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Other Names:
Osteogenic Sarcoma
Osteosarcoma

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What is osteosarcoma

Osteosarcoma is a disease in which cancer (malignant) cells are found in the bone. It is the most common type of bone cancer. In children, it occurs most commonly in the bones around the knee. Osteosarcoma most often occurs in adolescents and young adults.

Malignant fibrous histiocytoma of bone (MFH) is a rare tumor of the bone. It may occur following radiation treatments. MFH is generally treated the same as osteosarcoma and appears to have a similar response to treatment.

Ewingís sarcoma is another kind of bone cancer, but the cancer cells look different under a microscope than osteosarcoma cancer cells.

If a patient has symptoms (such as pain and swelling of a bone or a bone region), a doctor may order x-rays and blood tests. If it is suspected that the problem is osteosarcoma, your doctor may recommend seeing a specialist called an orthopedic oncologist. The orthopedic oncologist may cut out a piece of tissue from the affected area. This is called a biopsy. The tissue will be looked at under a microscope to see if there are any cancer cells. This test may be done in the hospital.

The chance of recovery (prognosis) and choice of treatment depend on the size, location, type, and stage of the cancer (how far the cancer has spread), how long the patient had symptoms, how much of the cancer is taken out by surgery and/or killed by chemotherapy, and the patientís age, blood and other test results, and general health.

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Stage Explanation

Stages of osteosarcoma

Once osteosarcoma has been found, more tests may be done to find out if cancer cells have spread to other parts of the body. This is called staging. At present, there is no staging system for osteosarcoma. Instead, most patients are grouped depending on whether cancer is found in only one part of the body (localized disease) or whether the cancer has spread from one part of the body to another (metastatic disease). Your doctor needs to know where the cancer is located and how far the disease has spread to plan treatment. The following groups are used for osteosarcoma:

Localized osteosarcoma

The cancer cells have not spread beyond the bone or nearby tissue in which the cancer began. In young patients, most tumors occur around the knee.

Metastatic osteosarcoma

The cancer cells have spread from the bone in which the cancer began to other parts of the body. The cancer most often spreads to the lungs. It may also spread to other bones.

Recurrent

Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the tissues where it first started or it may come back in another part of the body.

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How osteosarcoma is treated

If it is suspected that the problem is osteosarcoma, before the first biopsy, your doctor may recommend a specialist called an orthopedic oncologist.

There are treatments for all patients with osteosarcoma. Three kinds of treatment are used:

  • Surgery (taking out the cancer in an operation).
  • Chemotherapy (using drugs to kill cancer cells).
  • Radiation therapy (using high-dose x-rays to kill cancer cells).

Surgery

Surgery is a common treatment for osteosarcoma. The doctor may remove the cancer and some of the healthy tissue around the cancer. Sometimes all or part of an arm or leg may have to be removed (amputated) to make sure that all of the cancer is taken out. If cancer has spread to lymph nodes, the lymph nodes will be removed (lymph node dissection).

In patients with osteosarcoma that has not spread beyond the bone, researchers are studying whether surgery without amputation of the arm or leg (limb-sparing procedures) can be done without the cancer coming back. Sometimes the cancer can be taken out without amputation, and artificial devices or bones from other places in the body can be used to replace the bone that was removed.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill or put into the body by a needle in a vein or muscle. Chemotherapy is called systemic treatment because the drug enters the blood stream, travels through the body, and can kill cancer cells throughout the body. Chemotherapy with more than one drug is called combination chemotherapy.

Sometimes chemotherapy is injected directly into the area where the cancer is found (regional chemotherapy). In osteosarcoma, surgery is often used to remove the local tumor and chemotherapy is then given to kill any cancer cells that remain in the body. Chemotherapy given after surgery has removed the cancer is called adjuvant chemotherapy. Chemotherapy can also be given before surgery to shrink the cancer so that it can be removed during surgery; this is called neoadjuvant chemotherapy.

Radiation therapy

Radiation therapy uses x-rays or other high-energy rays to kill cancer cells and shrink tumors. Radiation for osteosarcoma usually comes from a machine outside the body (external radiation therapy).

Treatment for osteosarcoma depends on the stage of the disease, where the cancer is found, and the patientís age and general health.

A patient may receive treatment that is considered standard based on its effectiveness in a number of patients in past studies, or may choose to go into a clinical trial. Not all patients are cured with standard therapy, and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information.

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Localized Osteosarcoma/Malignant Fibrous Histiocytoma of Bone

Treatment of osteosarcoma may be the following:

  • Chemotherapy followed by surgery followed by adjuvant chemotherapy.
  • Clinical trials are evaluating new methods of giving chemotherapy and new schedules of treatment. The use of radiation therapy is also under study.

Treatment of malignant fibrous histiocytoma of bone may be the following:

  • Neoadjuvant chemotherapy followed by wide local excision of the tumor.

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Metastatic/Unresectable Disease

Metastatic disease is cancer that has spread from the place in which it started to other parts of the body. Unresectable disease is cancer that cannot be removed with surgery.

Treatment may be one of the following:

  • Chemotherapy followed by surgery to remove the cancer followed by adjuvant chemotherapy.
  • Surgery to remove the cancer followed by adjuvant chemotherapy.

Surgery often includes removal of cancer that has spread to the lungs.

The standard treatments for patients with unresectable or metastatic malignant fibrous histiocytoma of bone have not yet been determined.

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Recurrent Osteosarcoma

Treatment depends on where the cancer recurred, what kind of treatment was given before, as well as other factors. A clinical trial may be a reasonable treatment option.

If the cancer has come back only in the lungs, treatment may be surgery to remove the cancer in the lungs with or without chemotherapy. If the cancer has come back in other places besides the lungs, treatment may be combination chemotherapy. Clinical trials are evaluating new chemotherapy drugs.

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Osteosarcoma