If osteosarcoma has already spread to distant sites, such as the lungs or other bones, at the time of diagnosis, the long-term survival rate decreases significantly. In such cases, the long-term survival rate is around 30%. 

Metastatic osteosarcoma is more challenging to treat due to the presence of cancer in multiple locations, making it less responsive to treatment and associated with a poorer prognosis.