Osteosarcoma is a rare form of bone cancer that frequently affects children, adolescents, and young adults, though it can occur at any age. This type of cancer originates in the cells that form bone tissue.
Understanding Osteosarcoma
Osteosarcoma originates from osteoblasts, the cells responsible for creating new bone. While it can develop in any bone, it most commonly appears in the long bones of the limbs, such as the femur, tibia, or humerus. Most cases are diagnosed in individuals aged 10 to 30, with a peak during adolescence when bones grow rapidly.
Symptoms like bone pain or swelling, especially pain worsening at night or with activity, often prompt imaging studies. Initial evaluations include X-rays, which reveal bone changes, followed by MRI to assess tumor size and soft tissue involvement. A CT scan of the chest also checks for distant spread, especially to the lungs, a common site for metastasis. A definitive diagnosis requires a biopsy, where a tissue sample is examined by a pathologist to confirm cancerous cells and classify the specific osteosarcoma type.
Treatment for Osteosarcoma
Treatment for osteosarcoma involves a combination of therapies, aiming to eliminate cancer while preserving limb function. Chemotherapy is a key part of treatment, administered before surgery as neoadjuvant chemotherapy. Neoadjuvant chemotherapy helps shrink the tumor, making surgical removal easier and targeting microscopic cancer cells that may have spread. After tumor removal, adjuvant chemotherapy is given to destroy remaining cancer cells and reduce recurrence risk.
Surgical removal of the tumor is a primary treatment. Limb-sparing surgery is the most common approach, replacing the cancerous bone section with a metal prosthesis, bone graft, or a combination. If the tumor involves nerves, blood vessels, or is too extensive for limb preservation, rotationplasty or amputation may be necessary. Rotationplasty involves reattaching the lower leg and foot, rotated 180 degrees, to the thigh, allowing the ankle to function as a knee for a prosthetic limb. Radiation therapy has a limited role, primarily used when surgery is not feasible or to manage symptoms like pain in advanced cases.
Life During and After Treatment
Undergoing osteosarcoma treatment can significantly impact a patient’s daily life, necessitating comprehensive supportive care. Chemotherapy often leads to side effects such as nausea, vomiting, and fatigue due to its impact on rapidly dividing cells throughout the body. Other common effects include hair loss, mouth sores, and a temporary decrease in blood cell counts, which increases the risk of infection. Some chemotherapy drugs can also cause peripheral neuropathy, leading to numbness or tingling in the hands and feet.
Surgical recovery involves managing pain and addressing mobility challenges, particularly after limb-sparing procedures or amputation. Physical therapy and occupational therapy are important for regaining strength, flexibility, and adapting to new ways of movement. Rehabilitation helps patients learn to use prosthetic limbs effectively or maximize function in a reconstructed limb, promoting independence.
Psychosocial support, including counseling and support groups, helps patients and their families cope with the emotional and psychological burdens of cancer diagnosis and treatment. Nutritional support is also considered to help maintain strength and manage treatment side effects. Many patients gradually return to school or work, with adjustments made to accommodate ongoing recovery and any physical limitations.
Prognosis and Ongoing Care
The prognosis for osteosarcoma is influenced by several factors, including the stage of the cancer at diagnosis, the tumor’s location, and how well the tumor responds to neoadjuvant chemotherapy. Tumors that show a good response to initial chemotherapy, indicated by a high percentage of cancer cell death, have a more favorable outlook. The absence of metastatic disease at diagnosis, particularly in the lungs, also contributes to a better prognosis.
Long-term follow-up care is important for osteosarcoma survivors to monitor for potential recurrence and to manage any late effects of treatment. This typically involves regular imaging scans, such as chest X-rays or CT scans, and blood tests for several years after treatment completion. The frequency of these check-ups gradually decreases over time, but ongoing surveillance is maintained to detect any changes promptly. Survivorship clinics provide specialized care, addressing long-term health concerns that may arise from chemotherapy or radiation, such as cardiac issues or secondary cancers. Transitioning to long-term medical care ensures continued monitoring and support as survivors move beyond active treatment.