Osteosarcoma – Diagnosis and Treatment
Diagnosis
Scans and Imaging to Look at the Bone
Doctors use several imaging techniques to find out if osteosarcoma is present. These images show where the bone tumor is, if it has spread, and how big it is.
The most common imaging tests include:
- X-ray: Provides a first look at the bone to spot any tumors, breaks, or irregular growth.
- Magnetic Resonance Imaging (MRI): Produces detailed images of the bone and soft tissues, helping plan surgery or check for spread.
- Computed Tomography (CT) Scan: Gives cross-sectional images, helping doctors see if the cancer has reached the lungs or other organs.
- Bone scan: Locates additional areas where cancer might be growing in the bones.
- Positron Emission Tomography (PET) Scan: Finds cancer cells in other parts of the body and helps with staging.
These imaging tests help the healthcare team confirm the diagnosis and develop a treatment plan.
Taking a Piece of the Tumor for Lab Study
To confirm bone cancer, a specialist removes a sample of the tumor and tests it—a process called a biopsy. There are two main types:
- Needle Biopsy: A specialist inserts a thin needle through the skin into the bone tumor to take out a small sample.
- Surgical Biopsy: A specialist removes a larger piece of tissue through a minor operation.
Specialists with experience in osteosarcoma perform biopsies to ensure future treatments and surgeries are not affected. Lab testing of the tissue confirms if cancer is present, shows if the tumor is malignant, and identifies the specific type of sarcoma.
This information guides treatment choices, helps predict prognosis, and checks for things like metastasis or high-grade tumors.
Treatment
Surgery to Remove Tumors
Surgeons play a central role in treating osteosarcoma. Their main goal is to take out all the cancer cells while keeping as much healthy bone, muscle, and tissue as possible.
Several surgical approaches include:
- Limb-Salvage Operations: In most cases, surgeons remove the tumor without removing the arm or leg. They carefully cut out the cancer and some nearby tissue. Then, they rebuild the missing part of the bone using a metal implant or a bone graft.
- Amputation: Sometimes, the tumor is too large or too close to important nerves or blood vessels. In these cases, the surgeon removes the whole arm or leg. After this, a prosthetic limb is fitted to help the person move around more easily.
- Rotationplasty: For some patients, especially children with tumors near the knee, the surgeon may suggest rotationplasty. The operation removes the tumor and a portion of the leg, then attaches the lower part of the leg backwards to the thigh. The ankle acts as a knee joint, making it easier to use a prosthesis and remain active.
The size and location of the cancer, whether it has spread, and the patient’s age determine the choice of surgery.
Pros and Cons Table
| Surgical Method | Main Advantage | Main Limitation |
|---|---|---|
| Limb-salvage | Keeps limb; good function | Complex healing, repeat surgery possible |
| Amputation | Removes all cancer | Loss of limb |
| Rotationplasty | Good for young, active people | Major change to appearance |
Potential Side Effects:
- Pain after surgery
- Risk of infection
- Limited movement (depending on the type of surgery)
- Emotional impact from changes in body image
Cancer-fighting Medicines
Doctors use chemotherapy to kill cancer cells throughout the body. For osteosarcoma, they commonly give chemotherapy before and after surgery.
- Before Surgery (Neoadjuvant Chemotherapy): These drugs may shrink the tumor, making it easier to remove with less damage to healthy tissue.
- After Surgery (Adjuvant Chemotherapy): Treatment continues after the tumor has been removed to destroy any remaining cancer cells and reduce the risk of the cancer returning.
Doctors may also give chemotherapy if the cancer returns or spreads. In some cases, it helps with pain and slows tumor growth.
Chemotherapy Side Effects:
- Nausea and vomiting
- Loss of hair
- Increased risk of infections
- Tiredness
- Mouth sores
Doctors monitor patients closely throughout chemotherapy and help manage most side effects.
Targeted Energy Treatment
Healthcare professionals use radiation therapy to aim beams of energy, like X-rays or protons, directly at the tumor. They consider radiation therapy when surgery is not possible or to treat areas that cannot be fully operated on.
During each session, the patient lies still while a machine circles the body and focuses energy on the cancer site.
Key Points:
- Used when surgery is not a good option.
- May help shrink a tumor before surgery.
- Can help control pain if cancer comes back.
Possible Side Effects:
- Skin irritation at the treatment site
- Tiredness
- Loss of appetite
Coping and Support
Understanding Osteosarcoma and Treatment Choices
Learning about osteosarcoma and its treatment options helps families and patients feel more prepared to make decisions.
Doctors, nurses, and rehabilitation specialists answer questions and explain the treatments, such as surgery or chemotherapy.
Writing down questions and taking notes during appointments can help. For children, the healthcare team gives advice on how to discuss the diagnosis in an age-appropriate way.
Some teams also include occupational therapists, who support managing daily activities throughout the treatment process.
Staying Connected with Loved Ones
Strong relationships with friends and family support emotional well-being and daily needs. Loved ones help with chores, hospital visits, and caring for other family members when needed.
They also listen when the patient or family members need to talk. Keeping these bonds strong creates a sense of comfort and stability during treatment.
Ways friends and family can help:
- Running errands or preparing meals.
- Offering rides to appointments.
- Giving time to rest or take breaks.
- Sharing encouragement and support.
Finding Professional and Emotional Help
Sometimes, extra support helps manage stress and emotions. Counselors, medical social workers, or psychologists can provide assistance. The healthcare team can suggest mental health resources, including cancer support groups or therapists who work with children.
A multidisciplinary approach that includes occupational therapy and range of motion exercises may help improve day-to-day functioning and emotional recovery.
Getting Ready for Your Visit
Steps You Can Take
Planning ahead helps the appointment go smoother and ensures important details are not missed. Here are some steps to follow:
Make a preparation checklist:
| Task | Details |
|---|---|
| Write down symptoms. | Include all symptoms, even those that seem unrelated, and note when they started. |
| List medications and supplements. | Include names, doses, and how often they are taken (including vitamins and herbs). |
| Note personal events and stress. | Mention any big life changes or recent stresses. |
| Gather medical records. | Bring previous scans, X-rays, reports, and any documents related to the condition. |
Bring a list of questions to ask. Some example questions include:
- What type of cancer is it?
- Has the cancer spread, and if so, where?
- Are there more tests needed before treatment starts?
- What treatment options are available?
- What are the possible side effects or risks?
- Which treatment do the doctors think is best for this case?
- Could treatment affect future fertility, and are there options to preserve it?
Having a support person, like a family member or friend, can help with remembering information and asking questions.
Tip: Bringing a notebook or using a phone to record information can help keep track of details during the visit.
What Doctors May Ask During the Visit
When you meet with a healthcare specialist, such as an orthopedic surgeon, pediatric oncologist, or radiation oncologist, prepare to answer questions. They may ask:
- What symptoms have you noticed, and when did they begin?
- Are the symptoms constant, or do they come and go?
- How bad are the symptoms?
- Have you noticed anything that makes the symptoms better or worse?
- Is there a personal or family history of cancer?
Doctors use your answers to understand your case and decide on the next steps, like ordering tests or making referrals.
More than one specialist may join your care, such as an orthopedic surgeon for surgical planning, a pediatric oncologist for treatment in children, and a radiation oncologist for radiation treatment options.
