Osteosarcoma

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Overview

Osteosarcoma or osteogenic sarcoma occurs when the cells in the bones begin to divide abnormally. This is the most common type of bone cancer. However, it can also form in the soft tissues.

Osteosarcoma is more prevalent in children and young adults. It usually begins in the regions of legs or the arms – but it can form in any bone in the body.

There are multiple types of osteosarcoma depending on the location of their origin and their grade.

Osteosarcoma is a rare type of cancer in India. If detected early, osteosarcoma can be treated successfully with positive clinical outcomes and excellent survival rates.

Symptoms

Some of the early symptoms of osteosarcoma are pain, swelling and tenderness. The patient may also start limping as the tumour grows. Other main symptoms associated with osteosarcoma include:

Redness and warmth at the tumour site
Presence of lumps at the tumour site
Bone fractures
Extreme tiredness
Fever
Mobility issues
Unintentional weight loss
Anaemia

Courses

The exact cause of osteosarcoma is unknown. Some risk factors have been identified by the researchers and these factors are found to increase one’s chances of developing osteosarcoma:

Age: Although osteosarcoma can happen at any age, it is found to be more common among children and young adults.
History of Radiation Therapy: Those who have received radiation therapy in the past have higher chances of developing this disease.
Certain Inherited Genetic Disorders: Those diagnosed with specific inherited genetic disorders, namely Bloom syndrome, Rothmund-Thomson syndrome, Li-Fraumeni syndrome, Diamond Blackfan Anaemia, Werner syndrome and retinoblastoma, have an increased risk of developing osteosarcoma.
Existing Bone Disorders: Individuals with bone disorders, namely Paget’s disease, may also have a higher risk of getting diagnosed with osteosarcoma.

Diagnosis

The detection and diagnosis of osteosarcoma are done through a myriad of diagnostic tests:

a. Physical Examination and Medical History Assessment: The doctor initially examines the patient for signs of osteosarcoma, which could be lumps, fractures, redness, etc. He/she may also study the medical history of the patient to get a better understanding of the patient’s overall health, his/her past medical conditions, the treatments received and allergies. If osteosarcoma is suspected, the doctor may write for additional tests.

b. Imaging Tests: An X-ray scan is recommended initially to check if the lump present is a tumour or is associated with a benign condition. Other imaging tests, namely PET CT scan and MRI scan can help in determining the exact location of the tumour, its size and stage. The doctor may also recommend a chest X-ray in order to rule out lung metastasis.

Throughout the treatment, these imaging tests are carried out for various purposes, including staging, treatment planning and treatment monitoring.

c. Biopsy: During the biopsy, a small amount of tissue from the abnormal mass is collected and sent to be examined under a microscope for the presence of cancer cells. The sample may be collected either through fine-needle biopsy or surgical biopsy. A biopsy is necessary for the specialist to arrive at the definitive diagnosis of osteosarcoma.

d. Bone Scan: Bone scan is a nuclear imaging technique used in osteosarcoma diagnosis. During this procedure, a radioactive tracer is injected into the patient’s vein to examine the bones. This tracer substance gets absorbed by various regions of the bones and is later detected by a special camera. Non-cancerous regions or healthy bones appear lighter during the scan, whereas regions with abnormalities, such as a tumour, appear as visible spots. A bone scan can help doctors in determining if osteosarcoma has spread to other regions in the body.

Treatment

There are various treatment options available for osteosarcoma. However, the doctor devises the treatment plan upon considering various factors, such as the location of the tumour, the size, stage of the disease, its grade, patient’s age, his/her overall health condition and preferences.

Surgery, chemotherapy, radiation therapy are the main treatment options available for osteosarcoma. However, those with osteosarcomas may also be treated with targeted therapy.

a. Surgery: The primary goal of surgery is to remove the cancer cells entirely, while also striving to reduce disability and keep the cancer-affected bone functional. Following are various surgical procedures available, and the doctor may recommend one of these depending on the severity of the disease.

Limb-sparing Surgery (Limb-salvage Surgery): Most osteosarcoma cases can be treated successfully through limb-sparing surgery. It is often combined with radiation therapy or chemotherapy. This surgery involves the removal of the tumour without removing the entire limb. A small amount of healthy tissue around the tumour may also be removed. The main goal of this surgery is to preserve the structure and functioning of the limb. In a few cases, where a large section of the bone is removed, reconstructive surgery may be performed, wherein metal prosthetics or bone grafts are used to reconstruct the bone and restore its functions.
Amputation: In rare cases, especially in the case of high-grade osteosarcomas, amputation may be recommended by the doctor. During this procedure, a part or the entire limb is removed in order to remove the tumour successfully. Today, we have tremendous advancements in the field of prosthetics and various ways to improve the quality of clinical outcomes for patients undergoing amputation and help them return to the best state of health possible.
Rotationplasty: Rotationplasty is usually recommended for osteosarcomas that form in the areas close to the knees. During this procedure, the lower portion of the thigh bone (femur), the knee and the upper tibia (upper shinbone) are removed. The lower portion of the leg is rotated by 180 degrees (rotationplasty) and attached to the thigh bone. The foot is now attached to the thighbone in the backwards direction and the ankle functions as the knee. With regular training, the patient will learn how to use the ankle as the knee.

For the lower leg, a prosthesis may be used. After this procedure, the patient will be able to get back to their normal life and take part in physical activities, sports, etc., in three to six months.

b. Chemotherapy: Chemotherapy uses powerful anticancer drugs to stop the cancer cells from growing and dividing. Chemotherapy may be given before the surgery to shrink the tumour and/or after the surgery to destroy the residual cancers and reduce the risk of a relapse.

Chemotherapy may be administered orally or intravenously, or both.

c. Radiation Therapy: In a few cases, radiation therapy may also be recommended for osteosarcoma, especially if surgery is not feasible. Radiation therapy uses high-energy radiation beams, which could either be X-rays or proton beams, to kill the cancer cells. Radiation therapy could either be delivered externally or internally.

d. Targeted Therapy: Targeted therapy involves the usage of medications that block specific proteins that are vital for the growth of cancer cells. Unlike radiation therapy and chemotherapy, targeted therapy only attacks the cancer cells and thereby reduces damage to the healthy cells and causes fewer treatment-related complications.

e. Cryotherapy: During cryotherapy, liquid nitrogen is used to freeze the tumour cells and kill them.

Frequently Asked Questions

1. Is osteosarcoma treatable?

Yes, osteosarcoma is treatable. Today, we have advanced treatment approaches available that can help us treat even aggressive osteosarcoma cases with positive clinical outcomes.

However, like any other cancer, osteosarcomas are treated best when they are detected early. Therefore, it is important for one to be mindful of symptoms, especially pain, presence of a lump, fractures, etc. and immediately consult a doctor for an accurate diagnosis.

2. Will osteosarcoma come back?

Yes, osteosarcoma can come back after some time in a few cases. It can reoccur in the same region or distant organs. Nevertheless, they can be treated successfully if they are detected in the early stages.

Osteosarcoma patients should strictly keep up their follow-up appointments after the treatment as this helps them catch recurrences before they progress to advanced stages and cause complications.

3. Can osteosarcoma be seen on X-ray?

Yes, doctors will be able to detect the presence of a bone tumour (osteosarcoma) during an X-ray scan. However, for a definitive diagnosis, he/she may recommend additional tests.

4. Where does osteosarcoma usually start?

Osteosarcoma commonly begins in the long bones, such as the legs or arms. However, they can form in any bone.

5. Should I consider rehabilitation after my osteosarcoma treatment?

Yes, receiving rehabilitation care after your surgery will have a positive impact on your recovery rate.

Your rehabilitation programme will involve you receiving care and assistance from physiotherapists, prosthetists and other specialists who will help you with exercises that will improve the flexibility and functioning of your muscles and joints.

6. Can I prevent osteosarcoma?

The majority of identified osteosarcoma risk factors are unchangeable. There are no known lifestyle or environmental factors associated with osteosarcoma, except for radiation therapy.

If you are identified as a high-risk individual for osteosarcoma, you should talk to your doctor in order to understand the best practices that can help you reduce your osteosarcoma risk.