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Our multidisciplinary team of specialists provides comprehensive treatment for patients with bone cancers including osteosarcoma, chondrosarcoma and the Ewing Family of Tumors (EFTs).
The Neurosurgery Spine Program at Massachusetts General Hospital offers surgical treatment options for the entire spectrum of complex spinal disorders, treating the most challenging cases in the world.
In collaboration with Massachusetts Eye and Ear Infirmary, MassGeneral Hospital for Children offers a combined Pediatric Head and Neck Clinic for patients with head and neck tumors.
We have one of the largest pediatric proton therapy programs in the world and have treated well over 1,600 children. We are the only proton center in New England, and an international referral center for pediatric radiation oncology.
What is osteosarcoma?
Cancer is made of changed cells that grow out of control. The changed (abnormal) cells often grow to form a lump or mass called a tumor. Cancer cells can also grow into (invade) nearby areas. And they can spread to other parts of the body. This is called metastasis.
Osteosarcoma is a type of bone cancer that often develops in the osteoblast cells that form bone. The bone the cancer cells make is not as strong as normal bone.
It happens most often in children, teens, and young adults. About 1,000 new cases of osteosarcoma are reported each year in the U.S. Of these cases, about 450 are in children and teens. It happens slightly more often in males than in females.
Osteosarcoma most often starts in the long bones around the knee. Other sites for osteosarcoma include the upper leg (thighbone), the lower leg, or the upper arm bone. But it can start in any bone in the body, including those in the pelvis, shoulder, and skull.
Osteosarcoma may grow into nearby tissues, such as tendons or muscles. It may also spread, or metastasize, through the bloodstream to other organs or bones in the body.
What causes osteosarcoma?
The exact cause of osteosarcoma is not known. But it is believed to be due to DNA changes (mutations) inside bone cells. These changes are either inherited or acquired after birth.
Who is at risk for osteosarcoma?
A risk factor is anything that may increase your chance of having a disease. The exact cause of someone’s cancer may not be known. But risk factors can make it more likely for a person to have cancer. Some risk factors may not be in your control. But others may be things you can change.
Suggested risk factors for osteosarcoma include:
Teen growth spurts
Being tall for a specific age
Having treatment with radiation for another cancer, especially at a young age or with high doses of radiation
Presence of certain noncancer (benign) bone diseases
Presence of certain rare, inherited disorders, such as:
Li-Fraumeni syndrome. A rare family predisposition to many types of cancers (such as soft tissue sarcomas, breast cancer, brain tumors, osteosarcoma, and others) caused by a mutation in a gene—often the p53 tumor-suppressor gene—that normally curbs cancer.
Rothmund-Thompson syndrome. A rare inherited syndrome that includes skeletal problems, rashes, short height, and a higher risk of developing osteosarcoma. It is caused by an abnormality in the REQL4 gene.
Hereditary retinoblastoma. A cancer of the eye that often happens in children younger than 4 years old.
What are the symptoms of osteosarcoma?
Symptoms may be a bit different for each person. Symptoms may include:
Pain in the affected bone or joint that gets worse over time
Swelling around the affected site
Increased pain with activity or lifting
Decreased movement of the affected limb
The symptoms of osteosarcoma are a lot like the symptoms for other health conditions. Always talk with your healthcare provider for a diagnosis.
How is osteosarcoma diagnosed?
In addition to a complete health history and physical examination, diagnostic tests for osteosarcoma may include imaging tests:
X-ray. A diagnostic test that uses beams of radiation to produce images of internal tissues, bones, and organs on film.
Bone scans. A nuclear imaging method to evaluate any degenerative or arthritic changes in the joints. It can also find bone diseases and tumors. And it can find the cause of bone pain or inflammation.
MRI. This procedure uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures in the body. This test is done to better define a mass seen on X-ray and to look for any nearby spread of tumors.
CT scan. This imaging test uses X-rays and a computer to make detailed images of the body. A CT scan shows details of the bones, muscles, fat, and organs.
Positron emission tomography (PET) scan. Radioactive-tagged sugar (glucose) is injected into the bloodstream. Tissues that use the glucose more than normal tissues (such as tumors) can be found by a scanning machine. PET scans can be used to find small tumors that have spread.
You may also need:
Complete blood count (CBC). A measurement of size, number, and maturity of different blood cells in a specific volume of blood.
Other blood tests. These might include blood chemistries.
Biopsy of the tumor. A procedure in which tissue samples are removed (with a needle or during surgery) from the body. The samples are then checked under a microscope to see if cancer or other abnormal cells are present.
After a diagnosis of osteosarcoma, you’ll likely have other tests. These help your healthcare providers learn more about the cancer. They’ll show how much and how far the cancer has spread (metastasized) in your body. A stage grouping is then assigned.
How is osteosarcoma staged?
The stage of a cancer tells your doctor how much and how far it has spread in your body. The stage of a cancer is one of the most important things to know when deciding how to treat it.
In the staging system most often used, the stage groupings have a value of 1 to 3. They are written as Roman numerals I, II, and III. In another system, there's also a stage 4 (IV). The higher the number, the more advanced the cancer is. Letters and numbers can be used after the Roman numeral to give more details.
Staging for osteosarcoma also takes into account the grade of the cancer. This is a measure of how much the cancer cells look like normal cells. A grade of 1 or 2 is used. Grade 1 looks most like normal cells and tends to grow and spread slower than grade 2. This may be called low grade. Grade 2 3 is high grade. These cells look very different from normal cells. They tend to grow and spread faster than low-grade cancer cells..
Your healthcare provider will talk with you about what your cancer stage means for your treatment. Ask any questions or talk about your concerns.
How is osteosarcoma treated?
Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is.
Treatment may include:
Surgery to remove the tumor. This is the main treatment for most people.
Chemotherapy to kill cancer cells anywhere in the body.
Radiation therapy to kill cancer cells and shrink tumors. It might be used after surgery to kill any cancer cells that may be left behind.
Rehabilitation, including physical and occupational therapy, and psychosocial adapting
Supportive care for the side effects of treatment
Many people, particularly those with higher grade tumors, will receive a combination of treatments. Some types of treatment may later affect fertility. If this side effect is permanent, it might cause infertility. This means you may not be able to have children. Both men and women can be affected.
Talk with your healthcare providers about your treatment options. Make a list of questions. Think about the benefits and possible side effects of each option. Discuss your concerns with your healthcare provider before making a decision.
How do I manage osteosarcoma?
Managing a cancer diagnosis can be a life-changing event for both the person and the family. Each person decides how to adapt to the diagnosis. If physically able, some people find it helpful to keep their pre-diagnosis daily routine such as spending time with family and friends, going to work, and taking part in trips and other activities. Other people find the diagnosis life-changing and decide to rethink how they spend their time. An important factor in your decision will be the long-term outlook, or prognosis, for the osteosarcoma.
Prognosis for osteosarcoma depends on:
The extent of the disease
The size and location of the tumor
The pathologic grade of the cancer
The tumor's response to therapy
Your age and overall health
Your tolerance of specific medicines, procedures, or therapies
The type of treatment used
Your treatment preferences
As with any cancer, prognosis and long-term survival can vary greatly from person to person. Every person is unique and treatment and prognosis is structured around your needs. Prompt medical attention and aggressive therapy are important for the best prognosis. Continuous follow-up care is vital for a person diagnosed with osteosarcoma. Side effects of radiation and chemotherapy, including second cancers, can happen in survivors.
Key points about osteosarcoma
Osteosarcoma is a type of bone cancer that often develops in the osteoblast cells that form bone.
The bone the cancer cells make is not as strong as normal bone.
It happens most often in children, teens, and young adults.
It can start in any bone in the body. But it most often starts in the long bones around the knee. Other common sites are the upper leg, the lower leg, and the upper arm bone.
Treatment may include surgery, radiation, chemotherapy, and physical and occupational therapy.
Tips to help you get the most from a visit to your healthcare provider:
Know the reason for your visit and what you want to happen.
Before your visit, write down questions you want answered.
Bring someone with you to help you ask questions and remember what your provider tells you.
At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
Ask if your condition can be treated in other ways.
Know why a test or procedure is recommended and what the results could mean.
Know what to expect if you do not take the medicine or have the test or procedure.
If you have a follow-up appointment, write down the date, time, and purpose for that visit.
Know how you can contact your provider if you have questions.
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