Osteosarcoma (continued)

Sometimes the doctor does a needle biopsy, using a long hollow needle to take a sample of the tumor. A local anesthesia is typically used in the area that's being biopsied. Alternatively, the doctor may order an open biopsy, in which a portion of the tumor is removed in the operating room by a surgeon while the child is under general anesthesia.

If a diagnosis of osteosarcoma is made, the doctor will order CT chest scans as well as a bone scan and, sometimes, additional MRI studies. These will show if the cancer has spread to any part of the body beyond the original tumor. These tests will be repeated after treatment starts to determine how well it is working and whether the cancer is continuing to spread.

Treating Osteosarcoma

Treatment of osteosarcoma in children includes chemotherapy (the use of medical drugs to kill cancer cells and shrink the cancer) followed by surgery (to remove cancerous cells or tumors) and then more chemotherapy (to kill any remaining cancer cells and minimize chances of the cancer coming back). Surgery often can effectively remove bone cancer, while chemotherapy can help eliminate remaining cancer cells in the body.

Surgical Treatment

Surgical treatments for osteosarcoma consist of either amputation or limb-salvage surgery.

Currently, most teens with osteosarcomas involving an arm or leg can be treated with limb-salvage surgery rather than amputation. In limb-salvage surgery, the bone and muscle affected by the osteosarcoma are removed, leaving a gap in the bone that is filled by either a bone graft (usually from the bone bank) or more often a special metal prosthesis. These can be appropriately matched to the size of the bone defect. The risk of infection and fracture is higher with bank bone replacement and therefore metal prostheses are more commonly used for reconstruction of the bone after removal of the tumor.

If the cancer has spread to the nerves and blood vessels surrounding the original tumor on the bone, amputation (removing part of a limb along with the osteosarcoma) is often the only choice.

When osteosarcoma has spread to the lungs or elsewhere, surgery may also be performed to remove tumors in these distant locations.

Chemotherapy

Chemotherapy is usually given both before and after surgery. It eliminates small pockets of cancer cells in the body, even those too small to appear on medical scans. A child or teen with osteosarcoma is given the chemotherapy drugs intravenously (through a vein) or orally (by mouth). The drugs enter the bloodstream and work to kill cancer in parts of the body where the disease has spread, such as the lungs or other organs.

Short-Term and Long-Term Side Effects

Amputation carries its own short-term and long-term side effects. It usually takes at least 3 to 6 months until a young person learns to use a prosthetic (artificial) leg or arm, and this is just the beginning of long-term psychological and social rehabilitation.

With a limb salvage surgery, one usually starts bending the knee or the affected body part almost immediately. A continuous passive motion (CPM) machine, that continuously bends and straightens the knee may be used to improve motion for tumors around the knee. Physical therapy and rehabilitation for 6 to 12 months following surgery usually enables the child to walk initially with a walker or crutches and then without any assistive devices. Early complications after surgery include infection and slow healing of the surgical wound, and the metal prosthetic device or the bank bone may need to be replaced in the long term. Other late problems might include fracture of the bank bone or failure of the bank bone to heal to the child's bone, which might require more surgery.