ON THIS PAGE: You will find information about the estimated number of children and teens who will be diagnosed with osteosarcoma each year. You will also read general information on surviving the disease. Remember, survival rates depend on several factors, and no 2 people with cancer are the same. Use the menu to see other pages.

Every person is different, with different factors influencing their risk of being diagnosed with this cancer and the chance of recovery after a diagnosis. It is important to talk with your doctor about any questions you have around the general statistics provided below and what they may mean for your child individually. The original sources for these statistics are provided at the bottom of this page.

How many children and teens are diagnosed with osteosarcoma?

In 2023, an estimated 1,000 people of all ages in the United States will be diagnosed with osteosarcoma. About half of these cases will occur in children and teens.

Osteosarcoma makes up 2% of all cancers in children ages 0 to 14 and 3% of all cancers in teens ages 15 to 19. It is most often diagnosed between the ages of 10 and 30, with most of these diagnoses occurring in teens. However, osteosarcoma can be diagnosed at any age, including in older adults. Around 10% of osteosarcoma is diagnosed in people over age 60.

What is the survival rate for children and teens with osteosarcoma?

There are different types of statistics that can help doctors evaluate a person’s chance of recovery from osteosarcoma. These are called survival statistics. A specific type of survival statistic is called the relative survival rate. It is often used to predict how having cancer may affect life expectancy. Relative survival rate looks at how likely people with osteosarcoma are to survive for a certain amount of time after their initial diagnosis or start of treatment compared to the expected survival of similar people without this cancer.

Example: Here is an example to help explain what a relative survival rate means. Please note this is only an example and not specific to this type of cancer. Let’s assume that the 5-year relative survival rate for a specific type of cancer is 90%. “Percent” means how many out of 100. Imagine there are 1,000 people without cancer, and based on their age and other characteristics, you expect 900 of the 1,000 to be alive in 5 years. Also imagine there are another 1,000 people similar in age and other characteristics as the first 1,000, but they all have the specific type of cancer that has a 5-year survival rate of 90%. This means it is expected that 810 of the people with the specific cancer (90% of 900) will be alive in 5 years.

It is important to remember that statistics on the survival rates for children and teens with osteosarcoma are only an estimate. They cannot tell an individual person if cancer will or will not shorten their life. Instead, these statistics describe trends in groups of people previously diagnosed with the same disease, including specific stages of the disease.

The 5-year relative survival rate for children ages 0 to 14 with osteosarcoma is 69%. For teens ages 15 to 19, the 5-year relative survival rate is 67%.

The survival rates for osteosarcoma vary based on several factors. These include the stage of cancer, a person’s age and general health, and how well the treatment plan works. Other factors that can affect outcomes include the type and subtype of the cancer.

If osteosarcoma is diagnosed and treated before it can be detected outside the area where it started, the 5-year relative survival rate for people of all ages is 76%. If the cancer has spread outside of the bones and into the regional lymph nodes, the 5-year relative survival rate is 64%. If the cancer has spread to distant parts of the body, the 5-year relative survival rate is 24%.

Experts measure relative survival rate statistics for children and teens with osteosarcoma every 5 years. This means the estimate may not reflect the results of advancements in how osteosarcoma is diagnosed or treated from the last 5 years. Talk with your child’s doctor if you have any questions about this information. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society website and Seigel R, et al.: Cancer Statistics 2023. CA: A Cancer Journal for Clinicians. 2023 Jan; 73(1):17–48. doi/full/10.3322/caac.21763. (All sources accessed March 2023.)

The next section in this guide is Medical Illustrations. It offers a drawing of the body parts often affected by osteosarcoma. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will find out more about the factors that increase the chance of developing osteosarcoma. Use the menu to see other pages.

What are the risk factors for osteosarcoma?

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, 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.

• Genetic changes. Osteosarcoma is likely caused most commonly by a combination of genetic changes, called mutations or alterations. Together, these changes cause immature bone cells to become tumor cells instead of healthy bone. Osteosarcoma may start with overactive bone cells that have an impaired ability to correct mutations. Researchers are studying possible changes in certain genes that lead to this overactivity and impaired error correction. They are studying this in a small number of families in which siblings have developed osteosarcoma. Such inherited changes in genes are uncommon. However, it may help doctors better understand how osteosarcoma begins in people with no family history of the disease, too, as similar genetic changes often are observed in their cancer cells.

  A gene known as RB may be associated with osteosarcoma. This gene is abnormal in most children with the hereditary form of 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. Mutations in the p53 gene are referred to as Li-Fraumeni syndrome (see below), which is the most common cancer hereditary risk syndrome associated with osteosarcoma. The p53 gene is referred to as the "guardian of the genome" and has a major role in correcting or eradicating cells with mutations.

  Many other changes occur in the genes of osteosarcoma cells.

It is rare when anyone is diagnosed with osteosarcoma. However, some groups of people are more likely to develop osteosarcoma:

• People who have received radiation treatment for another type of cancer. Those who have previously received radiation treatment are more likely to develop osteosarcoma. High doses of radiation treatment at a younger age increase the risk. However, the time between radiation treatment and osteosarcoma risk is typically more than a decade and is rarely the cause of osteosarcoma in children and adolescents.

• Children with an inherited form of retinoblastoma. This group of children, who most often have changes in the RB gene throughout their body, are more likely to develop osteosarcoma.

• Children with Li-Fraumeni syndrome. A child with Li-Fraumeni syndrome has a higher risk of sarcoma, including osteosarcoma, as well as a higher risk of 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. These children 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. This group of people is 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. It explains what changes or medical problems osteosarcoma can cause. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find the cause of a medical problem. Use the menu to see other pages.

Doctors use many tests to find, or diagnose, cancer. They also do tests to learn if cancer has spread to another part of the body from where it started. If the cancer has spread, it is called metastasis. Doctors may also do tests to learn which treatments could work best.

For most types of cancer, including osteosarcoma, a biopsy is the only sure way for the doctor to know if an area of the body has cancer. During a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. It is important that the health care team members performing the biopsy are experienced with this type of tumor and would be able to remove the tumor, if needed.

How osteosarcoma is diagnosed

There are different tests used for gathering more information when a bone tumor is present. The diagnosis of osteosarcoma can only be confirmed by a biopsy. Not all tests described here will be used for every person. Your child’s doctor may consider these factors when choosing a diagnostic test:

• The type of cancer suspected

• Your child's signs and symptoms

• Your child's age and general health

• The results of earlier medical tests

In addition to a physical examination, the following tests may help in coming up with a suspected diagnosis of osteosarcoma. A health care team with experience diagnosing and treating bone tumors should perform these tests.

• X-ray. An x-ray creates a picture of the structures inside of the body using 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. Its appearance on an x-ray can lead to suspicion that an osteosarcoma may be present.

• Computed tomography (CT or CAT) scan. A CT scan takes pictures of the inside of the body using x-rays taken from different angles. A computer combines these pictures into a detailed, 3-dimensional image that shows any abnormalities or tumors. A CT scan can 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 person's vein or given as a pill or liquid to swallow. In osteosarcoma, CT scans are frequently used to get images of the lungs as a potential location of tumor metastases. They can also be used at the site the tumor started at as a means of characterizing the tumor and its relationship to vital normal structures. A CT scan is frequently performed before a biopsy to ensure the biopsy is placed properly.

• Magnetic resonance imaging (MRI). An MRI produces detailed images of the inside of the body using magnetic fields, not x-rays. MRI can 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 person's vein or given as a pill or liquid to swallow. An MRI creates an image that is based on different physical properties of the tumor as compared to CT scans. MRI is used by some doctors to find out more about the site where the tumor started. Similar to a CT scan, it can help the orthopedic oncologist plan surgery. An orthopedic oncologist is a doctor who specializes in surgery to remove tumors on the bones and soft tissues. Surgery removes the tumor-containing area of bone along with a portion of the surrounding healthy tissue, called the margin. Sometimes biopsies are performed by orthopedic oncologists or interventional radiologists, which are doctors who use image-guided procedures to diagnose and treat disease. Some oncologists prefer CT scans, some prefer MRI, and some prefer both along with x-rays to image the location where the tumor started.

• Positron emission tomography (PET) or PET-CT scan. A PET scan creates pictures of organs and tissues inside the body. A PET scan is usually combined with a CT scan (see above), called a PET-CT scan. However, you may hear your doctor refer to this procedure just as a PET scan. A small amount of a radioactive sugar substance is injected into the person'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. However, the amount of radiation in the substance is too low to be harmful. A scanner then detects this substance to produce images of the inside of the body. In osteosarcoma, a PET scan is used to find a tumor located in other places in the body that are distant from where the tumor started. Some oncologists prefer PET scans for distant disease (along with a chest CT scan), while other doctors prefer bone scans, which are described below.

• Bone scan. A bone scan looks at the inside of the bones using a radioactive tracer. The amount of radiation in the tracer is too low to be harmful. The tracer is injected into a patient’s vein. It collects in areas of the bone and is detected by a special camera. Healthy bone appears lighter to the camera, and areas of injury, such as those caused by cancer, stand out on the image. A bone scan is a way to find out whether or not osteosarcoma may have spread to other bones beyond the place it started. A bone scan is frequently omitted if the patient has received a PET scan.

• Biopsy. A biopsy is the only way to make a definite diagnosis, even if other tests can suggest that cancer is present. During biopsy, a small amount of tissue is removed for examination under a microscope. A pathologist analyzes the sample(s). A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. The material obtained from the biopsy can also be used for testing genetic changes in the tumor. You should discuss this with your child's doctor, as different sites may lead them to recommend different gene tests. Some of these studies are performed as part of participation in clinical trials.

  A doctor who specializes in bone tumors should perform the biopsy. The biopsy typically involves surgery. However, sometimes the doctor may use a needle biopsy. These procedures are at times performed by orthopedic oncologists and sometimes interventional radiologists. A needle biopsy uses a hollow needle inserted into the tumor. For bone tumors, a "core needle" biopsy may be large enough to make the diagnosis. A "fine needle" aspiration is a type of biopsy used for several other cancer types that uses a very thin needle. However, it is rarely appropriate for osteosarcoma. It is critical that enough material is obtained during the biopsy to ensure the pathologist can make an accurate diagnosis. Osteosarcoma is most often diagnosed based on its specific characteristics and appearance under a microscope. The doctor may analyze the genes or other features of the cancer cells, most often to tell osteosarcoma apart from other types of cancer that have more characteristic genetic features.

After diagnostic tests are done, your child’s doctor will review 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. It explains the system doctors use to describe the extent of the disease. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will learn about the different types of treatments doctors use for children and teens with osteosarcoma. Use the menu to see other pages.

In general, cancer in children and teenagers is uncommon. This means 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 when one is available. A clinical trial is a research study that tests a new approach to treatment. The “standard of care” is the best treatment known based on previous clinical trials. Clinical trials may test such approaches as a new drug, a new combination of existing treatments, or new doses of current therapies. The health and safety of all children participating in clinical trials are closely monitored.

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.

How osteosarcoma is treated

In many cases, a team of doctors, nurses, and pharmacists works with the patient and the family to provide care. This is called a multidisciplinary team. Pediatric cancer centers often have extra support services for patients and their families, such as child life specialists, dietitians, physical therapists, occupational therapists, social workers, and counselors. Special activities and programs to help your child and family cope may also be available. Learn more about the clinicians who provide cancer care.

All people with high-grade osteosarcoma require surgery and chemotherapy for the highest chance of successful treatment. Radiation therapy may also be an option for some patients. Your child's care plan also includes treatment for symptoms and side effects, an important part of cancer care. Treatment options and recommendations depend on several factors, including:

• The type and stage of cancer

• Possible side effects

• The child’s overall health

• The child’s and family’s preferences

Take time to learn about your child’s treatment options and be sure to ask questions about things that are unclear. Talk with your child’s doctor about the goals of each treatment and what your child can expect while receiving the treatment. These types of conversations are called “shared decision-making.” Shared decision-making is when you and your doctors work together to choose treatments that fit the goals of your child's care. Shared decision-making is important for osteosarcoma because there are different treatment options. Learn more about making treatment decisions.

The common types of treatment used for osteosarcoma are described below. Your child’s care plan also includes treatment for symptoms and side effects, an important part of cancer care. Learn more about preparing your child for treatment.

READ MORE BELOW:

• Surgery

• Chemotherapy

• Radiation therapy

• Physical, emotional, and social effects of cancer

• Remission and the chance of recurrence

• If treatment does not work

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.

In limb-sparing surgery, doctors use surgical techniques to help the child keep the use of an arm or leg affected by the tumor and to give the limb a more normal appearance. Surgical techniques include bone grafting and reconstructive surgery. A bone allograft uses bone from another person to repair and rebuild damaged bone. Most reconstructions are with allografts made of metal.

Limb-sparing surgery is used most often for children and teens with osteosarcoma. Sometimes, the operation that results in the most useful and strongest limb is different from the one that gives the most normal appearance.

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 their physical function. Rehabilitation can also help a child cope with the social and emotional effects of losing a limb. Learn more about rehabilitation.

Learn more about the basics of cancer surgery. Before surgery, talk with your child's health care team about the possible side effects from the specific surgery they will have.

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Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells. Chemotherapy is given by a pediatric oncologist or medical oncologist, which is a doctor who specializes in treating cancer with medication.

Chemotherapy may be given through the bloodstream to reach cancer cells throughout the body. When a drug is given this way, it is called systemic therapy. Medication may also be given locally, which is when the medication is applied directly to the cancer or kept in a single part of the body.

Chemotherapy is often given through an intravenous (IV) tube placed into a vein using a needle or as a pill that is swallowed (orally). If your child is given oral medications to take at home, be sure to ask your health care team about how to safely store and handle them. The chemotherapy used in osteosarcoma is typically given through an IV. Most children with osteosarcoma have a small box placed under the skin with a tube that goes into a large vein. This device, often called an infusaport or port-a-cath, allows direct access to veins to deliver chemotherapy. A small operation is needed to place the device.

A chemotherapy regimen, or schedule, usually consists of a specific number of cycles given over a set period of time. Your child may receive 1 drug at a time or a combination of different drugs given at the same time. Chemotherapy for osteosarcoma is generally given over a period of 6 months or more.

In high-grade osteosarcoma, nearly all children and teens receive systemic chemotherapy. The survival rate of people with localized, high-grade osteosarcoma without systemic chemotherapy is under 20%, as compared to 50% to 75% with chemotherapy. Chemotherapy is given both before and after surgery to destroy any tumor cells that are elsewhere in the body. Chemotherapy before surgery may help make surgery possible or easier to do.

The side effects of chemotherapy depend on the individual and the dose used. With the therapy typically used for osteosarcoma, side effects often include risk of infection, nausea and vomiting, hair loss, and loss of appetite. The health care team will manage these immediate side effects during treatment. These side effects usually go away after treatment is finished. Other side effects may continue after treatment. 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.

It is important to let the doctor know if your child is taking any other prescription or over-the-counter medications or supplements. Herbs, supplements, and other drugs can interact with cancer medications, causing unwanted side effects or reduced effectiveness. Learn more about your child’s prescriptions by using searchable drug databases.

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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.

When used, radiation treatment for osteosarcoma is usually external-beam radiation therapy. This is radiation therapy given from a machine outside the body. A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time.

Radiation therapy for osteosarcoma is uncommon. This is because osteosarcoma is relatively resistant to radiation therapy. Radiation therapy is mostly reserved for people whose osteosarcoma cannot be removed by surgery or if some of the tumor remains after surgery. Clinical trials have also tested forms of radiation therapy which are injected into the body and go to where bone is present as treatment for osteosarcoma.

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.

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Physical, emotional, social, and financial effects of cancer

Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative and supportive care. It is an important part of your child’s care that is included along with treatments intended to slow, stop, or eliminate the cancer. Some treatment centers have specific programs for young adults that can help patients with their psychological and social needs.

Palliative and supportive care focuses on improving how your child feels during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative and supportive care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. Your child may also receive palliative treatments, such as chemotherapy, surgery, or radiation therapy, to improve symptoms.

Before treatment begins, talk with your child’s doctor about the goals of each treatment in the recommended treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative and supportive care options. Many patients also benefit from talking with a social worker and participating in support groups. Ask your doctor about these resources, too.

Cancer care is often expensive, and navigating health insurance can be difficult. Ask your doctor or another member of your health care team about talking with a financial navigator or counselor who may be able to help with your financial concerns.

During treatment, your child’s health care team may ask you to answer questions about your child’s symptoms and side effects and to describe each problem. Be sure to tell the health care team if your child is experiencing a problem. This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future.

Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative and supportive care in a separate section of this website.

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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 child's 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 returns 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).

If a recurrence happens, a new cycle of testing will begin to learn as much as possible about it. After this 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 recurrent osteosarcoma.

Treatment for recurrent osteosarcoma generally depends on 4 factors:

• Where the cancer recurred

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

• How long after the completion of treatment the cancer recurred

• 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, too. 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 recommend surgery, particularly if chemotherapy has worked well.

Whichever treatment plan is chosen, palliative and supportive care will be important for relieving symptoms and side effects.

When cancer recurs, people with cancer and their families sometimes experience emotions such as disbelief or fear. You are encouraged to talk with your health care team about these feelings and ask about support services to help you and your family cope. Learn more about dealing with cancer recurrence.

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If treatment does not work

Although treatment is successful for many 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 particularly when involving a child, adolescent, or young adult, advanced cancer is difficult to discuss. However, it is important to have open and honest conversations with your child’s health care team to express your family’s feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help.

Hospice care is designed to provide the best possible quality of life for people who are expected to live less than 6 months. For children, hospice care may have more to do with the needs of the patient and family instead of how long the patient is expected to live. Parents and guardians are encouraged to talk with the health care team about hospice options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families.

Some children and teens may be happier and more comfortable if they can 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.

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The next section in this guide is About Clinical Trials. It offers more information about research studies that are focused on finding better ways to care for people with cancer. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will read about the scientific research being done to learn more about osteosarcoma and how to treat it. Use the menu to see other pages.

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 people with osteosarcoma through clinical trials. Always talk with your child’s doctor about the best diagnostic and treatment options for your child.

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, such as:

• One drug that was tested is the immunotherapy drug called mifamurtide (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 U.S. Food and Drug Administration (FDA) in the United States. Other approaches on how best to stimulate the patient's own immune system are in various stages of research.

• As part of the Children’s Oncology Group AOST 0331 study, pegylated interferon alpha (multiple brand names) was added to treatment after 8 months of standard chemotherapy. This study was done with people 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 first 10 weeks of chemotherapy treatment. The results of this study showed that adding pegylated interferon alpha did not benefit these people.

• In the same study (AOST 0331), etoposide (Toposar, VePesid) and ifosfamide (Ifex) were added to standard chemotherapy treatment for a total of 10 months of treatment instead of the standard 8 months. This study was done with people when the osteosarcoma was not completely eliminated by the first 10 weeks of chemotherapy. According to the results of this study, adding these drugs after surgery caused more side effects and did not improve the outcome of treatment. Therefore, the more intensive chemotherapy approach is not recommended.

  The Children’s Oncology Group and most of the world's experts consider this combination to be standard treatment: cisplatin (Platinol), doxorubicin (Adriamycin), and high-dose methotrexate (multiple brand names). Selected other combination therapies are similarly effective, but none has been proven better.

• A study of people with metastatic osteosarcoma has also been completed. The study added a bone-stabilizing drug called zoledronic acid (Zometa) to standard chemotherapy. It showed that this combination of treatments 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 people with osteosarcoma would improve the outcome of treatment. Half of the people received a standard chemotherapy treatment and surgery. The other half received zoledronic acid in addition to the standard treatment. The group that received zoledronic acid did not have additional improvements.

• The Children's Oncology Group has a number of active trials for people with newly diagnosed osteosarcoma, including a clinical trial testing whether adding a drug called cabozantinib, a typed of targeted therapy called a tyrosine kinase inhibitor, to standard chemotherapy will improve survival outcomes.

• A large number of clinical trials involve people with recurrent osteosarcoma. These studies include people who have had cancer come back once or more than once; people who have had a local or distant recurrence; and people whose cancer recurrence is located in the lungs, other bones, or both. A few of these clinical trials have found drugs that may work for osteosarcoma and are likely to be studied further. One of the trials being conducted by the Children's Oncology Group is a study investigating if the technique used to surgically remove lung nodules influences survival outcomes. If your child's cancer has come back, talk about the results of these studies with your child's health care team.

Palliative and supportive care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current osteosarcoma treatments to improve comfort and quality of life for patients. 

For information about these and other studies, visit the Children’s Oncology Group website or the U.S. National Institutes of Health website.

Talk with your child’s doctor for more information about clinical trials. They can provide additional details about the availability of the diagnostic tests, treatments, or other aspects of care 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 more information about the latest areas of research in osteosarcoma, explore these related items that will take you outside of this guide:

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

• Get updates from Cancer.Net delivered right to your inbox. Subscribe to the Inside Cancer.Net email newsletter.

• Visit the website of Conquer Cancer, the ASCO Foundation, to find out how to help support cancer research. Please note that this link takes you to a different ASCO website.

The next section in this guide is Coping with Treatment. It offers some guidance on how to cope with the physical, emotional, social, and financial changes that cancer and its treatment can bring. Use the menu to choose a different section to read in this guide.

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. Use the menu to see other pages.

Care for children diagnosed with cancer does not end when active treatment has finished. Your child’s health care team will continue to check that the cancer has not come back, 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.

Your child’s follow-up care may include regular physical examinations and medical tests. Doctors want to keep track of your child’s recovery in the months and years ahead. The main considerations for the long-term health of children and teens who have had osteosarcoma are recurrence of osteosarcoma, appearance of a new type of cancer (called a secondary cancer), orthopedic complications, and other late effects of the cancer treatment.

Cancer rehabilitation may be recommended, and this could mean any of a wide range of services such as physical therapy, occupational 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 as possible. Learn more about cancer rehabilitation.

Learn more about the importance of follow-up care.

Watching for recurrence or secondary cancer

One goal of follow-up care is to check for a recurrence, which means that the cancer has come back. 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 child's doctor will ask specific questions about your child’s health. Some children may have blood tests or imaging tests done as part of regular follow-up care, but testing recommendations depend on several factors, including the type and stage of cancer first diagnosed and the types of treatment given.

The anticipation before having a follow-up test or waiting for test results may add stress to you or a family member. This is sometimes called “scanxiety.” Learn more about how to cope with this type of stress.

Recurrence of osteosarcoma more than 5 years later is rare. The drugs used to treat osteosarcoma have a small chance, about 1.5%, of causing a blood cancer called leukemia. This is called secondary 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 after treatment has ended. Late effects can occur almost anywhere in the body. They include physical problems, such as heart, kidney, and lung problems and second cancers, which is a new cancer that happens in someone who has had cancer before. They also include emotional problems, such as anxiety and depression, and problems with memory, thinking, attention, and learning.

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

• Fractures, also called broken bones. Fractures may occur if treatment included bone grafting.

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

• Infection

Doctors typically treat fractures and internal prosthesis complications with another surgery. They treat infections with long-term antibiotic therapy. However, in rare cases, an amputation may be needed. Rehabilitative care will be offered for both the patient's physical and emotional needs.

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

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 secondary cancers. Follow-up care should also address your child’s quality of life, including any developmental or emotional concerns. 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, independent website: www.survivorshipguidelines.org. 

Keeping a child’s personal health records

You are encouraged to organize and keep a personal record of your child’s medical information. The doctor will help you create this. That way, as the child enters adulthood, they have a clear, written history of the diagnosis, the treatments, and the doctor’s recommendations about the schedule for follow-up care. The American Society of Clinical Oncology (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 when treatment is completed.

Some children continue to see their oncologist, while others transition back to the care of their pediatrician, primary care doctor, or another health care professional. This decision depends on several factors, including:

• The type and stage of cancer

• Treatments received

• Side effects

• Health insurance rules

• Your family’s personal preferences

Talk with the health care team about your child’s ongoing medical care and any concerns you have about their 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 them and with 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 their lifetime.

The next section in this guide is Survivorship. It describes how to cope with challenges in everyday life after a cancer diagnosis. Use the menu to choose a different section to read in this guide.

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

Talking often with the health care team 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. It may also be helpful to ask a family member or friend to come along to appointments to help take notes.

Questions to ask before a biopsy

• How experienced is the surgeon or radiologist in doing this type of biopsy specifically for osteosarcoma or bone tumors?

• Is the pathologist experienced in the diagnosis of osteosarcoma?

• Is there any molecular testing that should or can be performed on the tumor tissue?

• 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 an experienced team?

Questions to ask after getting a diagnosis

• What is the grade and type of osteosarcoma?

• Can you tell me if the tumor has spread to other places in the body?

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

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

• Is this something that my child inherited or could any future children of theirs potentially inherit?

Questions to ask about choosing a treatment and managing side effects

• What are my child’s treatment options?

• What types of research are being done for osteosarcoma in clinical trials? Do clinical trials offer additional treatment options for my child?

• 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 bone cancer?

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

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

• How will this treatment affect my child’s daily life? Will they be able to go to school and perform their usual activities?

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

• If I’m worried about managing the costs of cancer care, who can help me?

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

• If I have questions or problems, who should I call?

Questions to ask about having surgery

• What type of surgery do you recommend?

• How will my child's cosmetic appearance be changed by the surgery?

• Will my child have physical limitations after this surgery? If so, what will those be? Will those limitations be short term or long term?

• How long will the operation take?

• What are the risks of the operation?

• Is the intent to remove the entire tumor?

• How long will my child be in the hospital?

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

• Who should I contact about any side effects my child experiences? And how soon?

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

• Will other types of treatment be necessary after surgery?

Questions to ask about having chemotherapy

• What type of chemotherapy is recommended?

• What is the goal of this treatment?

• How long will it take to give this treatment?

• Will my child receive this treatment at a hospital or clinic? Or will they take it at home?

• What side effects can my child expect during treatment? How will they be managed?

• Who should I contact about any side effects my child experiences? And how soon?

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

• What can be done to prevent or relieve these side effects?

• What are the chances of successful treatment with and without using chemotherapy?

Questions to ask about having radiation therapy

• What type of radiation therapy is recommended?

• What is the goal of this treatment?

• How long will it take to give this treatment?

• Will my child receive this treatment at a hospital or clinic?

• What side effects can my child expect during treatment? How will they be managed?

• Who should I contact about any side effects my child experiences? And how soon?

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

• What can be done to prevent or relieve these side effects?

Questions to ask about planning follow-up care

• What is the chance that the cancer will come back? Should I watch for specific signs or symptoms?

• What follow-up tests will my child need, and how often will those tests be needed?

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

• When should my child return to their primary care doctor for regular medical care?

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

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

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

The next section in this guide is Additional Resources. It offers more resources on this website that may be helpful to you. Use the menu to choose a different section to read in this guide.