Osteosarcoma

What Is Osteosarcoma?

Osteosarcoma (also called osteogenic sarcoma) is a type of bone cancer that develops in the osteoblast cells that form the outer covering of bone. It occurs most often in children, adolescents, and young adults. Learn more about childhood osteosarcoma.

Osteosarcoma

Osteosarcoma most commonly occurs in the long bones around the knee. Other sites for osteosarcoma include the upper leg, or thighbone, the lower leg, upper arm bone, or any bone in the body, including those in the pelvis, shoulder, and skull.

Osteosarcoma may metastasize, or spread, into nearby tissues, such as tendons or muscles. It may also metastasize through the bloodstream to other organs or bones in the body.

The exact cause of osteosarcoma is not known, but may be due to DNA mutations—either inherited or acquired after birth.

Osteosarcoma Symptoms

The following are the most common symptoms for osteosarcoma. However, each individual may experience symptoms differently. Symptoms may include:

  • Pain in the affected bone
  • Swelling around the affected site
  • Increased pain with activity or lifting
  • Limping
  • Decreased movement of the affected limb

The symptoms of osteosarcoma may resemble other medical conditions, such as Ewing’s sarcoma. Always consult your doctor for a diagnosis.

Osteosarcoma Diagnosis

A number of procedures are used in the diagnosis of osteosarcoma.

Imaging tests

Imaging tests are done before the biopsy. The following tests and procedures may be used:

Physical exam and history

Physical exam and history is an exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.

Please provide your medical records to us before your appointment. At the visit itself, the nurses and doctors will ask additional questions and carry out a detailed physical exam.

X-ray

An X-ray of the organs and bones inside the body. An X-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.

Computed Tomography Scan (CT Scan)

Computed tomography scan (CT or CAT scan) is a non-invasive diagnostic imaging procedure that uses a combination of special X-ray equipment and sophisticated computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. These cross-sectional images of the area being studied can then be examined on a computer monitor or printed.

CT scans are more detailed than general X-rays, showing detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans of internal organs, bone, soft tissue and blood vessels provide greater clarity and reveal more details than regular X-ray exams. CT scans also minimize exposure to radiation. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly.

In standard X-rays, a beam of energy is aimed at the body part being studied. A plate behind the body part captures the variations of the energy beam after it passes through skin, bone, muscle, and other tissue. While much information can be obtained from a standard X-ray, a lot of detail about internal organs and other structures is not available.

In computed tomography, the X-ray beam moves in a circle around the body. This allows many different views of the same organ or structure. The X-ray information is sent to a computer that interprets the X-ray data and displays it in a two-dimensional (2D) form on a monitor.

Using specialized equipment and expertise to create and interpret CT scans of the body, radiologists can more easily diagnose problems such as cancers, cardiovascular disease, infectious disease, trauma and musculoskeletal disorders.

CT scans of the chest can provide more detailed information about organs and structures inside the chest than standard X-rays of the chest, thus providing more information related to injuries and/or diseases of the chest (thoracic) organs.

Chest CT scans may also be used to visualize placement of needles during biopsies of thoracic organs or tumors, or during aspiration (withdrawal) of fluid from the chest. This is useful in monitoring tumors and other conditions of the chest before and after treatment.

While many images are taken during a CT scan, in some cases the patient receives the same or less radiation exposure than with a single standard X-ray.

CT scans may be done with or without “contrast.” Contrast refers to a substance taken by mouth or injected into an intravenous (IV) line that causes the particular organ or tissue under study to be seen more clearly. Contrast examinations may require you to fast for a certain period of time before the procedure. Your physician will notify you of this prior to the procedure.

Care agreement:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

Related procedures

Other related procedures that may be used to assess the heart include:

  • Resting or exercise electrocardiogram (ECG or EKG)
  • Holter monitor
  • Signal-averaged ECG
  • Cardiac catheterization
  • Chest X-ray
  • Echocardiogram
  • Electrophysiological studies
  • Magnetic resonance imaging (MRI) of the heart
  • Myocardial perfusion scans
  • Radionuclide angiography
  • Ultrafast CT scan

MRI (magnetic resonance imaging)

A magnetic resonance (REZ-oh-nans) imaging scan is usually called an MRI. An MRI does not use radiation (X-rays) and is a noninvasive medical test or examination. The MRI machine uses a large magnet and a computer to take pictures of the inside of your body. Each picture or “slice” shows only a few layers of body tissue at a time. The pictures can then be examined on a computer monitor.

Pictures taken this way may help caregivers find and see problems in your body more easily. The scan usually takes between 15 to 90 minutes. Including the scan, the total examination time usually takes between 1.5 to 3 hours.

A substance called gadolinium is injected into a vein to help the physicians see the image more clearly. The gadolinium collects around cancer cells so they show up brighter in the picture. Sometimes a procedure called magnetic resonance spectroscopy (MRS) is done during the MRI scan. An MRS is used to diagnose tumors based on their chemical make-up.

How does MRI work?

The MRI machine is a large, cylindrical (tube-shaped) machine that creates a strong magnetic field around the patient. This magnetic field, along with a radiofrequency, alters the hydrogen atoms’ natural alignment in the body.

A magnetic field is created and pulses of radio waves are sent from a scanner. The radio waves knock the nuclei of the atoms in the body out of their normal position; as the nuclei realign back into proper position, they send out radio signals.

These signals are received by a computer that analyzes and converts them into an image of the part of the body being examined. This image appears on a viewing monitor. Some MRI machines look like narrow tunnels, while others are more open.

MRI may be used instead of a CT scan in situations where organs or soft tissue are being studied, because with MRI scanning bones do not obscure the images of organs and soft tissues, as does CT scanning.

Other related procedures that are used to assess the heart may include:

  • Resting or exercise electrocardiogram (ECG)
  • Signal-averaged electrocardiogram (ECG)
  • Holter monitor
  • Cardiac catheterization
  • Chest X-ray
  • Computed tomography (CT scan) of the chest
  • Electrophysiological studies
  • Myocardial perfusion scans
  • Radionuclide angiography
  • Ultrafast CT scans

Biopsies

Cells and tissues are removed during a biopsy so they can be viewed under a microscope by a pathologist to check for signs of cancer.

The type of biopsy that is done will be based on the size of the tumor and where it is in the body. There are three types of biopsy that may be used:

Fine-needle aspiration (FNA) biopsy

A fine-needle aspiration (FNA) biopsy is the removal of tissue, fluid, or very small pieces from a tumor using a thin needle. Local anesthetic is sometimes used to numb the area, but the test rarely causes much discomfort and leaves no scar. A small needle is inserted into the abnormal area in almost any part of the body, guided by imaging techniques, to obtain a tissue biopsy. This type of biopsy can provide a diagnosis without surgical intervention. FNA is not used for diagnosis of a suspicious mole, but may be used to biopsy large lymph nodes near a melanoma to see if the melanoma has metastasized (spread). A computed tomography scan (CT or CAT scan)—an X-ray procedure that produces cross-sectional images of the body—may be used to guide a needle into a tumor in an internal organ such as the lung or liver.

Core biopsy

A core biopsy is the removal of tissue using a wide hollow needle. Most are performed with local anesthetic and sedation only without the need for general anesthesia. Patients go home with nothing more than a band-aid.

Incisional biopsy

When the entire tumor is removed, the procedure is called an excisional biopsy. If only a portion of the tumor is removed, the procedure is referred to as an incisional biopsy. When possible, excisional biopsy is the preferred method when melanoma is suspected.

An excisional biopsy, also called a wide local incision, involves surgical removal of a tumor and some normal tissue around it. The amount of normal tissue taken (also called the clinical margin) depends on the thickness of the tumor. In the case of possible melanoma, skin grafting (taking skin from another part of the body to replace the skin that is removed) or rotation flaps of skin from other sites may be used to cover the wound resulting from the wide local excision, but most cutaneous melanoma excisions can be closed without placement of a skin graft.

The following tests may be done on the tissue that is removed:

Light and electron microscopy

A light and electron microscopy is a laboratory test in which cells in a sample of tissue are viewed under regular and high-powered microscopes to look for certain changes in the cells.

Cytogenetic analysis

In this laboratory test, cells in a sample of blood or bone marrow are viewed under a microscope to look for certain changes in the structure or number of chromosomes in the lymphocytes.

Immunocytochemistry Study

An immunocytochemistry study is a laboratory test in which a substance such as an antibody, dye, or radioisotope is added to a sample of cancer cells to test for certain antigens. This type of study is used to tell the difference between different types of cancer.

Osteosarcoma Staging

Osteosarcoma is described as either localized or metastatic.

Localized osteosarcoma

Localized osteosarcoma has not spread out of the bone where the cancer started. There may be one or more areas of cancer in the bone that can be removed during surgery.

Metastatic osteosarcoma

Metastatic osteosarcoma has spread from the bone in which the cancer began to other parts of the body. The cancer most often spreads to the lungs. It may also spread to other bones.

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