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Osteosarcoma - Childhood - Overview

This section has been reviewed and approved by the Cancer.Net Editorial Board, 11/2015

ON THIS PAGE: You will find some basic information about this disease and the parts of the body it may affect. This is the first page of Cancer.Net’s Guide to Childhood Osteosarcoma. To see other pages, use the menu on the side of your screen. Think of that menu as a roadmap to this full guide.

About sarcoma

Sarcoma is cancer that develops in the tissues that support and connect parts of the body. These include bone, fat, muscle, and soft tissue. Cancer begins when healthy cells change and grow uncontrollably. They form a mass called a tumor. A tumor can be cancerous or benign. A cancerous tumor is malignant. This means that it can spread to other parts of the body. A benign tumor means the tumor will not spread.

About osteosarcoma

Osteosarcoma is a cancer of the bone that destroys tissue and weakens the bone. It develops from immature bone cells that normally form new bone tissue.

Places osteosarcoma begins

It most often starts in the bones around the knee joint, either at the femur, which is the lower end of the thigh bone, or the tibia, which the upper end of the shin bone. The next most common place osteosarcoma begins is in the humerus. This is the upper arm bone close to the shoulder.

However, osteosarcoma can develop in any bone in the body. Rarely, it occurs as a tumor in the body’s soft tissue, outside the bone.

Types and subtypes of osteosarcoma

  • Medullary tumor, also called a central tumor

  • Peripheral tumor, also called a surface tumor

Each has different subtypes. The type and subtype of osteosarcoma is determined by looking at the tumor cells through a microscope.

The most common subtype is called conventional central osteosarcoma. The other subtypes are much less common. They each account for less than 5% of all osteosarcomas.

Medullary osteosarcoma subtypes:

  • Conventional central osteosarcoma

  • Telangiectatic osteosarcoma

  • Intraosseous well-differentiated, or low-grade, osteosarcoma

  • Small cell osteosarcoma

Peripheral osteosarcoma subtypes:

  • Parosteal, well-differentiated or low-grade, osteosarcoma. Also called juxtacortical osteosarcoma.

  • Periosteal osteosarcoma that is low grade to intermediate grade

  • High-grade surface osteosarcoma

This section covers osteosarcoma that is diagnosed during childhood. To learn more about other types of bone cancer and soft-tissue sarcoma, visit their specific sections on Cancer.Net.

Looking for More of an Overview?

If you would like additional introductory information, explore these related items. Please note these links take you to other sections on Cancer.Net:

  • ASCO Answers Fact Sheet: Read a one-page fact sheet (available as a PDF) that offers an easy-to-print introduction to this type of cancer.

  • Cancer.Net Patient Education Video: View a short video led by an ASCO expert in childhood cancer that provides basic information and areas of research.

The next section in this guide is Statistics and it helps explain how many people are diagnosed with this disease and general survival rates. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Osteosarcoma - Childhood - Statistics

This section has been reviewed and approved by the Cancer.Net Editorial Board, 11/2015

ON THIS PAGE: You will find information about how many people, including children, are diagnosed with this type of cancer each year and some general survival information. Remember, survival rates depend on several factors. To see other pages, use the menu on the side of your screen.

This year, an estimated 800 people total, including 400 people younger than 20, will be diagnosed with osteosarcoma in the United States. About 2% of all childhood cancers are osteosarcoma. It most often affects adolescents and young adults in their 20s.

The five-year survival rate is the percentage of people who survive at least five years after the cancer is found. It depends on the type and subtype of the cancer, the cancer’s response to treatment, and the degree to which the cancer has spread. The five-year survival rate for children with osteosarcoma that is only in one place at the time of diagnosis is 71%.

Cancer survival statistics should be interpreted with caution. These estimates are based on data from thousands of people with this type of cancer in the United States, so the actual risk for a particular individual may be different. It is not possible to tell a person how long he or she will live with osteosarcoma. Because the survival statistics are measured in five-year intervals, they may not represent advances made in the treatment or diagnosis of this cancer. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society’s (ACS) publication, Cancer Facts & Figures 2015, and the ACS website.

The next section in this guide is Medical Illustrations, and it offers drawings of body parts often affected by this disease. Or, use the menu on the left side of your screen to choose another section to continue reading this guide.

Osteosarcoma - Childhood - Medical Illustrations

This section has been reviewed and approved by the Cancer.Net Editorial Board, 11/2015

ON THIS PAGE: You will find a basic drawing of the skeleton. To see other pages, use the menu on the side of your screen.

Adolescent Skeletal Anatomy
Larger Image

The next section in this guide is Risk Factors and it explains what factors may increase the chance of developing this disease. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Osteosarcoma - Childhood - Risk Factors

This section has been reviewed and approved by the Cancer.Net Editorial Board, 11/2015

ON THIS PAGE: You will find out more about the factors that increase the chance of developing this type of cancer. To see other pages, use the menu on the side of your screen.

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development of a tumor, most do not directly cause cancer. Some people with several risk factors never develop a tumor, while others with no known risk factors do.

Most osteosarcoma begins sporadically. This means it appears in people who have no other diseases and no family history of bone cancer.

Osteosarcoma may start because of overactive bone cells. Researchers are studying possible changes in genes that lead to this overactivity. They are studying this in a small number of families in which siblings have developed osteosarcoma. Such changes in genes are very uncommon. However, it may help doctors better understand how osteosarcoma begins in people with no family history of the disease. Similar genetic changes may occur in their cancer cells.

Osteosarcoma is probably caused by a combination of genetic changes. Together, they cause immature bone cells to become tumor cells instead of healthy bone.

A gene known as RB may be associated with osteosarcoma. This gene is abnormal in many children with a rare type of eye cancer called retinoblastoma.

RB is a tumor suppressor gene that controls cell growth. When it is changed, it no longer controls cell growth. As a result, a tumor can form.

In addition, many other changes occur in the genes of osteosarcoma cells.

All osteosarcomas are rare. However, some groups of people are more likely to develop osteosarcoma:

  • Teenagers who are having a growth spurt are most likely to develop osteosarcoma. Researchers are looking for a link between rapid bone growth and tumor development.

  • Osteosarcoma is about 50% more common in boys than girls.

  • People who have received radiation treatment for other types of cancer are more likely to develop osteosarcoma. Also, high doses of radiation treatment at a younger age increase the risk.

  • Children with an inherited form of retinoblastoma are more likely to develop osteosarcoma.

  • Children with Li-Fraumeni syndrome have a higher risk of sarcoma, brain cancer, breast cancer, leukemia, and adrenal cancer. Li-Fraumeni syndrome is a rare disorder of the p53 gene. That gene is responsible for getting rid of abnormal cells.

  • Children with Werner syndrome have a higher risk of sarcoma, thyroid cancer, and melanoma. Werner syndrome is a very rare disorder that may involve the WRN gene.

  • People with Rothmund-Thomson syndrome are more likely to develop osteosarcoma. Rothmund-Thomson syndrome is an uncommon disorder. It is characterized by short height, rash, hair loss, and skeletal dysplasia. Skeletal dysplasia are noncancerous abnormalities of the bones,

The next section in this guide is Symptoms and Signs and it explains what body changes or medical problems this disease can cause. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Osteosarcoma - Childhood - Symptoms and Signs

This section has been reviewed and approved by the Cancer.Net Editorial Board, 11/2015

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. To see other pages, use the menu on the side of your screen.

The symptoms of osteosarcoma depend on the bone in which the tumor developed. Children and teens with osteosarcoma may experience the following symptoms or signs. Sometimes, people with osteosarcoma do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not cancer.

  • Pain in a bone or joint that gets worse over time, especially if the pain interferes with sleep

  • Painless swelling

  • A noticeable mass or lump in an arm or leg

  • A broken bone with no injury to explain how it occurred

  • Stiffness or swelling of joints. This is not a common symptom.

  • Back pain or a loss of bowel or bladder control. These can occur if the tumor is in the pelvis or at the base of the spine. They are uncommon early symptoms.

If you are concerned about one or more of the symptoms or signs on this list, please talk with your child’s doctor. Your doctor will ask how long and how often your child has been experiencing the symptom(s), in addition to other questions. This is to help find out the cause of the problem, called a diagnosis

If cancer is diagnosed, relieving symptoms remains an important part of cancer care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your child’s health care team about symptoms your child experiences, including any new symptoms or a change in symptoms.

The next section in this guide is Diagnosis and it explains what tests may be needed to learn more about the cause of the symptoms. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Osteosarcoma - Childhood - Diagnosis

This section has been reviewed and approved by the Cancer.Net Editorial Board, 11/2015

ON THIS PAGE: You will find a list of the common tests, procedures, and scans that doctors can use to find out what’s wrong and identify the cause of the problem. To see other pages, use the menu on the side of your screen.

Doctors use many tests to diagnose a tumor and find out if it has metastasized. Metastasis means that the tumor has spread from where it began to another part of the body. Some tests may also determine which treatments may be the most effective.

For most tumors, a biopsy is the only way to make a definitive cancer diagnosis. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. For example, imaging tests may be used to find out whether the cancer has spread.

This list describes options for diagnosing this type of cancer. Not all tests listed will be used for every child. Your child’s doctor may consider these factors when choosing a diagnostic test:

  • Age and medical condition

  • Type of tumor suspected

  • Signs and symptoms

  • Previous test results

In addition to a physical examination, the following tests may be used to diagnose osteosarcoma. A health care team with experience diagnosing and treating bone tumors should perform these tests.

Imaging tests

X-ray. An x-ray is a way to create a picture of the structures inside of the body. It uses a small amount of radiation. The doctor will take an x-ray of the area where there is a lump or swelling. Osteosarcoma usually shows certain common features on an x-ray.

Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. A CT scan can also be used to measure the tumor’s size. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a pill to swallow.

Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI can also be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a pill to swallow.

An MRI creates more detailed pictures than CT scans. Sometimes, it helps find a smaller tumor. Also, an MRI provides more exact pictures of the tumor and the surrounding healthy tissue. This can help the orthopedic surgeon, a doctor who specializes in surgery on the bones, plan surgery. Surgery removes the tumor-containing area of bone with a portion of the surrounding healthy tissue called the margin. 

Positron emission tomography (PET) scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body.

Bone scan. A bone scan uses a radioactive tracer to look at the inside of the bones. The tracer is injected into a patient’s vein. It collects in areas of the bone, and a special camera detects it. Healthy bone appears gray to the camera. Meanwhile, areas of injury, such as those caused by a tumor, appear dark. However, areas where new bone is being formed also appear dark. This is normal.

Arteriogram (also called angiogram). An arteriogram is a way for doctors to see inside the arteries. A small amount of a contrast medium is injected into an artery, making it appear on an x-ray. A surgeon may use this test to help plan surgery.

Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that a tumor is present, but only a biopsy can make a definitive diagnosis. A pathologist then analyzes the sample(s). A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease.

A doctor who specializes in bone tumors should perform the biopsy. The biopsy typically involves surgery. However, sometimes, the doctor performs a needle biopsy. A needle biopsy uses a hollow needle inserted into the tumor. The doctor may analyze the genes or other features of the cancer cells to distinguish osteosarcoma from other types of cancer.

After diagnostic tests are done, your child’s doctor will review all of the results with you. If the diagnosis is cancer, these results also help the doctor describe the location(s) of the cancer. This is called staging.

The next section in this guide is Stages, and it explains the system doctors use to describe the extent of the disease. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Osteosarcoma - Childhood - Stages

This section has been reviewed and approved by the Cancer.Net Editorial Board, 11/2015

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread. This is called the stage. To see other pages, use the menu on the side of your screen.

Staging is a way of describing where the tumor is located, if or where it has spread, and whether it is affecting other parts of the body. Doctors use diagnostic tests to find out the tumor's stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis, which is the chance of recovery. There are different stage descriptions for different tumors.

Terms doctors use to describe the stage of osteosarcoma and plan treatment include:

Localized. The tumor is only in the bone where it began and in the tissue around it. The tumor has not spread to other parts of the body.

Metastatic. The tumor has spread from the bone where it began to another part of the body. Most often, it has spread to the lungs or other bones.

Recurrent. Recurrent osteosarcoma is a tumor that has come back during or after treatment. It can come back in the same place where it started or in another part of the body. Osteosarcoma recurs most often in the lungs and other bones. If there is a recurrence, the cancer may need to be staged again. This is called re-staging.

Source: National Cancer Institute.

Information about the cancer’s stage will help the doctor recommend a specific treatment plan. The next section in this guide is Treatment Options. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Osteosarcoma - Childhood - Treatment Options

This section has been reviewed and approved by the Cancer.Net Editorial Board, 11/2015

ON THIS PAGE: You will learn about the different ways doctors use to treat children and teens with this type of cancer. To see other pages, use the menu on the side of your screen.

In general, cancer in children is uncommon, so it can be hard for doctors to plan treatments unless they know what has been most effective in other children. That is why more than 60% of children with cancer are treated as part of a clinical trial. Clinical trials are research studies that compare the standard treatments (the best treatments available) with newer approaches to treatments that may be more effective. Clinical trials may test such approaches as a new drug, a new combination of standard treatments, or new doses of current therapies. Studying new treatments involves careful monitoring using scientific methods, and all participants are followed closely to track their health and progress.

To take advantage of these newer treatments, all children with cancer should be treated at a specialized cancer center. Doctors at these centers have extensive experience in treating children with cancer and have access to the latest research. A doctor who specializes in treating children with cancer is called a pediatric oncologist.

In many cases, a team of doctors works with a child and the family to provide care; this is called a multidisciplinary team. Pediatric cancer centers often have extra support services for children and their families, such as child life specialists, nutritionists, physical and occupational therapists, social workers, and counselors. Special activities and programs to help your child and family cope may also be available.

Descriptions of the most common treatment options for osteosarcoma are listed below. The three most common types of treatment for osteosarcoma are surgery, chemotherapy, and radiation therapy.

Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, the child’s overall health, and the child’s and family’s preferences. Your child’s care plan may also include treatment for symptoms and side effects, an important part of cancer care.

Take time to learn about your child’s treatment options and be sure to ask questions about things that are unclear. Also, talk about the goals of each treatment with your child’s doctor and what your child can expect while receiving the treatment. Learn more about making treatment decisions.

Surgery

Surgery is the removal of the tumor and some surrounding tissue during an operation. An orthopedic oncologist is a doctor who specializes in surgery when cancer affects the bone.

Chemotherapy and occasionally radiation therapy may be used with surgery, particularly with limb-sparing surgery. In limb-sparing surgery, doctors use surgical techniques to help the child keep the use of the arm or leg and to give the limb a more normal appearance. Surgical techniques include bone grafting and reconstructive surgery.

Limb-sparing surgery is used whenever possible. Sometimes, the operation that results in the most useful and strongest limb is different from the one that gives the most normal appearance. Learn more about the basics of cancer surgery.

Occasionally, doctors will need to remove a limb to ensure that the entire tumor has been eliminated. This is called amputation. If amputation is needed, rehabilitation can help the child maximize his or her physical functioning. Rehabilitation can also help a child cope with the social and emotional effects of losing a limb. Learn more about rehabilitation.

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cells’ ability to grow and divide. Chemotherapy is given by a pediatric or medical oncologist, a doctor who specializes in treating cancer with medication.

Systemic chemotherapy gets to the bloodstream to reach tumor cells throughout the body. Common ways to give chemotherapy include an intravenous (IV) tube placed into a vein using a needle or in a pill that is swallowed (orally). Chemotherapy for osteosarcoma is usually given intravenously. Occasionally, medications are taken by mouth or injected under the skin. This may be done to limit the side effects of treatment.

A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a set period of time. Your child may receive one drug at a time or a combination of different drugs at the same time.

Chemotherapy is often given before surgery to reduce the tumor size and avoid amputation of the arm or leg. Also, it is almost always given after surgery to destroy any tumor cells that may still be in the body.

The side effects of chemotherapy depend on the individual and the dose used. They can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhea. The health care team will manage these immediate side effects during treatment. And these side effects usually go away once treatment is finished. Other side effects may continue after treatment, so be sure to let them know of new side effects or a change in side effects. These may include decreased strength of the heart muscle, hearing loss, or decreased kidney function. The severity of the side effects depends on the type of drug given and the length of treatment. Learn more about long-term side effects in the Follow-Up Care section. 

Learn more about chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your child’s doctor is often the best way to learn about the medications prescribed for your child, their purpose, and their potential side effects or interactions with other medications. Learn more about your child’s prescriptions by using searchable drug databases.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. The most common type of radiation treatment for osteosarcoma is called external-beam radiation therapy. This is radiation therapy given from a machine outside the body. A radiation therapy regimen usually consists of a specific number of treatments given over a set period of time.

Radiation therapy for osteosarcoma is uncommon. It is only used when trying to avoid amputating an arm or leg. This is because osteosarcoma is relatively resistant to radiation.

Surgery and chemotherapy are the most common types of treatment for osteosarcoma. However, this situation may change if researchers find ways to deliver higher doses of radiation safely to any part of body.

Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Most side effects go away soon after treatment is finished. Learn more about the basics of radiation therapy.

Getting care for symptoms and side effects

Cancer and its treatment often cause side effects. In addition to treatment to slow, stop, or eliminate the cancer, an important part of cancer care is relieving a person’s symptoms and side effects. This approach is called palliative or supportive care, and it includes supporting the patient with his or her physical, emotional, and social needs.

Palliative care is any treatment that focuses on reducing symptoms, improving quality of life, and supporting patients and their families. It works best when palliative care is started as early as needed in the cancer treatment process.

People often receive treatment for the cancer and treatment to ease side effects at the same time. In fact, patients who receive both often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, and other therapies. Your child may also receive palliative treatments similar to those meant to eliminate the cancer, such as chemotherapy, surgery, or radiation therapy. Talk with your child’s doctor about the goals of each treatment in the treatment plan.

Before treatment begins, talk with your child’s health care team about the possible side effects of the recommended treatment plan and palliative care options. And during and after treatment, be sure to tell your child’s doctor or another health care team member if your child experiences a problem so it can be addressed as quickly as possible. Learn more about the basics of palliative care.

Remission and the chance of recurrence

A remission is when cancer cannot be detected in the body. This may also be called having “no evidence of disease” or being “NED.”

A remission may be temporary or permanent. While many remissions are permanent, it is important to talk with your doctor about the possibility of the cancer returning. Understanding your child’s risk of recurrence and the treatment options may help you and your child feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence

If the cancer does return after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).

When this occurs, a cycle of testing will begin again to learn as much as possible about the recurrence. After testing is done, you and your child’s doctor will talk about the treatment options. Often the treatment plan will include the treatments described above, such as surgery and chemotherapy. However, these treatments may be used in a different combination or given at a different pace. Your child’s doctor may also suggest clinical trials that are studying new ways to treat this type of recurrent cancer.

Treatment for recurrent osteosarcoma depends on three factors:

  • Where the cancer recurred

  • The type of treatment your child received for the original tumor

  • The overall health of your child

If the disease recurs in the lungs, surgery is often used to remove the nodules, or tumors, in the lung. In these situations, there is usually a better outcome for children who have the lung nodules completely removed. This is especially true if the disease has recurred after the initial treatment has been completed.

The doctor may use chemotherapy or other approaches, as well. If the cancer comes back elsewhere in the body, the doctor may use a combination of drugs. If the cancer has spread to another bone or to a small number of other bones, the doctor may perform surgery, particularly if chemotherapy has worked well.

When cancer recurs, patients and their families often experience emotions such as disbelief or fear. Families are encouraged to talk with their health care team about these feelings and ask about support services to help them cope. Learn more about dealing with cancer recurrence.

If treatment fails

Although treatment is successful for the majority of children with cancer, sometimes it is not. If a child’s cancer cannot be cured or controlled, this is called advanced or terminal cancer. This diagnosis is stressful, and it may be difficult to discuss. However, it is important to have open and honest conversations with your child’s doctor and health care team to express your family’s feelings, preferences, and concerns. The health care team is there to help. Many team members have special skills, experience, and knowledge to support patients and their families.

Parents or guardians are encouraged to think about where the child would be most comfortable. This could be at home, in a home-like setting elsewhere, in the hospital, or in a hospice environment.

Hospice care is a type of palliative care for people who are expected to live less than 6 months. It is designed to provide the best possible quality of life for people who are near the end of life. Most often, this care is provided in the home. Nursing care and special equipment can make staying at home a workable alternative for many families.

Some children and teens may be happier if they can arrange to attend school part-time or keep up other activities and social connections. The child’s health care team can help parents or guardians decide on an appropriate level of activity.

Making sure a child is physically comfortable and free from pain is extremely important as part of end-of-life care. Learn more about caring for a terminally ill child and advanced cancer care planning.

The death of a child is an enormous tragedy, and families may need support to help them cope with the loss. Pediatric cancer centers often have professional staff and support groups to help with the process of grieving. Learn more on grieving the loss of a child.

The next section in this guide is About Clinical Trials, and it offers more information about research studies that are focused on finding better ways to care for people with cancer. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Osteosarcoma - Childhood - About Clinical Trials

This section has been reviewed and approved by the Cancer.Net Editorial Board, 11/2015

ON THIS PAGE: You will learn more about clinical trials, which are the main way that new medical approaches are tested to see how well they work. To see other pages, use the menu on the side of your screen.

Doctors and scientists are always looking for better ways to treat children and teens with osteosarcoma. To make scientific advances, doctors create research studies involving volunteers, called clinical trials. In fact, every drug that is now approved by the U.S. Food and Drug Administration (FDA) was previously tested in clinical trials.

Many clinical trials are focused on new treatments, evaluating whether a new treatment is safe, effective, and possibly better than the current (standard) treatment. These types of studies evaluate new drugs, different combinations of existing treatments, new approaches to radiation therapy or surgery, and new methods of treatment. Children and teens who participate in clinical trials are often among the first to receive new treatments before they are widely available. However, there is no guarantee that the new treatment will be safe, effective, or better than a standard treatment.

There are also clinical trials that study new ways to ease symptoms and side effects during treatment and manage the late effects that may occur after treatment. Talk with your child’s doctor about clinical trials regarding side effects.

Deciding to join a clinical trial

People decide to participate in clinical trials for many reasons. For some, a clinical trial is the best treatment option available. Because standard treatments are not perfect, people are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other people volunteer for clinical trials because they know that these studies are the only way to make progress in treating osteosarcoma. Even if they do not benefit directly from the clinical trial, their participation may benefit future children and teens with osteosarcoma.

Sometimes people have concerns that, in a clinical trial, their child may receive no treatment by being given a placebo or a “sugar pill.” The use of placebos in cancer clinical trials is rare overall and especially uncommon in childhood cancer research. Find out more about placebos in cancer clinical trials.

Patient safety and informed consent

To join a clinical trial, parents and children must participate in a process known as informed consent. During informed consent, the doctor should list all of the child’s options so that the parent and child understand how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different than the risks of the standard treatment. Finally, the doctor must explain what will be required of each child in order to participate in the clinical trial. This includes the number of doctor visits, tests, and the schedule of treatment.

Patients who participate in a clinical trial may stop participating at any time for any personal or medical reason. This may include that the new treatment is not working or there are serious side effects. Clinical trials are also closely monitored by experts who watch for any problems with each study. It is important that parents of a child participating in a clinical trial talk with their child’s doctor and the researchers about who will be providing their child’s treatment and care during the clinical trial, after the clinical trial ends, and/or if they choose to leave the clinical trial before it ends. 

Finding a clinical trial

Research through clinical trials is ongoing for all types of cancer. For specific topics being studied for osteosarcoma, learn more in the Latest Research section.

Cancer.Net offers a lot of information about cancer clinical trials in other areas of the website, including a complete section on clinical trials and places to search for clinical trials for a specific type of cancer.

The next section in this guide is Latest Research, and it explains areas of scientific research currently going on for this type of cancer. Or, use the menu on the side of your screen to choose another section to continue reading this guide.

Osteosarcoma - Childhood - Latest Research

This section has been reviewed and approved by the Cancer.Net Editorial Board, 11/2015

ON THIS PAGE: You will read about the scientific research being done now to learn more about this type of cancer and how to treat it. To see other pages, use the menu on the side of your screen.

Doctors are working to learn more about osteosarcoma, how to best treat it, and how to provide the best care to children and teens diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your child’s doctor about the diagnostic and treatment options best for your child.

  • Improved detection. Two types of imaging tests are being studied that may improve the detection of metastases: total body MRI and positron emission tomography (PET) scanning. These tests are described in the Diagnosis section. These tests can suggest the presence of metastatic disease. However, other tests would be needed to confirm this suspicion. Specialists familiar with using these tests must interpret the results of the images. A biopsy may also be needed.

  • Supportive care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current osteosarcoma treatments in order to improve patients’ comfort and quality of life.

  • Improved treatment. In several studies, researchers are looking at adding different drugs to standard treatment that may improve the treatment’s success without increasing the side effects.

    • As part of the Children’s Oncology Group AOST 0331 study, pegylated interferon alpha (multiple brand names) was added after 8 months of chemotherapy. This study was conducted with patients who have localized osteosarcoma or metastases to the lungs or bones that can be surgically removed and whose tumor was almost completely eliminated by the initial 10 to 12 weeks of chemotherapy treatment. The preliminary results of this study showed that the addition of pegylated interferon alpha caused no significant improvements compared with chemotherapy alone. More information will become available as patients are followed for a longer time.

    • As part of the same recent study (AOST 0331), etoposide (Toposar, VePesid,) and ifosfamide (Ifex) were added to treatment after surgery for a total of 10 months of treatment instead of the standard 8 months for patients with osteosarcoma that did not respond as well to initial treatment. According to the results, the additional therapy caused more side effects and did not improve the outcome of treatment. Therefore, the more intensive chemotherapy is not recommended. The Children’s Oncology Group considers the combination of cisplatin, doxorubicin, and high-dose methotrexate (multiple brand names) to be the standard treatment. Other combination therapies are similarly effective, but none of them is better. 

    • A study for patients with initially metastatic disease has also recently been completed. It included a bone-stabilizing drug called zoledronic acid (Zometa) added to standard chemotherapy. It showed that the combination did not increase general side effects, which was the goal of the study. A French group studied whether the addition of zoledronic acid to chemotherapy for newly diagnosed patients with osteosarcoma would improve the outcome of treatment. Half of the patients received a standard chemotherapy treatment and surgery. The other half received zoledronic acid, in addition to the standard treatment. No additional improvements were seen in the group who received zoledronic acid. 

    • Another drug that is currently being tested is the immunotherapy mifamurtide (liposomal muramyl tripeptide phosphatidyl ethanolamine [L-MTP-PE] or MEPACT). Immunotherapy, also called biologic therapy, is designed to boost the body's natural defenses to fight the cancer. Mifamurtide is currently licensed in Europe by the European Medicines Association for the treatment of localized osteosarcoma that can be removed with surgery. However, it has not been approved by the FDA because the agency feels more research is needed to prove the drug’s effectiveness.

For information about these and other studies, visit the Children’s Oncology Group website or the U.S. National Institutes of Health website. There are clinical trials using new drugs for patients with recurrent osteosarcoma. These studies include cases in which cancer has come back a first, second, or subsequent time; cases of local or distant recurrence; and cases in which the recurrence is located in the lungs, other bones, or both.

Talk with your child’s doctor for more information about clinical trials. Your doctor can provide additional details concerning the availability of these diagnostic tests or treatments or others that are being studied. Also, your doctor can provide details on whether they are appropriate for your child.

Looking for More about the Latest Research?

If you would like additional information about the latest areas of research regarding osteosarcoma, explore these related items that will take you outside of this guide:

  • To find clinical trials specific to your diagnosis, talk with your child’s doctor or search online clinical trial databases now.

  • Visit ASCO’s CancerProgress.Net website to learn more about the historical pace of research for Childhood Cancers (called Pediatric Cancers on this website). Please note this link takes you to a separate ASCO website.

The next section in this guide is Coping with Side Effects, and it offers some guidance in how to cope with the physical, emotional, and social changes that cancer and its treatment can bring. Or, use the menu on the side of your screen to choose another section to continue reading this guide.

Osteosarcoma - Childhood - Coping with Side Effects

This section has been reviewed and approved by the Cancer.Net Editorial Board, 11/2015

ON THIS PAGE: You will find out more about steps to take to help your child cope with physical, social, and emotional side effects. This page includes several links outside of this guide to other sections of this website. To see other pages, use the menu on the side of your screen.

Fear of treatment side effects is common after a diagnosis of cancer, but it may help to know that preventing and controlling side effects is a major focus of your child’s health care team. This is called palliative care, and it is an important part of the overall treatment plan, regardless of the stage of disease.

There are possible side effects for every cancer treatment, but patients don’t experience the same side effects when given the same treatments for many reasons. That can make it hard to predict exactly how you will feel during treatment. Common side effects from each treatment option for osteosarcoma are described in detail within the Treatment Options section. Learn more about the most common side effects of cancer and different treatments, along with ways to prevent or control them. Side effects depend on a variety of factors, including the cancer’s stage, the length and dosage of treatment(s), and your child’s overall health.

Talking with your health care team about side effects

Before treatment begins, talk with your child’s doctor about possible side effects of each type of treatment your child will be receiving. Ask which side effects are most likely to happen, when they are likely to occur, and what can be done to prevent or relieve them.

And, ask about the level of caregiving your child may need during treatment and recovery. Family members and friends play an important role in the care of a child with osteosarcoma. Learn more about caregiving.

In addition to physical side effects, there may be emotional and social effects as well. Patients and their families are encouraged to share their feelings with a member of their health care team who can help with coping strategies, including concerns about managing the cost of cancer care

During and after treatment, be sure to tell the health care team about the side effects your child experiences, even if you feel they are not serious. Sometimes, side effects can last beyond the treatment period, called a long-term side effect. A side effect that occurs months or years after treatment is called a late effect. Treatment of both types of effects is an important part of survivorship care. Learn more by reading the Follow-up Care section or talking with your child’s doctor.

The next section in this guide is Follow-up Care, and it explains the importance of check-ups after cancer treatment is finished. Or, use the menu on the side of your screen to choose another section to continue reading this guide. 

Osteosarcoma - Childhood - Follow-Up Care

This section has been reviewed and approved by the Cancer.Net Editorial Board, 11/2015

ON THIS PAGE: You will read about your child’s medical care after cancer treatment is finished and why this follow-up care is important. To see other pages, use the menu on the side of your screen.

Care for children diagnosed with cancer doesn’t end when active treatment has finished. Your child’s health care team will continue to check to make sure the cancer has not returned, manage any side effects, and monitor your child’s overall health. This is called follow-up care. All children and teens treated for cancer, including osteosarcoma, should have life-long follow-up care.

This plan may include regular physical examinations and/or medical tests to monitor your child’s recovery for the coming months and years. Learn more about the importance of follow-up care.

The main considerations for the long-term health of children and teens who have had osteosarcoma are recurrence of the disease or appearance of a new type of cancer, orthopedic complications, and other late effects of the cancer treatment.

Watching for recurrence or secondary cancer

One goal of follow-up care is to check for a recurrence. Cancer recurs because small areas of cancer cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms.

During follow-up care, a doctor familiar with your child’s medical history can give you personalized information about the risk of recurrence. Your doctor will also ask specific questions about your child’s health. Some children may have blood tests or imaging tests as part of regular follow-up care, but testing recommendations depend on several factors, including the type and stage of cancer originally diagnosed and the types of treatment given.

Recurrence of osteosarcoma more than five years later is rare. The drugs used to treat osteosarcoma have a small chance, approximately 1.5%, of causing a blood cancer called leukemia. This is called secondary or induced leukemia.

Managing long-term and late side effects of childhood cancer

Sometimes, side effects may linger beyond the active treatment period. These are called long-term side effects. In addition, other side effects called late effects may develop months or even years afterwards. Late effects can occur almost anywhere in the body and include physical problems, such as heart and lung problems and second cancers, and emotional and cognitive (memory, thinking, and attention) problems, such as anxiety, depression, and learning difficulties.

For osteosarcoma, there may be orthopedic complications following treatment. During follow-up care, doctors evaluate whether the surgery resulted in a well-functioning limb or whether there were complications.

Common orthopedic complications include:

  • Fractures, commonly called broken bones. Fractures may occur if treatment included bone grafting. A bone allograft uses bone from another person to repair and rebuild damaged bone.

  • Problems with an internal prosthesis, which is an artificial body part, such as an artificial knee

  • Infection

Doctors typically treat fractures and prosthesis complications with another surgery. And they treat infections with long-term antibiotic therapy. However, occasionally, these approaches fail and an amputation is needed.

Other possible late effects for children treated for osteosarcoma are related to the type of chemotherapy used. The most common drugs and related long-term effects include:

Chemotherapy drug used

Potential long-term effect

Monitoring and management

Cisplatin (Platinol)

Hearing loss, neuropathy, which is pain or numbness in fingers and toes

Hearing tests; hearing aids, in some cases

Doxorubicin (Adriamycin)

Heart problems

Periodic echocardiograms

Etoposide

Induced leukemia (see above)

Treatment, typically similarly to the treatment a newly diagnosed person with leukemia receives

Ifosfamide

Infertility,

kidney damage, memory impairment

Freezing of sperm for boys who have gone through puberty before beginning chemotherapy

Ovarian cryopreservation, the freezing of a portion of the ovary, could be recommended for girls when it becomes a standard technique.

Learn more about preserving fertility in children with cancer.

Meanwhile, kidney damage, especially loss of salts in the urine, may require supplements. This is unlikely if kidney damage was not already been a problem during treatment.

Methotrexate

Scarring of the lungs or liver, memory impairment

Breathing function tests, blood tests

Generally, most children and teens recovering from osteosarcoma do well. Based on the type of treatment your child received, the doctor will determine what examinations and tests are needed to check for long-term side effects, such as heart problems, hearing loss, kidney damage, and the secondary cancers. Follow-up care should also address your child’s quality of life, including any developmental or emotional concerns, especially if amputation was necessary. Learn more about childhood cancer survivorship.

The Children's Oncology Group (COG) has studied the physical and psychological effects that childhood cancer survivors face. Based on these studies, COG has created recommendations for long-term follow-up care for childhood, adolescent, and young adult cancer survivors that can be found on a separate website: www.survivorshipguidelines.org.

Keeping personal health records

You are encouraged to organize and keep a personal record of the child’s medical information. The doctor will help you create this. That way, as the child enters adulthood, he or she has a clear, written history of the diagnosis, the treatment given, and the doctor’s recommendations about the schedule for follow-up care. ASCO offers forms to help create a treatment summary to keep track of the cancer treatment your child received and develop a survivorship care plan once treatment is completed.

Some children continue to see their oncologist, while others transition back to the general care of their family doctor or another health care professional. This decision depends on several factors, including the type and stage of cancer, side effects, health insurance rules, and your family’s personal preferences. Talk with your health care team about your child’s ongoing medical care and any concerns you have about his or her future health.

If a doctor who was not directly involved in your child’s cancer care will lead the follow-up care, share the cancer treatment summary and survivorship care plan forms with him or her, as well as all future health care providers. Details about the specific cancer treatment given are very valuable to the health care professionals who will care for your child throughout his or her lifetime.

The next section in this guide is Survivorship, and it describes how to cope with challenges in everyday life after a cancer diagnosis. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Osteosarcoma - Childhood - Survivorship

This section has been reviewed and approved by the Cancer.Net Editorial Board, 11/2015

ON THIS PAGE: You will read about how to cope with challenges in everyday life after your child’s cancer diagnosis. To see other pages, use the menu on the side of your screen.

What is survivorship?

The word survivorship means different things to different people, but it often describes the process of living with, through, and beyond cancer. In some ways, survivorship is one of the most complex aspects of the cancer experience because it is different for every patient and his or her family.

After active cancer treatment ends, children and their families may experience a mixture of strong feelings, including joy, concern, relief, guilt, and fear. Some people say they appreciate life more after a cancer diagnosis. Other families stay very anxious about their child’s health and become uncertain of how to cope with everyday life.

One source of stress may occur when frequent visits to the health care team end following treatment. Often, relationships built with the cancer care team provide a sense of security during treatment, and children and their families miss this source of support. This may be especially true as new worries and challenges surface over time, such as any late effects of treatment, educational issues, emotional challenges, sexual development and fertility concerns, and/or financial issues.

Every family faces different concerns and challenges. With any challenge, a good first step is being able to recognize each fear and talk about it. Effective coping requires:

  • Understanding the challenge your family is facing,

  • Thinking through solutions,

  • Asking for and allowing the support of others, and

  • Feeling comfortable with the course of action your family chooses.

It may be helpful to join an in-person support group or online community of childhood cancer survivors. Support groups also exist for parents of children diagnosed with cancer. This allows you to talk with people who have had similar first-hand experiences. Other options for finding support include talking with a friend or member of your health care team, individual counseling, or asking for assistance at the learning resource center of the center where your child received treatment.

Changing role of caregivers

Parents, other family members, and friends may also go through periods of transition. A caregiver plays a very important role in supporting a child diagnosed with cancer, providing physical, emotional, and practical care on a daily or as-needed basis. Many caregivers become focused on providing this support, especially if the treatment period lasts for many months or longer.

However, as treatment is completed, the caregiver's role often changes. Eventually, the need for caregiving related to a child’s cancer diagnosis will lessen or come to an end as your child gets older. Family counselors at pediatric cancer centers can help with this transition. You can also learn more about adjusting to life after caregiving in this article.

Healthy living after cancer

Survivorship often serves as a strong motivator to make positive lifestyle changes, often for the family as a whole. 

Children and teens who have had cancer can enhance the quality of their future by following established guidelines for good health into and through adulthood, including not smoking, maintaining a healthy weight, eating well, managing stress, and participating in regular physical activity. Talk with the doctor about developing a plan that is best for your child’s needs. Learn more about making healthy lifestyle choices.

In addition, it is important that your child has recommended medical check-ups and tests (see Follow-up Care) to take care of his or her health. Cancer rehabilitation may be recommended, and this could mean any of a wide range of services such as physical therapy, family or individual counseling, nutritional planning, and/or educational assistance. The goal of rehabilitation is to help survivors and their families regain control over many aspects of their lives and remain as independent and productive as possible.

Talk with your child’s doctor to develop a survivorship care plan that is best for your child’s needs.

Looking for More Survivorship Resources?

For more information about cancer survivorship, explore these related items. Please note these links will take you to other sections of Cancer.Net:

  • Survivorship Resources: Cancer.Net offers a lot of information and resources to help survivors cope, including specific sections for children, teens, and young adults. There is also a main section on survivorship for people of all ages.

  • ASCO Answers Cancer Survivorship Guide: This 44-page booklet (available as a PDF) can help with the transition into life after treatment. It includes blank treatment summary and survivorship care plan forms.

  • Cancer.Net Patient Education Video: View a short video led by an ASCO expert that provides information about childhood cancer survivorship. 

The next section offers Questions to Ask the Doctor to help start conversations with your child’s cancer care team. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Osteosarcoma - Childhood - Questions to Ask the Doctor

This section has been reviewed and approved by the Cancer.Net Editorial Board, 11/2015

ON THIS PAGE: You will find some questions to ask your child’s doctor or other members of your child’s health care team, to help you and your family better understand your child’s diagnosis, treatment plan, and overall care. To see other pages, use the menu on the side of your screen.

Talking often with the doctor is important to make informed decisions about your child’s health care. These suggested questions are a starting point to help you learn more about your child’s cancer care and treatment. You are also encouraged to ask additional questions that are important to you and your family. You may want to print this list and bring it to your child’s next appointment, or download Cancer.Net’s free mobile app for an e-list and other interactive tools to manage your child’s care.

Questions to ask before a biopsy

  • How experienced is the surgeon in doing this type of biopsy?

  • If the diagnosis is bone cancer, is the surgeon part of a team that is experienced in treating people with bone cancer? If not, can you or the surgeon refer me to a team?

  • Is the pathologist experienced in the diagnosis of osteosarcoma?

Questions to ask after getting a diagnosis

  • What type (or subtype) of osteosarcoma does my child have?

  • Can you explain my child’s pathology report (laboratory test results) to me?

  • What stage is the osteosarcoma? What does this mean?

Questions to ask about choosing a treatment and managing side effects

  • What are my child’s treatment options?

  • What clinical trials are open to my child? Where are they located, and how do I find out more about them?

  • What treatment plan do you recommend? Why?

  • What is the goal of each treatment? Is it to eliminate the cancer, help my child feel better, or both?

  • What are the possible side effects of each treatment, both in the short term and the long term?

  • Does this cancer center specialize in the treatment of children, adolescents, and young adults with cancer?

  • Who will be part of my child’s health care team, and what does each member do?

  • Who will be coordinating my child’s overall treatment?

  • How will this treatment affect my child’s daily life? Will he or she be able to go to school and perform his or her usual activities?

  • Could this treatment affect my child’s ability to become pregnant or have children? If so, should my family talk with a fertility specialist before cancer treatment begins?

  • If I’m worried about managing the costs related to my child’s cancer care, who can help me with these concerns?

  • What support services are available to my child? To my family?

  • Whom should I call for questions or problems?

  • Is there anything else I should be asking?

Questions to ask about having surgery

  • What type of surgery will my child have? Will lymph nodes be removed?

  • How long will the operation take?

  • How long will my child be in the hospital?

  • Can you describe what my child’s recovery from surgery will be like?

  • What are the possible long-term effects of having this surgery?

Questions to ask about having chemotherapy or radiation therapy

  • What type of treatment is recommended?

  • What is the goal of this treatment?

  • How long will it take to give this treatment?

  • What side effects can my child expect during treatment?

  • What are the possible long-term effects of having this treatment?

  • What can be done to relieve the side effects?

Questions to ask about planning follow-up care

  • What is the risk of the cancer returning? Are there signs and symptoms I should watch for?

  • What long-term side effects or late effects are possible based on the cancer treatment my child received?

  • What follow-up tests will my child need, and how often will he or she need them?

  • How do I get a treatment summary and survivorship care plan to keep in my child’s personal records?

  • Who will be coordinating my child’s follow-up care?

  • What survivorship support services are available to my child? To my family?

The next section in this guide is Additional Resources, and it offers some more resources on this website beyond this guide that may be helpful to you. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Osteosarcoma - Childhood - Additional Resources

This section has been reviewed and approved by the Cancer.Net Editorial Board, 11/2015

ON THIS PAGE: You will find some helpful links to other areas of Cancer.Net that provide information about cancer care and treatment. This is the final page of Cancer.Net’s Guide to Childhood Osteosarcoma. To go back and review other pages, use the menu on the side of your screen.

Cancer.Net includes many other sections about the medical and emotional aspects of cancer, both for the person diagnosed and their family members and friends. This website is meant to be a resource for you and your loved ones from the time of diagnosis, through treatment, and beyond.

Beyond this guide, here are a few links to help you explore other parts of Cancer.Net:

This is the end of Cancer.Net’s Guide to Childhood Osteosarcoma. Use the menu on the side of your screen to continue reading this guide.