Osteosarcoma is a cancerous (malignant) bone tumor that usually develops during the period of rapid growth that occurs in adolescence, as a teenager matures into an adult.

Osteogenic sarcoma

Osteosarcoma is the most common cancerous (malignant) bone tumor in youth. The average age at diagnosis is 15. Boys and girls have a similar incidence of this tumor until late adolescence, at which time boys are more commonly affected. There is another peak in incidence among adults in their 60s and 70s.

The cause is not known. In some cases, osteosarcoma runs in families. At least one gene has been linked to an increased risk. This gene is also associated with familial retinoblastoma, a cancer of the eye that occurs in children.

Osteosarcoma tends to occur in the bones of the:

• Shin (near the knee)
• Thigh (near the knee)
• Upper arm (near the shoulder)

This cancer occurs most commonly in larger bones and in the area of bone with the fastest growth rate. Osteosarcoma can occur in any bone, however.

• 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

• Biopsy (at time of surgery for diagnosis)
• Blood tests
• Bone scan to see if the cancer has spread to other bones
• CT scan of the chest to see if the cancer has spread to the lungs
• CT scan of the affected area
• X-ray of the affected area

Treatment usually starts after a biopsy of the tumor is done.

Before major surgery to remove the tumor, chemotherapy is usually given. This can shrink the tumopr and it makes surgery easier. It also may kill any cancer cells that have spread to other parts of the body.

Common chemotherapy medicines include:

• Cisplatin
• Carboplatin (Paraplatin)
• Cyclophosphamide (Cytoxan)
• Doxorubicin (Adriamycin)
• High-dose methotrexate with leucovorin
• Ifosfamide (Ifex)

Surgery is used after chemotherapy to remove any remaining tumor. In most cases, surgery can remove the tumor while saving the affected limb (this is called limb-salvage surgery). Rarely, more radical surgery (such as amputation) may be necessary.

Association of Cancer Online Resources -- www.acor.org

Cure Search for Children's Cancer --www.curesearch.org

If the tumor has not spread to the lungs (pulmonary metastasis), long-term survival rates are better. If the cancer has spread to other parts of the body, prognosis is better but there is still a chance of cure with effective treatment.

• Limb removal
• Spread of cancer to the lungs
• Side effects of chemotherapy

Call your health care provider if you have persistent bone pain, tenderness, or swelling.

Baker MH. Bone tumors: primary and metastatic bone lesions. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 212.

Gebhardt MC, Springfield D, Neff JR. Sarcomas of the bone. In: Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKenna WG, eds. Abeloff's Clinical Oncology. 4th ed. Philadelphia, Pa: Elsevier Churchill Livingstone, 2008;chap 96.