Osteosarcoma

Question 1

What is osteosarcoma?

Answer 1

Osteosarcoma is a type of bone cancer. This usually presents in adolescents and younger adults aged 10 – 20 years. The most common bone to be affected is the femur. Other common sites are the tibia and humerus.

Question 2

Presentation osteosarcoma?

Answer 2

The main presenting feature is persistent bone pain, particularly worse at night time. This may disturb or wake them from sleep.

Other symptoms that may be present include bone swelling, a palpable mass and restricted joint movements.

Question 3

Diagnosis osteosarcoma?

Answer 3

NICE guidelines recommend a very urgent direct access xray within 48 hours for children presenting with unexplained bone pain or swelling. If the xray suggests a possible sarcoma they need very urgent specialist assessment within 48 hours.

Xrays show a poorly defined lesion in the bone, with destruction of the normal bone and a “fluffy” appearance. There will be a periosteal reaction (irritation of the lining of the bone) that is classically described as a “sun-burst” appearance. There can an associated soft tissue mass.

Blood tests may show a raised alkaline phosphatase (ALP).

Further investigations used to better define the lesion and stage the cancer:

CT scan
MRI scan
Bone scan
PET scan
Bone biopsy

Question 4

Management osteosarcoma?

Answer 4

Management involves surgical resection of the lesion, often with a limb amputation. Adjuvant chemotherapy is used alongside surgery to improve outcomes.

They will require support and input from the multidisciplinary team in addition to treatment of the tumour:

Paediatric oncologists and surgeons
Specialist nurses
Physiotherapy
Occupational therapy
Psychology
Dietician
Prosthetics and orthotics
Social services

The main complications are pathological bone fractures and metastasis.