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Pediatric Cancers - Osteogenic Sarcoma

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Pediatric Cancers - Osteogenic Sarcoma

What is osteogenic sarcoma?

Also called osteosarcoma, osteogenic sarcoma is one of the most common types of bone cancer in children.

The disease usually occurs in the long bones, such as the arms (humerus), legs (femur/tibia), and pelvis. It rarely occurs in the jaw and fingers, but often occurs at the ends of these bones near growth plates. Osteosarcoma affects adolescents and young adults.

Osteogenic sarcoma cancer cells can also spread (metastasize) to other areas of the body. Most commonly, these cells spread to the lungs. However, bones, kidneys, the adrenal gland, the brain, and the heart can also be sites of metastasis.

What causes osteogenic sarcoma?

It has been suggested that repeated trauma to an area may be a risk factor for developing this type of cancer. It is uncertain whether trauma is a cause or effect of the disease. Cancer lesions in the bone can make that area of the bone weaker, thus, making injury more likely. However, repeated injuries to a certain area of the bone may lead to an increased production of osteoid tissue to repair the damaged area. The rapid production of osteoid tissue may lead to the malignancy. It is thought, most often, that injury simply brings the condition to attention and has no causal relationship.

Genetics may play an important role in developing osteosarcoma. Children and adults with other hereditary abnormalities, including exostoses (bony growths), retinoblastoma, Ollier's disease, osteogenesis imperfecta, polyostotic fibrous dysplasia, and Paget's disease, have an increased risk for developing osteosarcoma.

This form of cancer has also been linked to exposure to ionizing irradiation associated with radiation therapy for other types of cancer (i.e., Hodgkin and non-Hodgkin disease).

What are the symptoms of osteogenic sarcoma?

The following are the most common symptoms of osteogenic sarcoma. However, each child may experience symptoms differently. Symptoms may include, but are not limited to, the following:

  • pain (sharp or dull) at the site of the tumor
  • swelling and/or redness at the site of the tumor
  • increased pain with activity or lifting
  • limping
  • decreased movement of the affected limb

The symptoms may have been present over a short period of time or may have been occurring for six months or more. Often, an injury brings a child into a medical facility, where an x-ray may indicate suspicious bone lesions.

The symptoms of osteogenic sarcoma may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.

How is osteogenic sarcoma diagnosed?

In addition to a complete medical history and physical examination of your child, diagnostic procedures for osteogenic sarcoma may include:

  • multiple imaging studies of the tumor and sites of possible metastasis, such as:
    • x-rays -  a diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
    • bone scans - a nuclear imaging method to evaluate any degenerative and/or arthritic changes in the joints; to detect bone diseases and tumors; to determine the cause of bone pain or inflammation. This test is to rule out any infection or fractures.
    • magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body. This test is done to rule out any associated abnormalities of the spinal cord and nerves.
    • computed tomography scan (Also called a CT or CAT scan.) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.
  • complete blood count (CBC) - a measurement of size, number, and maturity of different blood cells in a specific volume of blood.
  • blood tests (including blood chemistries)
  • biopsy of the tumor

Treatment for osteogenic sarcoma:

Specific treatment for osteogenic sarcoma will be determined by your child's physician based on:

  • your child's age, overall health, and medical history
  • extent of the disease
  • your child's tolerance for specific medications, procedures, or therapies
  • expectations for the course of the disease
  • your opinion or preference

Treatment may include, but is not limited to, one or more of the following:

  • surgery (i.e., biopsy, resections, bone/skin grafts, limb salvage procedures, reconstructions)
  • amputation
  • chemotherapy
  • radiation therapy
  • resections of metastases (spreading of the tumor to other locations)
  • rehabilitation including physical and occupational therapy and psychosocial adapting
  • prosthesis fitting and training
  • supportive care (for the side effects of treatment)
  • antibiotics (to prevent and treat infections)
  • continued follow-up care (to determine response to treatment, detect recurrent disease, and manage the side effects of treatment)

Long-term outlook for a child with osteogenic sarcoma:

Prognosis for osteogenic sarcoma greatly depends on:

  • the extent of the disease.
  • the size and location of the tumor.
  • presence or absence of metastasis.
  • the tumor's response to therapy.
  • the age and overall health of your child.
  • your child's tolerance of specific medications, procedures, or therapies.
  • new developments in treatment.

As with any cancer, prognosis and long-term survival can vary greatly from child to child. Every child is unique and treatment and prognosis is structured around the child's needs. Prompt medical attention and aggressive therapy are important for the best prognosis. Continuous follow-up care is essential for a child diagnosed with osteogenic sarcoma. Side effects of radiation and chemotherapy, as well as second malignancies, can occur in survivors of osteogenic sarcoma. New methods are continually being discovered to improve treatment and to decrease side effects.

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