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Leading-edge diagnosis and treatment
Diagnosis of sarcomas can be challenging, but accurate findings are essential to successful treatment. Our pathologists are focused on osteosarcoma, which means they know what to look for to diagnose this type of bone cancer, and they use the latest, most sophisticated tests to pinpoint the type and extent of the cancer.
Treatment of bone cancer often requires a multi-level approach. Children's Cancer Hospital's specialized surgeons use the most advanced techniques to save limbs, and they are joined by dedicated oncologists, radiologists, rehabilitation experts, nurses and therapists. We offer the very latest in chemotherapy and other types of treatments.
Research and discovery
Many patients with osteosarcoma are treated with clinical trials. We participate in protocols of the Children's Oncology Group and offer innovative treatments through clinical trials, many available only at Children's Cancer Hospital and a few other hospitals in the nation.
Our Osteosarcoma and Ewing's Sarcoma Center coordinates care and access to clinical trials, streamlining and expediting enrollment in clinical trials. In addition, sarcoma researchers work with clinicians to translate laboratory research into new clinical trials.
Researchers at Children's Cancer Hospital are pioneering new, less toxic and more effective treatments for osteosarcoma. For instance, they discovered chemotherapy can be used with radiation to control osteosarcoma tumors that cannot be removed surgically. They are investigating new targeted therapies, as well as aerosolized treatments that target osteosarcoma that has metastasized to the lungs.
Children's Cancer Hospital is designed just for children, with a full range of services and amenities that help make the child and family's experience as comfortable as possible. We go beyond medical care to deliver a comprehensive experience that treats the whole child.
And at Children's Cancer Hospital, your child benefits from the resources and expertise of one of the nation's top cancer centers.
Did You Know?
The one gift cancer gave me is perspective. Now each day is a new day and is filled with possibilities.
Osteosarcoma is a type of bone cancer in which malignant (cancerous) cells produce immature bone.
Osteosarcoma is rare. According to the American Cancer Society, some 800 cases of osteosarcoma are diagnosed annually in the nation. About half of these are in children and teens. This accounts for about 3% of pediatric cancers.
Nearly 80% of the tumors are in the thighbone (femur) or lower leg bones (tibia or fibula). They also may develop in the upper arm bone (humerus). Usually, tumors develop during “growth spurts,” or periods of rapid growth in the teen years.
Although osteosarcoma may appear to be in only one location in the lower leg or forearm, almost all patients have tumor cells called micrometastases in the lungs.
Bones support, give structure to body
Bones, which usually are hollow, have three main parts:
Matrix: The outer part of bones, which is made of fiber-like tissue and covered with a layer of tissue called the periosteum.
Bone marrow: The soft tissue in the space in hollow bones, which is called the medullary cavity. Cells inside bone marrow include:
- Fat cells
- Red blood cells, white blood cells and platelets
- Fibroblasts, a type of cell that helps build connective tissue
- Plasma, in which blood cells are suspended
Cartilage: Material that is at the end of most bones. It is softer than bone, but it is firmer than soft tissue. Cartilage and other tissues, including ligaments, make up joints, which connect some bones.
Bone constantly changes as new bone forms and old bone dissolves. To make new bone, the body deposits calcium into the cartilage. Some of the cartilage stays at the ends of bones to make joints.
Many types of cancer that start in other organs of the body can spread to the bones. These are sometimes referred to as metastatic bone cancers, but they are not true bone cancers.
Osteosarcoma risk factors
The cause of osteosarcoma, or bone cancer, is unknown, and it usually does not run in families. However, certain things seem to put children at a higher risk of developing osteosarcoma:
- Age: Osteosarcoma, or bone cancer, is most common in people between 10 and 30 years old, particularly teenagers in rapid growth cycles or “growth spurts.”
- Height: Most children with osteosarcoma are tall for their ages.
- Gender: More males than females develop the disease.
- Race: African Americans have a slightly higher risk of osteosarcoma.
- Previous radiation therapy
- Non-cancer bone diseases including Paget's disease and osteochondromas
- Rare inherited cancer syndromes, including, Li-Fraumeni, Rothmund-Thompson, and the RB1 gene mutation, which causes retinoblastoma
- Other rare genetic conditions, including Bloom syndrome and Werner syndrome
Osteosarcoma is rare, and not everyone with risk factors gets the disease. However, if you are concerned about your child’s risk for bone cancer, you should talk to his or her doctor.
Some cases of osteosarcoma can be passed down from one generation to the next. Genetic counseling may be right for you. Learn more about the risk to you and your family on our genetic testing page.
Did You Know?
Osteosarcoma is most common in people between 10 and 30 years old, particularly teens going through growth spurts.
Osteosarcoma symptoms, or pediatric osteosarcoma, vary from child to child. However, the first symptom usually is an aching pain in a bone or joint. At first, the pain may go away and come back. Gradually, it becomes worse and is constant, often getting worse at night.
Other signs of osteosarcoma include:
- Difficulty with normal activities, such as moving, lifting or walking
- Limping, pain, tenderness, swelling or lump close to or in a joint. The area may be warm and red.
- Weight loss
- Broken bone at the site of the tumor; bone may break with routine, normal movement
- Low red blood cell count (anemia)
These symptoms are not always caused by osteosarcoma. In fact, they usually are caused by a less serious condition.
Leg and arm pain are common in growing boys and girls, and usually it is nothing to worry about. But if the pain persists, worsens or if other symptoms are present, you should speak to your child’s doctor.
Accurate diagnosis is important for successful osteosarcoma treatment, and an error or misdiagnosis may actually be harmful. The specialized surgeons and pathologists at Children’s Cancer Hospital are among the most experienced and skilled in the nation in diagnosing pediatric osteosarcoma. They use the latest methods and technology.
If at all possible, the first biopsy should be at the cancer center where your child will receive treatment. Try to go to a cancer center that sees a large number of pediatric osteosarcoma patients and has a dedicated sarcoma team that includes specialized pathologists.
If your child has symptoms of osteosarcoma, or bone cancer, the doctor will examine your child carefully and ask questions about your child’s and family’s medical history.
One or more of the following diagnostic tests may be used to find out if your child has osteosarcoma and if it has spread. These tests also may be used to find out if treatment is working.
Imaging tests, which may include:
- CT (computed tomography) scans
- MRI (magnetic resonance imaging) scans
- PET (positive emission tomography) scans
- Bone scans
Two types of biopsies are used to diagnose osteosarcoma. Your child’s doctor will choose the best method for your child.
- Core biopsy: A needle is used to remove small cylinder-shaped samples (cores).
- Surgical (open) biopsy: An incision (cut) is made in the skin, and the surgeon removes a small piece of the tumor. If tissue removed during a surgical biopsy is found to be osteosarcoma, surgery to remove the tumor may be done during the same procedure.
Our treatment approach
Osteosarcoma, or bone cancer, is rare, and most oncologists have little experience treating it. Children’s Cancer Hospital physicians treat a high number of patients with osteosarcoma, which translates to a remarkable level of skill and expertise. This has earned us the reputation of being one of the best osteosarcoma treatment centers in the country.
Since osteosarcoma usually requires multiple treatments, a comprehensive, personalized team approach is crucial. At the Children’s Cancer Hospital, your child is the focus of a multidisciplinary group of specialized physicians, including surgeons, oncologists, radiation oncologists and pathologists, who are with your child throughout treatment. They are supported by highly trained rehabilitation specialists, therapists, nurses and other health care professionals who work together to ensure your child receives the best care.
In most osteosarcoma cases, very small areas of cancer have spread to other parts of the body. They are called micrometastases. These areas usually do not show up in imaging tests. For that reason, chemotherapy, which travels to all parts of the body, is almost always the first treatment for osteosarcoma. Chemotherapy is almost always given after surgery as well.
Osteosarcoma treatment almost always includes surgery. Children’s Cancer Hospital surgeons are among the most skilled in the nation. They use the most up-to-date techniques and technologies, including limb-sparing surgeries, so most patients can avoid the loss of an arm or leg. If limb-sparing surgery is not an option, Children’s Cancer Hospital offers the most advanced prostheses, with specialized pediatric rehabilitation services.
Many children with osteosarcoma are treated with innovative agents through clinical trials. The Children’s Cancer Hospital participates in Children’s Oncology Group protocols, as well as other clinical trials available at only a few hospitals in the nation.
Our osteosarcoma treatments
If your child is diagnosed with osteosarcoma, the doctor will discuss the best treatment options. This depends on several factors, including the size and location of the cancer, if it has spread, and your child’s age and general health.
Osteosarcoma usually is treated with a combination of therapies that may include surgery, chemotherapy and radiation. Surgery is almost always part of treatment.
The experts at Children’s Cancer hospital will customize a course of treatment especially for your child’s needs. One or more of the following therapies may be recommended to treat the cancer or help relieve symptoms.
At Children’s Cancer Hospital, our specialized orthopedic surgeons are often able to avoid amputation when osteosarcoma is in an arm or leg. Complex limb-sparing surgery removes the tumor, but saves the tendons, nerves and blood vessels. Bone is replaced with a bone graft or an internal prosthesis, similar to an artificial joint.
Like all surgeries, osteosarcoma surgery is most successful when performed by a specialist with a great deal of experience in the particular procedure. MD Anderson surgeons are among the most skilled and recognized in the world. They among the few surgeons in the world who specialize in pediatric sarcoma treatment, and they use the least-invasive and most advanced methods.
Whenever possible, the biopsy and surgical treatment should be planned together.
Osteosarcoma chemotherapy treatment is usually given before (neoadjuvant chemotherapy) and after surgery (adjuvant chemotherapy).
Children’s Cancer Hospital offers the most up-to-date and advanced chemotherapy options.
Radiation therapy (also called radiotherapy) uses high-energy beams to destroy cancer cells. Osteosarcoma cells do not respond well to radiation, so it is not a main part of treatment for most cases. It may be used if the tumor cannot be completely removed by surgery or to help control symptoms.
If radiation is needed, new radiation therapy techniques allow Children’s Cancer Hospital doctors to target tumors more precisely, delivering the maximum amount of radiation with the least damage to healthy cells.
Children’s Cancer Hospital provides leading-edge radiation treatments, including 3D-conformal radiation therapy and intensity-modulated radiotherapy (IMRT), which are tailored to the specific shape of the tumor.
The Proton Therapy Center at MD Anderson is one of the world’s largest and most advanced centers. It’s the only proton therapy facility in the country located within a comprehensive cancer center. This means this cutting-edge therapy is backed by all the expertise and compassionate care for which MD Anderson is famous.
Proton therapy delivers high radiation doses directly into the tumor, sparing nearby healthy tissue and vital organs. For many patients, this results in better cancer control with less impact on the body.
Radioactive drugs (radiopharmaceuticals)
Children’s Cancer Hospital is leading into the future of cancer treatment by developing innovative targeted therapies. These agents are specially designed to treat each cancer’s specific genetic/molecular profile to help the body fight the disease. Many of the doctors who treat osteosarcoma, or bone cancer, at Children’s Cancer Hospital are dedicated researchers who have pioneered and actively lead national and international clinical trials with novel targeted agents.
Anthony Quinn hardly remembers his osteosarcoma treatment, but he sees a reminder of
his journey each day. At just 4 years old, Anthony lost his leg
shortly after his osteosarcoma diagnosis. But Anthony has never let
that hold him back. Today, the 27-year-old is training with big
dreams: to one day make it to the Paralympics.
"I've always been competitive and loved sports," Anthony says. "I've always felt that if I was given the opportunity to compete athletically in adaptive sports, I would excel."
Remembering pediatric osteosarcoma treatment
Anthony remembers going to the doctor after hitting his ankle on the coffee table -- an accident that occurred while running around with his older brother and eventually led to his osteosarcoma diagnosis. He remembers how nice the nurses were. He remembers his IV -- which he called "Robot Charlie" -- and the smells of the drugs used to save his life.
And he remembers picking out the color of the cast he would wear after the amputation. After undergoing several rounds of chemotherapy, it was clear the cancer wasn't going away. The doctors needed to amputate Anthony's leg to save his life.
His first few steps on crutches were difficult. He fell the first
time. He was tired, frustrated and didn't understand. But as he grew,
Anthony chose not let the amputation stop him. Inspired by his
basketball star older brother, he played basketball in elementary and
Training after an amputation
But when Anthony made it to high school, he decided not to try out for the basketball team. It was something he always regretted.
After college, he became determined to get back in shape. Anthony purchased a running leg in hopes of participating in some 5Ks and other similar competitions.
Getting back in shape was a slow process, but one that Anthony has learned from.
"The biggest challenge for me is probably patience and courage," he says. "I'm still very new to competitions and not as fast as I would like to be. It's a bit unnerving at times. Maintaining a positive attitude is a must."
But when Anthony discovered the Texas Regional Paralympic Sports through Facebook, he started thinking about competing more seriously. Since then, Anthony has received seven gold and silver medals (mostly gold) in 100-meter, 200-meter, 400-meter and 5K races throughout Texas. At the 2014 Texas Regional Paralympic Sports' Texas Regional Games, Anthony qualified for the U.S. Paralympics Track and Field National Championships in the 100-meter and 200-meter races. He is planning on competing again soon in hopes of qualifying in the 400-meter race as well.
Finding another way to represent his country
Anthony had always wanted to serve in the military, but was extremely frustrated when he discovered his amputation prevented him from doing so. But he's found another way he can represent the U.S.
"I feel indebted to my country and the men and women who sacrificed, some with their lives, in defense of our Constitution," he says. "I love my country and would be honored to represent the U.S. in the Paralympics."
Based on the number of gold medals he's already won, it seems he's well on his way to doing just that.