Osteosarcoma

Osteosarcoma overview

Osteosarcoma is the most common type of bone cancer in children. Tumours can appear in any bone in the body, however, mostly occur in the bones on either side of the knee and in the upper arm. Osteosarcoma symptoms may include bone pain (commonly leg pain in children), swelling, redness and bone fracture. Osteosarcoma cancer mainly affects children and young adults under the age of 25 and has a survival rate of 65%.

What is osteosarcoma?

Incidence

There are approximately 30 new cases of childhood osteosarcoma each year in Great Britain. Although osteosarcoma can develop in any bone, it occurs most often in the bones on either side of the knee (tibia or femur) and in the upper arm. Osteosarcoma is extremely rare under the age of three years and gradually increases with age, with two thirds of childhood cases occurring in the 10-14 year age group. Incidence is similar in girls and boys up to age 14 years but a male excess emerges at around 15-16 years. This male excess arises earlier in Ewing sarcoma of bone (at 10-14 years).In addition to these childhood cases, a further 45 teenagers and young adults (15 to 24 years) are diagnosed with osteosarcoma every year in the UK. 

Osteosarcoma survival rate

65 out of 100 children (65%) with osteosarcoma survive for 5 years or more after diagnosis in the UK. Patients with localized disease can expect 5-year survival rates as high as 60–78%, but survival drops to 20–30% for those with metastatic disease. Osteosarcoma in patients younger than 12 years old without metastases have similar prognosis as adolescent and young adults.

How is osteosarcoma treated?

Great advances have been made in the treatment of malignant osteosarcoma in children during the past few decades. In the 1960s the only available treatment was amputation. Only a small number of patients survived more than two years after diagnosis.

It has now been shown that giving chemotherapy before and after surgery improves the outlook for osteosarcoma patients. It also allows some people to have limb-sparing surgery rather than amputation.

Treatment varies according to the size, grading and position of the bone cancer. It usually involves surgery, chemotherapy and/or radiotherapy.

• Surgery generally forms the mainstay of treatment for osteosarcoma but the extent of surgery will again depend on the site and size of the tumour. In some cases, the affected limb may need to be amputated, in which case an artificial limb will be developed by a specialist centre. Limb-sparing surgery (involving a prosthesis or bone graft) is possible in many cases.
  
• Chemotherapy may be used before surgery to kill the bone cancer cells and shrink the tumour. It may also continue after surgery to prevent recurrence (relapse).
  A new type of chemotherapy – a biological therapy called mifamurtide – has been introduced in recent years for the treatment of non-metastasised osteosarcoma following surgery. This is given alongside conventional chemotherapy and has improved survival.
  
• Radiotherapy is sometimes used in combination with the other forms of treatment.

Research

Many children have their treatment as part of a clinical trial.

Trials aim to improve our understanding of the best way to treat the cancer, usually by comparing the standard treatment with a new or modified version.

If appropriate, the child’s medical team will discuss participation in a relevant trial. Participation is optional but may offer the opportunity to receive new treatments.

Children with Cancer UK is funding a number of research projects focused on bone tumours.

I had a biopsy and results day arrived. The doctor looked at me and said ‘I’m sorry but it’s cancer’. I will never forget those words but I was thinking ‘no he has it wrong, I’m 14 I can’t have cancer’. He said that the osteosarcoma tumour would need to be removed with surgery.

The big day arrived, I remember going there thinking ‘I may leave here with just one leg’. And that, I couldn’t accept. It took five hours, but the doctors were able to save my leg and successfully remove all of the tumour.

Two years later I was in a show dancing, cartwheeling and doing the splits and handstands! The doctors were amazed and said that I should be using crutches!

I am now 18 years old and have been clear for almost five years. I have finished a dance BTEC at college and am at university studying Dance Education.”

If you’ve been touched by Bethany’s journey, help us invest in the high quality research that really matters which would otherwise go unfunded, helping to support children with cancer so they can be with their families for longer.