Osteosarcoma is a malignant type of bone cancer that typically affects children between the ages of 10 and 19, that is to say, during puberty. In some cases, adults can develop osteosarcoma, but this is very rare.
While it can technically affect any bone, in most cases the tumor appears in the longest bones of the body, which are the humerus, femur and tibia.
The reason this cancer develops is because of a genetic mutation, and this is the case for all types of bone cancers. During this mutation, a DNA change happens within the healthy bone cells, and that causes the cell to believe they need to start growing an additional bone.
However, since there isn’t any need for a new bone, the cells end up creating a tumor that grows into bone cancer.
Osteosarcoma is a very rare disease and it only accounts for approximately 2.4% of all childhood cancers. However, it is the most common type of bone cancer, and once it’s diagnosed, the medical professional in charge of your child’s case will go forth with the appropriate treatment.
Osteosarcoma Treatment Options
There are multiple different ways to treat osteosarcoma, so let’s explore the different options as well as when and why a certain method would be used.
Surgery is performed on cancer patients to remove all of the cancerous cells from their bodies, but there are a couple of different things the doctor needs to take into consideration when planning said surgery.
The most important factors that will determine the type of surgery a patient will receive are the size of the tumor and where it’s located. Once the doctor examines the tumor thoroughly and decides to operate on it, they will choose between one of three surgeries.
When osteosarcoma is caught early and the tumor isn’t too big, the doctor will perform limb-sparing surgery, also sometimes known as a limb-saving surgery. This is only an option if the patient doesn’t need to have too much tissue or muscle removed.
During limb-sparing surgery, the doctor cuts an incision to remove the tumor, and in the process, removes some of the healthy tissue around it. This procedure is done to remove only the cancer and it’s performed in a way that saves the limb completely so it will still be functional even after the tumor’s removal.
However, in some cases during the surgery, a section of the bone will have to be removed but it will be reconstructed afterward with bone grafts or metal prosthetics.
If limb-sparing surgery isn’t an option, the doctor will have to perform an amputation, meaning they will cut off the infected limb. However, there has been great advancement in limb-sparing surgery over the years, so the need for amputation has reduced significantly.
Still, it can be necessary in some cases when the tumor is too advanced, but even if an amputation is done, the doctor will offer the patient a prosthetic to improve limb function after surgery.
Rotationplasty is a surgery in which the lower portion of the leg is removed and it’s mostly performed on children who are still growing and their tumor is located near the knee. During rotationplasty, the surgeon removes the cancer as well as the surrounding area, and this includes the knee joint.
Afterward, they rotate the foot and ankle and place the ankle where the knee used to be. The patient is left without their lower leg and foot, but typically they receive a prosthesis to be able to continue performing all physical activities with little to no issues.
Chemotherapy is the process of giving a certain type of drug to patients suffering from cancer and the aim of chemotherapy is to stop or significantly slow down cancer cell growth.
If a patient is suffering from osteosarcoma, they will most likely receive chemotherapy before surgery. The doctor will take into account how the patient is responding to the chemotherapy and how the tumor is reacting to the treatment so they could plan further steps.
Chemotherapy is also given after surgeries to ensure all the cancer cells that were left remaining in the body are completely eliminated.
Radiotherapy, also known as radiation therapy, isn’t used as the main cancer treatment option for osteosarcoma because the cancer cells aren’t easily killed by radiation therapy. This type of treatment uses high-energy beams directed at the tumor to remove cancer cells.
Radiotherapy is typically used if the entire tumor can’t be removed by surgery or otherwise when doctors want to slow down the growth of the tumor and alleviate symptoms.
Targeted therapy is generally very similar to chemotherapy but it works differently. During this type of treatment, a doctor will use certain drugs to identify and attack cancer cells as precisely as possible.
As the name suggests, this type of treatment is very targeted and it mostly has an effect on the cancer cells while leaving the healthy cells alone. If targeted therapy works as intended, it will stop the cancer cells from multiplying.
Osteosarcoma Treatment by Stage
When doctors are deciding what treatment they’re going to use when a patient has osteosarcoma, they take into consideration what stage the cancer is in.
Osteosarcoma can be localized, metastatic and recurrent. Doctors need to utilize different approaches in each case.
Localized Osteosarcoma Treatment
Most osteosarcomas are considered to be high-grade, which means the tumor spreads quickly to other parts of the body. However, when it’s caught early before it spreads, it’s considered to be localized – contained within the part of the body where it first materialized.
Localized osteosarcoma can be classified as resectable and non-resectable.
Resectable osteosarcoma can be removed with surgery alone, and that is usually done without complications. The surgery is limb-saving, meaning there is no need for amputation.
Non-resectable osteosarcomas on the other hand can’t be removed by surgery, either because they’re too large or perhaps too close to a vital organ or structure.
In that case, chemotherapy is given to the patient in hopes their osteosarcoma will become resectable and then it will be possible to remove it with surgery. If this doesn’t work, then the patient will receive radiation therapy.
Metastatic Osteosarcoma Treatment
When osteosarcoma reaches the metastatic stage, that means it’s spread to other areas of the body, in most cases to the lungs.
The first treatment for this cancer is typically chemotherapy followed by surgery and then more rounds of chemotherapy. Sometimes radiation therapy is needed, but only if the cancer cells weren’t completely removed with chemotherapy.
Recurrent Osteosarcoma Treatment
When a cancer is recurrent, that means it returned even after the patient received treatment and this can happen with any cancer, including osteosarcoma. When a cancer is recurrent, it can appear locally in the same part of the body where it was the first time, but that’s not always the case.
Recurrent osteosarcoma can be localized or metastatic and will be treated accordingly. Some patients with recurrent osteosarcoma require chemotherapy, some need surgery, and others even need radiation – it’s different from person to person.
Osteosarcoma Treatment Side Effects
Side effects following any kind of cancer treatment are common, but not everyone is going to have the same ones. Additionally, the side effects are going to differ based on what kind of treatment the patient received.
Most side effects related to osteosarcoma treatment happen due to chemotherapy, which is the most commonly given treatment. Chemotherapy has the following side effects:
- Hair loss
- Nausea and vomiting
- Significant loss of appetite
- Mouth sores
- Low blood cell counts
- Increased risk of infection
If a patient receives radiation therapy, they can experience some of the following symptoms:
- Upset stomach
- Mild skin reactions
- Loose bowel movements
Most of the side effects that patients experience disappear not long after treatment, usually within a month or two. However, since osteosarcoma mostly affects children, it’s important for parents to know there may be some psychological side effects.
Talk to your child after their cancer treatment to ensure they understand the situation in an age-appropriate way. If you think it’s necessary, send them to a psychologist so they can process this event in the best way possible.
Osteosarcoma Treatment at Sheba
Cancer treatment can be a daunting experience for everyone, but especially children who are unfortunately the ones who are usually affected by osteosarcoma. Even though it’s an extremely rare cancer, there are still cases diagnosed all over the world.
It’s important to keep an eye on children to see if they are developing any symptoms and if they require treatment, take them to the best possible institution.
Sheba Medical Center is one of the best hospitals in the world and our osteosarcoma doctors approach each case with extreme professionalism.
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Sheba Medical Center provides innovative, personalized medical care to patients from around the world. We are the largest, most comprehensive hospital in the Middle East and dedicated to providing advanced and compassionate medicine for everyone. We welcome all cases, including the rarest and the most challenging. Our medical teams collaborate to provide the best possible health outcomes. From your initial inquiry through the long-term follow-up care, we are here for you.
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