Childhood Osteosarcoma

Sarcomas are cancers that begin in the body's connective tissues. Sarcomas are often divided into two groups:

  • Bone cancers that begin in the hard part of the bone
  • Soft tissue sarcomas that start in muscle, fat, fibrous tissue, blood vessels, nerves, or other supportive tissues of the body

Osteosarcoma is the most common form of bone cancer in children. 

The tumor usually starts in the faster growing ends of the long bones in the arms and legs. Common places where the tumor is found are the lower end of the thigh bone, the upper end of the shin bone, and the upper end of the long bone of the upper arm. This tumor occurs less often in the jaw, spinal column, shoulder blades and pelvis.

Osteosarcomas are seen more often in boys than girls. It is most often seen in children between the ages of 10 and 20, but it can occur in younger children and adults.

Symptoms of osteosarcoma include swelling and bone pain. The pain often worsens over time. Osteosarcoma is suspected when an X-ray shows destruction of the normal bone.

Diagnosis of osteosarcoma is made by biopsy of the involved bone. This is a surgical procedure done under general anesthesia where medication is given so the child is not conscious and will not feel any pain. A piece of the suspicious bone is removed and looked at under a microscope. Besides the biopsy, CT and bone scans, or MRIs are performed to see if the disease has spread.

A combination of surgery and chemotherapy is used to treat osteosarcoma. Radiation treatment is generally not useful. Often chemotherapy is given to try to shrink the tumor and to prevent its spread.

After initial chemotherapy, X-rays are repeated to see how well the tumor responds. The results will help the doctors decide the type of surgery that will be necessary to save the limb or if amputation is needed.

In the past, amputation was the most common surgery used, but limb-salvage procedures are becoming more common. In this procedure, the cancerous bone and tissue are removed and replaced with artificial material or bone from another part of the body. However, the limb-salvage procedure is not always possible. The decision to perform this procedure will be made only if the X-rays and scans show there is no spread of the tumor and that the tumor can be completely removed with tumor-free margins.

If these options cannot be done or if the bone would not be strong enough, amputation is the only option. If an amputation is performed, an artificial limb is provided when healing is complete. In many cases, artificial limbs work well.

After surgery, sometimes additional chemotherapy is needed. Osteosarcoma can often spread to the lungs. Your child will have chest CT scans to check for tumors in the lungs. The treatment for lung tumors is surgery or more intensive chemotherapy. Sometimes more than one operation is needed to take out the tumors in the lungs. This treatment can be very effective in improving the survival rate of children whose lungs become involved.

With the way surgery and chemotherapy are now used, patients with localized disease have a 60 percent to 80 percent five-year survival rate, compared to 15 percent to 30 percent in those with metastatic disease.

Cincinnati Children's is an international referral center for the treatment of children and young adults with high-risk and relapsed cancers. Our faculty members lead national efforts in the development of new targeted therapies, immunological approaches, and stem cell transplantation.

For additional information on this topic, contact us at cancer@cchmc.org.


Last Updated 11/2013