Osteosarcoma

Question 1

What is it and what bones are commonly affected?

Answer 1

A type of bone cancer. The most common bone affected is the femur. Other common sites are the tibia and humerus.

Question 2

Which age group is most affected?

Answer 2

Usually in adolescents and younger adults aged 10-20.

Question 3

What is the presentation?

Answer 3

• persistent bone pain, particularly worse at night (can disturb or wake them from sleep)
• bone swelling
• palpable mass
• restricted joint movements

Question 4

How is a diagnosis made?

Answer 4

Very urgent direct access x-ray within 48 hours for children with unexplained bone pain or swelling. If the x-ray suggests a possible sarcoma, they need very urgent specialist assessment within 48 hours.

Question 5

What will an x-ray show?

Answer 5

• 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 describe as a ‘sun burst appearance’
• can be an associated soft tissue mass

Question 6

What may blood tests show?

Answer 6

Raised ALP

Question 7

What are other investigations to define the lesion and stage the cancer?

Answer 7

CT, MRI, bone scan, PET scan, bone biopsy.

Question 8

What is the management?

Answer 8

Surgical resection of the lesion, often with a limb amputation. Adjuvant chemotherapy alongside surgery.

Question 9

Who’s involved in the MDT?

Answer 9

Paediatric oncologists and surgeons, specialist nurses, physiotherapy, occupational therapy, psychology, dietician, prosthetics and orthotics, social services.

Question 10

What are the main complications?

Answer 10

Pathological bone fractures, metastasis.