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Osteosarcoma - Childhood and Adolescence - Introduction

Approved by the Cancer.Net Editorial Board, 11/2020

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 Osteosarcoma in Childhood and Adolescence. Use the menu to see other pages. Think of that menu as a roadmap to this complete 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 out of control. 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, called metastasis. A benign tumor means the tumor is unlikely to 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 where osteosarcoma begins

Osteosarcoma most often starts in a leg bone around the knee joint, either at the femur, which is the lower end of the thigh bone, or the tibia, which is 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

There are 2 types of osteosarcoma.

  • Central tumor, also called a medullary tumor

  • Surface tumor, also called a peripheral tumor

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

Subtypes of medullary osteosarcoma include:

  • Conventional central osteosarcoma, such as osteoblastic, chondroblastic, fibroblastic, and mixed types

  • Telangiectatic osteosarcoma

  • Intraosseous well-differentiated or low-grade central osteosarcoma

  • Small cell osteosarcoma

Subtypes of peripheral osteosarcoma include:

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

  • Periosteal osteosarcoma that is low grade to intermediate grade

  • High-grade surface osteosarcoma

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

Grade is the most important factor in treatment decision-making. This is because low-grade tumors only recur in the same area, called locally. High-grade tumors metastasize, or spread, to other parts of the body and can recur anywhere in the body. Most osteosarcoma in children are high grade.

This guide covers osteosarcoma that is diagnosed during childhood and adolescence, also called pediatric osteosarcoma. Visit the bone cancer and soft-tissue sarcoma sections on Cancer.Net to learn more about other types of sarcoma.

Looking for More of an Introduction?

If you would like more of an introduction, explore these related items. Please note that these links take you to other sections on Cancer.Net:

  • ASCO Answers Fact Sheet: Read a 1-page fact sheet that offers an introduction to osteosarcoma. This free fact sheet is available as a PDF, so it is easy to print.

The next section in this guide is StatisticsIt helps explain the number of people who are diagnosed with osteosarcoma and general survival rates. Use the menu to choose a different section to read in this guide.

Osteosarcoma - Childhood and Adolescence - Statistics

Approved by the Cancer.Net Editorial Board, 02/2021

ON THIS PAGE: You will find information about the number of children and teens who are diagnosed with osteosarcoma each year. You will also read general information on surviving the disease. Remember, survival rates depend on several factors. Use the menu to see other pages.

This year, in the United States, an estimated 1,000 people of all ages 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.

The 5-year survival rate tells you what percent of children and teens live at least 5 years after the cancer is found. Percent means how many out of 100. However, the survival rate for osteosarcoma depends on several different factors, including the type and subtype of the cancer, the cancer’s response to treatment, and how much the cancer has spread.

The overall 5-year survival rate for children ages 0 to 14 with osteosarcoma is 68%. For teens ages 15 to 19, the 5-year survival rate is 67%. If osteosarcoma is diagnosed and treated before it has spread outside the area where it started, the general 5-year survival rate for people of all ages is 74%. If the cancer has spread outside of the bones and into surrounding tissues or organs and/or the regional lymph nodes, the 5-year survival rate is 66%. If the cancer has spread to distant parts of the body, the 5-year survival rate is 27%.

It is important to remember that statistics on the survival rates for children and teens with osteosarcoma are an estimate. The estimate comes from annual data based on the number of children and teens with this cancer in the United States. Also, experts measure the survival statistics every 5 years. So the estimate may not show the results of better diagnosis or treatment available for less than 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 2021. CA: A Cancer Journal for Clinicians. 2021 Jan; 71(1):7–33. doi/full/10.3322/caac.21654 (sources accessed February 2021).

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

Osteosarcoma - Childhood and Adolescence - Medical Illustrations

Approved by the Cancer.Net Editorial Board, 11/2020

ON THIS PAGE: You will find a drawing of the skeleton. Use the menu to see other pages.

The illustration shows the major bones in the skeleton of an adolescent. Bones highlighted include the skull and bones in the torso such as the clavicle, ribs, sternum, vertebrae, and sacrum. It also highlights the bones of the arms, including the humerus, ulna, and radius and the bones of the legs, including the femur, tibia, and fibula. Copyright 2013 American Society of Clinical Oncology. Robert Morreale/Visual Explanations, LLC.

The next section in this guide is Risk Factors. It explains the factors that may increase the chance of developing osteosarcoma. Use the menu to choose a different section to read in this guide.

Osteosarcoma - Childhood and Adolescence - Risk Factors

Approved by the Cancer.Net Editorial Board, 11/2020

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.

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.

  • Genetic changes. Osteosarcoma is probably caused by a combination of genetic changes, or mutations. Together, these changes cause immature bone cells to become tumor cells instead of healthy bone. Osteosarcoma may start because of overactive bone cells. Researchers are studying possible changes in certain 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 uncommon. However, it may help doctors better understand how osteosarcoma begins in people with no family history of the disease, too. Similar genetic changes may occur 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 predisposition syndrome associated with osteosarcoma.

    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 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 body changes or medical problems osteosarcoma can cause. Use the menu to choose a different section to read in this guide.

Osteosarcoma - Childhood and Adolescence - Symptoms and Signs

Approved by the Cancer.Net Editorial Board, 11/2020

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. Use the menu to see other pages.

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, children and teens with osteosarcoma do not have any of these changes. Or, the cause of a symptom may be a different medical condition that is not cancer.

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

  • A noticeable mass or lump in an arm or leg, particularly in the areas around a shoulder or knee

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

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

Osteosarcoma seems to relate to rapid bone growth. This is because it most often occurs around the age when most adolescents' bodies go through their growth spurt. It is also slightly more common in boys than girls, which may be related to boys usually being taller on average.

If you are concerned about any changes your child experiences, 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 figure 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 be called palliative care or supportive care. It is often started soon after diagnosis and continued throughout treatment. Be sure to talk with your child’s health care team about the symptoms your child experiences, including any new symptoms or a change in symptoms.

The next section in this guide is Diagnosis. It explains what tests may be needed to learn more about the cause of the symptoms. Use the menu to choose a different section to read in this guide.

Osteosarcoma - Childhood and Adolescence - Diagnosis

Approved by the Cancer.Net Editorial Board, 11/2020

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 this happens, it is called metastasis. For example, imaging tests can show if the cancer has spread. Imaging tests show pictures of the inside of the body. 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.

This section describes options for gathering more information when a bone tumor is present. The diagnosis of osteosarcoma can only be confirmed by a biopsy. Not all tests listed below 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 diganosis of 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 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, this is frequently used to get images of the lungs as a potential location of tumor metastases. It 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. This is frequently performed before a biopsy to ensure the biopsy is placed properly.

  • Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. 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. This 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. 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 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 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 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. A scanner then detects this substance to produce images of the inside of the body. In osteosarcoma, this is used to find a tumor at other places in the body that are distant from where the tumor started. Some oncologists prefer PET-CT for distant disease (along with a chest CT scan), while other doctors prefer bone scans, which are described below.

  • 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 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.

  • Biopsy. 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. 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 physician, as different sites may 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. 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. 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 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. 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.

Osteosarcoma - Childhood and Adolescence - Stages

Approved by the Cancer.Net Editorial Board, 11/2020

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread. This is called the stage. Use the menu to see other pages.

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 person's prognosis, which is the chance of recovery. There are different stage descriptions for different tumors.

Doctors use the following terms to describe the stage of osteosarcoma and to decide on the treatment plan:

  • Localized. The tumor is only in the bone where it began and in the tissue around it. The tumor has not detectably 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 rarely 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 Types of Treatment. Use the menu to choose a different section to read in this guide.

Osteosarcoma - Childhood and Adolescence - Types of Treatment

Approved by the Cancer.Net Editorial Board, 11/2020

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. 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.

Treatment overview

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 teamPediatric cancer centers often have extra support services for patients and their families, such as child life specialists, dietitians, 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 common types of treatment used for osteosarcoma are listed below. All people with high-grade osteosarcoma require surgery and chemotherapy for the highest chance of successful treatment. Radiation therapy is used 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 talks 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 particularly important for osteosarcoma because there are different treatment options. Learn more about making treatment decisions.


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 the arm or leg 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 patients are reconstructed with allografts made of metal.

Limb-sparing surgery is used most often. 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 surgeryBefore surgery, talk with your child's health care team about the possible side effects from the specific surgery you will have.


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, a doctor who specializes in treating cancer with medication.

Systemic chemotherapy is given through 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). 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 60% 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 treatmentThe 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. 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.

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 another treatment or if some of the tumor remains after other treatment.

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.

Physical, emotional, and social 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 care or 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 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 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 similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.

Before treatment begins, talk with your child’s doctor about the goals of each treatment in the treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative care options.

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 care in a separate section of this website.

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 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).

When this occurs, a new cycle of testing will begin again to learn as much as possible about the recurrence. 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 suggest clinical trials that are studying new ways to treat recurrent osteosarcoma.

Treatment for recurrent osteosarcoma depends on 3 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, 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 perform surgery, particularly if chemotherapy has worked well.

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

When cancer recurs, people with cancer and their families often experience emotions such as disbelief or fear. You are encouraged to talk with the 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.

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 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.

The next section in this guide is About Clinical TrialsIt 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.

Osteosarcoma - Childhood and Adolescence - About Clinical Trials

Approved by the Cancer.Net Editorial Board, 11/2020

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. Use the menu to see other pages.

What are clinical trials?

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. Every drug that is now approved by the U.S. Food and Drug Administration (FDA) was tested in clinical trials, although these may not have specifically involved children and adolescents.

Clinical trials are used for all types and stages of osteosarcoma. Many focus on new treatments to learn if a new treatment is safe, effective, and possibly better than the existing treatments. These types of studies evaluate new drugs, different combinations of treatments, new approaches to radiation therapy or surgery, and new methods of treatment.

Children and teens who participate in clinical trials can be some of the first to get a treatment before it is available to the public. That said, new drugs are usually tested in adults prior to testing in children and teens. However, there are some risks with a clinical trial, including possible side effects and the chance that the new treatment may not work. People are encouraged to talk with their health care team about the pros and cons of joining a specific study.

Some clinical trials study new ways to relieve symptoms and side effects during treatment. Others study ways to manage the late effects that may happen a long time after treatment. Talk with your child's doctor about clinical trials for symptoms and side effects.

Deciding to join a clinical trial

People decide to participate in clinical trials for many reasons. For some people, 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 a way to contribute to 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.

Insurance coverage and the costs of clinical trials differ by location and by study. In some programs, some of a person's expenses from participating in the clinical trial are reimbursed. In others, they are not. It is important to talk with the research team and your insurance company first to learn if and how your treatment in a clinical trial will be covered. Learn more about health insurance coverage of clinical trials.

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 not done at all in childhood cancer research. Find out more about placebos in cancer clinical trials.

It is important that the patient, especially adolescents, participate in the discussion and decision-making process surrounding clinical trials, depending on their level of understanding and their desire to participate. Young adults over the age of 18 are adults and need to be the primary decision maker. They will be asked to sign a form indicating "informed consent" has taken place. The concept of informed consent is described more below.

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:

  • Describe all of the treatment options so that the parent and child understand how the new treatment differs from the standard treatment

  • List all of the risks of the new treatment, which may or may not be different than the risks of the standard treatment

  • Explain what will be required of each child in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment

Clinical trials also have certain rules called “eligibility criteria” that help structure the research and keep people safe. You and the research team will carefully review these criteria together. Even if someone wants to participate in the trial, they cannot do so if they are not eligible. Part of eligibility can be to define the safety of participation, and the trial organizers may have access to information that is not known to all treating physicians.

People who participate in a clinical trial may stop participating at any time for personal or medical reasons. 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 Children's Oncology Group is a National Cancer Institute-funded cooperative group that conducts clinical trials in all types of childhood cancer, including those focused on osteosarcoma. Many clinical trials are conducted by other groups as well. (Please note this link takes you to another website.)

PRE-ACT, Preparatory Education About Clinical Trials

In addition, you can find a free video-based educational program about cancer clinical trials in another section of this website.

The next section in this guide is Latest Research. It explains areas of scientific research for osteosarcoma. Use the menu to choose a different section to read in this guide.

Osteosarcoma - Childhood and Adolescence - Latest Research

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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 FDA in the United States. Other approaches on how best to stimulate the patient's own immune system are in the early 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 are 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.

  • 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; there is local or distant recurrence; and the 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. If your child's cancer has come back, talk about the results of these studies with the health care team.

Palliative care/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. Your doctor can provide additional details about 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:

The next section in this guide is Coping with TreatmentIt 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.

Osteosarcoma - Childhood and Adolescence - Coping with Treatment

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ON THIS PAGE: You will learn more about coping with the physical, emotional, social, and financial effects of childhood cancer and its treatment. Use the menu to see other pages.

Every cancer treatment can cause side effects or changes to your child’s body and how they feel. For many reasons, people do not experience the same side effects even when they are given the same treatment for the same type of cancer. This can make it hard to predict how your child will feel during treatment.

As your family prepares to start cancer treatment, it is normal to fear treatment-related side effectsIt may help to know that your child's health care team will work to prevent and relieve side effects. Doctors call this part of cancer treatment "palliative care" or "supportive care." It is an important part of your child’s treatment plan, regardless of their age or the stage of disease.

Coping with physical side effects

Common physical side effects from each treatment option for osteosarcoma are listed in the Types of Treatment section. Learn more about side effects of cancer and its treatment, along with ways to prevent or control them. Changes to your child’s physical health depend on several factors, including the cancer’s stage, the length and dose of treatment, and your child’s general health.

It is important to discuss any new side effects or changes in existing side effects with your child’s health care team. Providing this information helps them find ways to treat or manage the side effects so your child feels more comfortable and can potentially keep any side effects from worsening.

You may find it helpful to keep track of your child’s side effects so you are prepared to discuss any changes with the health care team. Learn more about why tracking side effects is helpful.

Sometimes, physical side effects can last after treatment ends. Doctors call these long-term side effects. They call side effects that occur months or years after treatment late effects. Treating long-term side effects and late effects is an important part of care for childhood cancer survivors. Learn more by reading the Follow-up Care section of this guide or talking with your child’s doctor.

Coping with emotional and social effects

Your family can have emotional and social effects after a cancer diagnosis. This may include dealing with difficult emotions, such as sadness, anxiety, anger, or managing stress. Sometimes, people find it difficult to express how they feel to their loved ones. Some have found that talking to an oncology social worker, counselor, or member of the clergy can help them develop more effective ways of coping and talking about cancer.

You can also find coping strategies for emotional and social effects in a separate section of this website. This section includes many resources for finding support and information to meet your family’s needs.

Coping with the costs of cancer care

Cancer treatment can be expensive. It is often a big source of stress and anxiety for families dealing with a cancer diagnosis. In addition to treatment costs, many people find they have extra, unplanned expenses related to their child’s care. For some people, the high cost of medical care stops them from following or completing their cancer treatment plan. This can put your child's health at risk and may lead to higher costs in the future. Families are encouraged to talk about financial concerns with a member of their health care team.

Learn more about managing financial considerations in a separate part of this website. Most programs to have social workers that can help address needs, including identifying specific organizations that may provide assistance.

Caring for a child with cancer

Family members and friends often play an important role in taking care of a person with osteosarcoma. This is called being a caregiver. As a parent or guardian, you are the primary caregiver for your child. However, friends and family members can give your family valuable support, even if they live far away.

When your child has osteosarcoma, you may have an additional range of responsibilities. These may include giving medications or managing symptoms and side effects. However, it is important to seek help from others. Below are some of the responsibilities your family or friends could help with:

  • Providing short-term care for your child with osteosarcoma, or for your other children

  • Talking with the health care team

  • Giving support and encouragement

  • Assisting with meals or household chores

  • Helping with insurance and billing issues

Learn more about caregiving.

Talking with your child's health care team about side effects

Before starting treatment, talk with your child’s doctor about possible side effects. Ask:

  • Which side effects are most likely?

  • When are they likely to happen?

  • What can we do to prevent or relieve them?

Be sure to tell your child's health care team about any side effects that happen during treatment and afterward, too. Tell them even if you do not think the side effects are serious. This discussion should include physical, emotional, social, and financial effects of cancer.

Also, ask how much care your child may need at home and with daily tasks during and after treatment. This can help you make a caregiving plan. Create a caregiving plan with this 1-page fact sheet that includes an action plan to help make caregiving a team effort. This free fact sheet is available as a PDF, so it is easy to print.

Looking for More on How to Track Side Effects?

Cancer.Net Mobile app symptom tracker

Cancer.Net offers several resources to help you keep track of symptoms and side effects. Please note that these links will take you to other sections of Cancer.Net:

  • Cancer.Net Mobile: The free Cancer.Net mobile app allows you to securely record the time and severity of your child's symptoms and side effects.

  • ASCO Answers Managing Pain: Get this 36-page booklet about the importance of pain relief that includes a pain tracking sheet to record how pain affects your child. The free booklet is available as a PDF, so it is easy to print.

  • ASCO Answers Fact Sheets: Read 1-page fact sheets on anxiety and depression, constipation, diarrhea, and rash that provide a tracking sheet to record details about the side effect. These free fact sheets are available as a PDF, so they are easy to print, fill out, and give to your health care team.

The next section in this guide is Follow-up CareIt explains the importance of checkups after your child finishes cancer treatment. Use the menu to choose a different section to read in this guide.

Osteosarcoma - Childhood and Adolescence - Follow-Up Care

Approved by the Cancer.Net Editorial Board, 11/2020

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, 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. 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 can add stress to you or a family member. This is sometimes called “scan-xiety.” 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 afterwards. Late effects can occur almost anywhere in the body. They include physical problems, such as heart 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:

Chemotherapy used

Potential long-term effect

Monitoring and management


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

Hearing tests or, in some cases, hearing aids


Heart problems

Periodic echocardiograms


Secondary leukemia (see above)

Treatment, often similar to the treatment for newly diagnosed leukemia


Infertility and kidney damage

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

Ovarian cryopreservation, which is freezing a portion of the ovary, might 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 taking supplements. This is unlikely if kidney damage was not already a problem during treatment.

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. 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:

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. 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 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

  • 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 SurvivorshipIt 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.

Osteosarcoma - Childhood and Adolescence - Survivorship

Approved by the Cancer.Net Editorial Board, 11/2020

ON THIS PAGE: You will read about how to cope with challenges in everyday life after your child’s cancer diagnosis. Use the menu to see other pages.

What is survivorship?

The word “survivorship” means different things to different people, but it often describes 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 child with cancer and their 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 after completing 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 when 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

  • Feeling comfortable with the course of action your family chooses

It may be helpful for your child 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 the health care team, individual counseling, or asking for assistance at the learning resource center of the place 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.

Healthy living after cancer

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

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.

It is important that your child has recommended medical checkups and tests (see Follow-up Care) to take care of his or her health.

Talk with the 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 information and resources to help survivors cope, including specific sections for children and teens and young adults. There is also a main section on survivorship for people of all ages.

  • ASCO Answers Cancer Survivorship Guide: Get this 44-page booklet that helps people transition into life after treatment. It includes blank treatment summary and survivorship care plan forms. The free booklet is available as a PDF, so it is easy to print.
  • 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 Health Care Team to help start conversations with your child’s cancer care team. Use the menu to choose a different section to read in this guide.

Osteosarcoma - Childhood and Adolescence - Questions to Ask the Health Care Team

Approved by the Cancer.Net Editorial Board, 11/2020

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, or download Cancer.Net’s free mobile app for a digital list and other interactive tools to manage your child’s care. It may also be helpful to ask a family member or friend to come along to appointments to help take notes.

Cancer.Net Mobile app question tracker

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 a 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 clinical trials are available for 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 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? 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 effects of having this treatment?

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

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?

  • 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 some more resources on this website that may be helpful to you. Use the menu to choose a different section to read in this guide.

Osteosarcoma - Childhood and Adolescence - Additional Resources

Approved by the Cancer.Net Editorial Board, 11/2020

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 Osteosarcoma in Childhood and Adolescence. Use the menu to go back and see other pages.

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.

Here are a few links to help you explore other parts of Cancer.Net:

This is the end of Cancer.Net’s Guide to Osteosarcoma in Childhood and Adolescence. Use the menu to choose a different section to read in this guide.