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Macmillan and Cancerbackup merged in 2008. Together we provide free, high quality information for people affected by cancer through our publications, website and phone service. Find out more|.
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This information is about osteosarcoma| in children. You may find it helpful to read it alongside the Macmillan/CCLG booklet A parent’s guide to children’s cancer|, which contains more information about children's cancers, diagnosis, treatment, and support services.
About 30 children in the UK develop osteosarcomas each year. These tumours are more common in older children and teenagers, and are very rarely seen in children under five. They are also more common in boys than girls.
Osteosarcoma is a cancer that starts in the bone. It often starts at the ends of the bones, where new bone tissue forms as a young person grows. 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. Most occur in the centre of the bone. There are also rare subtypes, such as parosteal, periosteal telangiectatic, and small cell osteosarcoma.
As with most cancers, the cause of osteosarcoma is unknown. Children who have hereditary retinoblastoma (a rare tumour of the eye) have an increased risk of developing osteosarcoma. Children who have previously had radiotherapy| and chemotherapy| also have an increased risk of developing osteosarcoma.
It's not caused by injuries or damage to the bone, although an injury may draw attention to a bone tumour.
Pain in the affected bone is the most common symptom. This pain may initially come and go, and then gradually become more severe and constant. There may also be swelling around the affected bone. Primary bone cancer is sometimes discovered when a bone that has been weakened by cancer breaks after the person has had a minor fall or accident.
The symptoms described above can be caused by many things other than cancer. However, any persistent bone pain, particularly at night, should be checked by your child's doctor.
Usually you begin by seeing your family doctor (GP), who will examine your child and may arrange tests or x‑rays. If a bone tumour is suspected, they will refer your child 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 child's full medical history. They will then do a physical examination. This will include an examination of the painful bone to check for any swelling or tenderness. Your child will probably have a blood test done to check their 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. This is called a biopsy. It's a small operation performed under general anaesthetic.
Other tests are taken to check whether the cancer has spread to other parts of the body. These include a chest x-ray, blood tests, a bone scan, a bone marrow aspirate and an MRI or CT scan.
Any tests and investigations that your child needs will be explained to you. The booklet A parent’s guide to children’s cancer gives details of what the tests and scans involve.
Grading refers to the appearance of the cancer cells under the microscope, and gives an idea of how quickly the cancer may develop. Low-grade cancer cells look very much like normal cells, and are usually slow growing and less likely to spread.
In high-grade tumours, the cells look very abnormal, are likely to grow quickly, and are more likely to spread.
Most osteosarcomas are high grade, but a type known as parosteal osteosarcoma is usually low grade. A further subtype (periosteal osteosarcoma) is usually treated as though it was high grade.
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 the cancer helps the doctors to decide on the most appropriate treatment.
Most patients 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).
A staging system commonly used for osteosarcomas is described below:
The cancer is low grade and is found only within the hard coating of the bone.
The cancer is low grade, extending outside the bone and into the soft tissue spaces that 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 has spread outside the bone and into surrounding soft tissue spaces that contain nerves and blood vessels. Most osteosarcomas are stage 2B.
The cancer can be low or high grade and is found either within the bone or extends outside the bone. 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 will depend on a number of factors including the size, position and stage of the tumour.
Surgery| is a very important part of treatment for osteosarcoma. Chemotherapy is a very important part of treatment for osteosarcoma. Chemotherapy uses anti‑cancer (cytotoxic) drugs to destroy cancer cells, and is usually given to shrink the main tumour before surgery. It's also given after the tumour has been removed by surgery, to help reduce the risk of the cancer coming back (recurring). It's common for a combination of drugs| to be used.
Radiotherapy may occasionally be given. This treats cancer by using high-energy rays to destroy the cancer cells, while doing as little harm as possible to normal cells.
The type and extent of surgery depends on the position and size of the tumour in the body. This surgery will need to be carried out at a specialist orthopaedic centre, and your child should be referred to one.
Surgery may include removing the whole limb (amputation) or part of the affected bone, which is then replaced by some form of false limb (prosthesis). If only part of the affected bone is removed, this is known as limb-sparing surgery.
Amputation of the limb is sometimes unavoidable if the cancer is affecting the surrounding blood vessels and nerves. After amputation, a false limb will be fitted and will be regularly adjusted as your child grows. False limbs can work very well. It should be possible for your child to join in with normal activities and even sport.
Limb-sparing surgery preserves the limb. There are two ways in which this may be done:
After this type of surgery, children will usually be able to use their limbs almost normally. However, they're advised not to participate in any contact sports. This is because any damage to the bone graft or prosthesis may require another major operation to repair or replace it.
If your child is still growing, the limb prosthesis will need to be lengthened as the bone grows. This will mean further short stays in hospital.
Treatment often causes side effects, and your child’s doctor will discuss these with you before the treatment starts. Any possible side effects will depend upon the treatment being given and the part of the body that's being treated.
For example, side effects of chemotherapy can include feeling sick (nausea) and being sick (vomiting)|, hair loss|, an increased risk of infection|, bruising and bleeding. Radiotherapy can cause irritation or soreness of the skin in the area being treated and tiredness. If your child is having surgery, the surgeon will explain about any possible complications of surgery.
We have booklets that describe these side effects in more detail.
A small number of children may develop late side effects|, sometimes many years later. These include a reduction in bone growth, infertility, 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 child’s doctor or nurse will talk to you about any possible late side effects. There is more detailed information about these long-term side effects in the booklet A parent’s guide to children’s cancer.
Many children have their treatment as part of a clinical research trial|. Trials aim to improve our understanding of the best way to treat an illness, usually by comparing the standard treatment with a new or modified version.
Specialist doctors carry out trials for children's cancer. If appropriate, your child's medical team will talk to you about taking part in a clinical trial and will answer any questions you have. Written information is provided to help explain things.
Taking part in a research trial is completely voluntary, and you'll be given plenty of time to decide if it's right for your child. Your child's doctor can tell you what trials are available that might be suitable for your child.
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.
If you decide to take part in a trial, your doctor or a research nurse must discuss the treatment with you. This is so you have a full understanding of the trial and what it means for your child to take part. You may decide not to take part, or you can withdraw from a trial at any stage and will then receive the best standard treatment available.
Many children with osteosarcoma are cured. However, the child may need to have surgery to lengthen the affected limb from time to time. Your child will have regular check-ups and x-rays in the paediatric or adolescent oncology clinic and at the orthopaedic centre.
If you have specific concerns about your child’s condition and treatment, it is best to discuss them with your child’s doctor, who knows the situation in detail.
As a parent, the fact that your child has cancer is one of the worst situations you can be faced with. You may have many different emotions, such as fear, guilt, sadness, anger and uncertainty. These are all normal reactions| and are part of the process that many parents go through at such a difficult time.
It's not possible to address here all of the feelings you may have. However, the booklet A parent’s guide to children’s cancer talks about the emotional impact of caring for a child with cancer and suggests sources of help and support.
Your child may have a variety of powerful emotions| throughout their experience of cancer. The parent's guide discusses these further and talks about how you can support your child|.
Our booklet Peppermint Ward| is a storybook for younger children with cancer. It looks at the issues that they and their family may face and helps them explore their feelings.
CCLG| coordinates research and care for children and their parents. There are 21 CCLG specialist centres for the treatment of childhood cancer and leukaemia, covering all areas of the UK and Ireland (there's a map of the centres| on the website). Has information about the CCLG, childhood cancer and leukaemia.
CLIC Sargent| offers practical support to children and young people aged 21 and under with cancer or leukaemia, and to their families.
This section has been compiled using information from a number of reliable sources, including:
For answers, support or just a chat, call the Macmillan Support Line free (Monday to Friday, 9am-8pm)
If you have any questions about cancer, need support or just want someone to talk to, ask Macmillan.