Osteosarcoma is a rare type of sarcoma of the bone and is also called osteogenic sarcoma. This information should ideally be read with our general information about primary bone cancer.
We hope this section answers your questions. If you have any further questions, you can ask your doctor or nurse at the hospital where you’re having your treatment.
Primary bone cancers are cancers that start in the bone. They are rare, with only about 400 new cases each year in the UK. There are several different types of bone cancer.
Osteosarcoma is the most common type of primary bone cancer and usually develops in growing bones. Although it can occur at any age, it‘s most commonly found in teenagers and young adults and is slightly more common in males. Any bone in the body can be affected, but the most common sites are the arms or legs, particularly around the knee joint.
There are several different types of osteosarcoma, including osteoblastic and chondroblastic osteosarcoma. There are also rare subtypes, such as parosteal, periosteal, telangiectatic and small cell osteosarcoma.
Causes of osteosarcoma
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The exact causes of primary bone cancer are unknown. It’s thought to be related to periods of rapid bone growth, such as adolescence. Adults who have a bone condition known as Paget’s disease or who have been exposed to previous radiotherapy may have a slightly increased risk of developing bone cancer. Rarely, some bone cancers may occur in people from families where there is an inherited faulty gene that increases the risk of developing several types of cancer (Li Fraumeni syndrome).
Signs and symptoms of osteosarcoma
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Pain is the most common symptom of bone cancer. However, symptoms may vary depending on the location and size of the cancer. Tumours that occur in or near joints may cause swelling or tenderness in the affected area.
Primary bone cancer is sometimes discovered when a bone that has been weakened by cancer breaks after a minor fall or accident.
These symptoms can be caused by many things other than cancer. However, any persistent bone pain, particularly at night, should be checked by your doctor.
How osteosarcoma is diagnosed
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Usually you begin by seeing your family doctor (GP), who will examine you and may arrange any necessary tests or x-rays. If a bone tumour is suspected, you'll be referred directly to a specialist hospital or bone tumour centre for further tests. Many of the specific tests for diagnosing bone tumours, such as biopsies, require experience and specialist techniques.
The doctor at the hospital will take your full medical history before doing a physical examination. This will include an examination of the painful bone to check for any swelling or tenderness. You will probably have a blood test to check your general health.
A variety of tests and investigations may be needed to diagnose an osteosarcoma. An x-ray of the painful part of the bone will usually identify a tumour, although sometimes they can be difficult to see.
A small piece of the tumour will be removed and looked at under a microscope (biopsy). This is done during a small operation, and under a general anaesthetic. Other tests are done to check whether the cancer has spread elsewhere. These may include a bone x-ray, chest x-ray, bone scan, bone marrow sample, biopsies and an MRI or CT scan.
Further tests for osteosarcoma
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This involves the use of x-rays to build up a picture of the bone.
For this test a small sample of the tumour is taken from the affected bone. The doctor then examines the sample under a microscope to identify the exact type of tumour you may have.
This type of biopsy is not often used, as the needle biopsy is much quicker and simpler. In an open biopsy a small piece of bone is removed during a minor operation while you're under a general anaesthetic. It may be necessary to do this if a needle biopsy can’t be done or doesn’t give a clear diagnosis.
This is a more sensitive test than the simple x-ray and shows up any abnormal areas of bone more clearly. For this test, a small amount of a mildly radioactive substance is injected into a vein, usually in your arm. Abnormal bone absorbs more radioactivity than normal bone so these areas are highlighted and picked up by the scanner as hot spots.
MRI (magnetic resonance imaging) scan
This test is similar to a CT scan (see below), but uses magnetism instead of x-rays to build up cross-sectional pictures of your body. During the test, you'll be asked to lie very still on a couch inside a large metal cylinder that is open at both ends. The whole test may take up to an hour. It can be slightly uncomfortable and some people feel a bit claustrophobic during the scan.
It's very noisy, but you will be given earplugs or headphones. You'll be able to hear, and speak to, the person operating the scanner.
If you have any metal implants (such as surgical clips, pacemakers, metal in the eye from previous accidents or trauma), it will not be possible for you to have this test.
CT (computerised tomography) scan
A CT scan takes a series of x-rays that build up a three-dimensional picture of the inside of the body. The scan is painless and takes just a few minutes. CT scans use small amounts of radiation, which is very unlikely to harm you or anyone you come into contact with. You'll be asked not to eat or drink for at least four hours before the scan.
You may be given a drink or an injection of dye that allows particular areas to be seen more clearly. This may make you feel hot all over for a few minutes. If you’re allergic to iodine or have asthma, you could have a more serious reaction to the injection so it’s important to let your doctor know beforehand.
You'll probably be able to go home as soon as the scan is over.
PET (positron emission tomography) scan or PET-CT scan
This uses low-dose radioactive sugar to measure the activity of cells in different parts of the body. A very small amount of a mildly radioactive substance is injected into a vein, usually in your arm. A scan is then taken a couple of hours later. Areas of cancer are usually more active than surrounding tissue and show up on the scan. Sometimes a type of scan that combines a PET scan and a CT scan (called PET-CT) may be used, as it can give more information about the position and size of a tumour.
Grading of osteosarcoma
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Grading refers to the appearance of cancer cells under a microscope and gives an idea of how quickly a cancer may develop. Low-grade means that the cancer cells look very much like normal cells. They are usually slow-growing and are less likely to spread. In high-grade tumours the cells look very abnormal, are likely to grow more quickly, and are more likely to spread.
Most osteosarcomas are high-grade, but a type known as a parosteal osteosarcoma is usually low-grade. Another subtype (periosteal osteosarcoma) is usually treated as though it were high-grade.
Staging of osteosarcoma
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The stage of a cancer is a term used to describe its size and whether it has spread beyond its original site. Knowing the particular type and stage of a cancer helps the doctors decide on the most appropriate treatment.
Most people are grouped depending on whether cancer is found in only one part of the body (localised disease) or whether the cancer has spread from one part of the body to another (metastatic disease).
The cancer is low-grade and is contained within the hard coating of the bone.
The cancer is low-grade and extends outside the bone into the soft tissue spaces, which contain nerves and blood vessels.
The cancer is high-grade and is completely contained within the hard coating of the bone.
The cancer is high-grade and extends outside the bone into the soft tissue spaces, which contain nerves and blood vessels. Most osteosarcomas are stage 2B.
The cancer can be low-grade or high-grade and it’s found either within the bone or extending outside the bone. In stage 3, the cancer has spread to other parts of the body, or to other bones not directly connected to the bone where the tumour started.
If the cancer comes back after initial treatment, this is known as recurrent or relapsed cancer.
Treatment of osteosarcoma
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As osteosarcomas are very rare, they are usually treated at specialist hospitals by a team of doctors and other health professionals. This means that you may have to travel some distance to have your treatment.
The type of treatment you are given will depend on a number of things, including the position and size of the cancer, whether it has spread, the grade of the cancer and your general health.
Most people with an osteosarcoma will need to have a combination of different treatments. The treatments that may be used are surgery, chemotherapy and radiotherapy.
Surgery is a very important part of treatment and is used to remove the tumour in the bone. If surgery is not possible, radiotherapy may be used instead. Chemotherapy is used for most people with an osteosarcoma. It's often given to shrink the tumour before surgery.
Major improvements have been made in surgery for bone cancer. In the past, it was often necessary to remove (amputate) the affected limb if osteosarcoma was found. Now it’s often possible just to remove the affected part of the bone and some of the healthy tissue around it. The bone is then replaced with a specially designed metal replacement (prosthesis) or a bone graft (bone taken from another part of the body). If the cancer affects a bone in or near a joint, the whole joint can often be replaced with an artificial one. These operations are known as limb-sparing surgery.
Unfortunately, it’s not always possible to use limb-sparing surgery and sometimes removing the whole of the affected limb (amputation) may be the only way to treat the cancer. This is often due to the cancer spreading from the bone into the nerves and blood vessels around it.
The type of surgery you have will depend on a number of factors. Your surgeon will discuss the different types of surgery before any decision is made about your treatment.
It’s often helpful to talk to someone who has had the same operation you are going to have. The medical and nursing staff can arrange this. On some wards a special counsellor may be available to discuss any worries you may have.
Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. It’s an important treatment for most people with osteosarcoma as it can greatly improve the results of surgical treatment. It is usually given before surgery and may shrink large tumours enough to avoid amputation. The course of chemotherapy continues after surgery to destroy any remaining cancer cells and to stop the sarcoma from spreading outside the bone. This is known as adjuvant chemotherapy.
Chemotherapy can make you feel better by relieving the symptoms of the cancer, but it can sometimes have unpleasant side effects. Any side effects that occur can often be controlled well with medicines.
Radiotherapy treats cancer by using high energy rays to destroy the cancer cells, while doing as little harm as possible to normal cells. Radiotherapy is sometimes used after surgery and may be used to treat the primary tumour (for example where surgery is not possible).
Radiotherapy can cause side effects such as skin redness (erythema) and tiredness (fatigue). These side effects can be mild or more troublesome, depending on the strength of the radiotherapy dose and the length of your treatment. The radiotherapist will be able to advise you on what to expect.
Follow-up after osteosarcoma treatment
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After your treatment is completed, you will have regular check-ups and x-rays. These will continue for several years. If you have any problems or notice any new symptoms in between these times, let your doctor know as soon as possible.
Possible late side effects of osteosarcoma treatment
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A small number of people may develop late side effects, sometimes many years after their treatment for an osteosarcoma. These can include a change in the way the heart and lungs work and a slight increase in the risk of developing another cancer in later life. Your doctor or nurse will explain more about any possible late side effects.
Clinical trials for osteosarcoma
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Research into new ways of treating osteosarcoma is going on all the time. Treatments that are carried out on patients are known as clinical trials. These are especially important for finding improvements in treatment for rare cancers. Your specialist can tell you more about trials that may be relevant to you.
Before any trial is allowed to take place, it must be approved by an ethics committee, which protects the interests of the patients taking part.
Your doctor or a research nurse will discuss the treatment with you, so that you fully understand the trial and what it means to take part. You may decide not to take part or withdraw from a trial at any stage. You will still receive the best standard treatment available.
The need for practical and emotional support will vary from person to person. It may depend on the treatment you receive and any side effects the treatment may cause. Your specialist will inform you of any potential side effects and how to deal with them before you begin any treatment.
You may experience many different emotions. Anger, guilt, anxiety and fear are some of the most common feelings people have. You may find yourself tearful, restless and unable to sleep. You may have feelings of hopelessness and depression. These are all normal reactions but it can be difficult and distressing to admit to them.
You don't have to cope with these feelings on your own and there are people available to help you. You may find it helpful to talk to your family and friends about how you feel. Some hospitals have their own emotional support services with specially trained staff, and some of the nurses on the ward will have received training in counselling.
You may feel more comfortable talking to a counsellor outside the hospital environment or to a member of your religious faith. Ypu might find it helpful to speak to one of our cancer support specialists.
We can put you in touch with counselling services in your area.
This information has been compiled using a number of reliable sources, including:
European Society of Medical Oncology (ESMO) Clinical practice guideline on diagnosis, treatment, and follow-up of bone sarcomas. Annals of oncology. 2010. Volume 21: Supplement 5.
Hornieck et al. Bone sarcomas: Preoperative evaluation, histologic classification, and principles of surgical management. Uptodate. September 2012 (accessed November 2012).
Osteogenic sarcoma. Dynamed summary. November 2012.
Scottish Intercollegiate Guidelines Network (SIGN) national clinical guideline on long-term follow-up of survivors of childhood cancer can be found at SIGN 2004 Jan PDF.
The ESMO / European Sarcoma Network Working Group. Bone sarcomas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of oncology. 2012. Vol 23: Issue Supplement 7.
Tobias J and Hochhauser. D Cancer & its management. 6th edition. 2010. Willey Blackwell.
Wang et al. Osteosarcoma: Epidemiology, pathogenesis, clinical presentation, diagnosis, and histology. Uptodate. September 2012 (accessed November 2012).
With thanks to: Dr Beatrice Seddon, Consultant Clinical Oncologist; and the people affected by cancer who reviewed this edition. Reviewing is just one of the ways you can help when you join our Cancer Voices network.