Has your child been complaining about a sore leg or arm lately? You might think they fell while playing, or that they're just too tired. But sometimes, there could be something more serious behind this persistent bone pain. So never ignore it. Today, we're going to talk about one such serious condition, osteosarcoma, a type of bone cancer that often affects children and young adults.
Simply put, what is osteosarcoma?
Osteosarcoma is a type of cancer that develops in the bones . It starts out as normal bone cells. But over time, these cells become malignant (cancerous) cells, clump together, and form tumors inside or on the surface of the bone. These tumors weaken and deform the healthy bone.
Sometimes doctors also call this osteogenic sarcoma. Here, 'sarcoma' is a general name for cancers that develop in the connective tissues of our body, such as bones, cartilage, and muscles. The word 'osteo' means 'bone'. 'Osteogenic' means that it produces bone cells.
This type of cancer is most common in children and young adults . The risk of developing it is especially high during periods of rapid growth and development.
Which bones are most likely to develop this cancer?
Osteosarcoma cancer most often develops in the long bones of our body. That is, in the long bones of the arms and legs. It is especially common at the ends of these bones, that is, near the joints. Think of places like the knee, hip, and shoulder.
Let's explain this further with the table below.
| Places where cancer most commonly occurs | Places where cancer rarely occurs |
|---|---|
| Thigh bone (Femur) | Jawbone |
| Shin bone (Tibia) | Pelvis |
| Upper arm bone (Humerus) | Skull |
| (Especially near the knee and shoulder) | Soft tissues in the abdomen and chest |
What does the 'grade' of cancer mean?
Doctors classify osteosarcoma cancer by what they call 'grading' it. This refers to how quickly the cancer can spread. That is, its ability to spread (metastasize) to other parts of the body. There are three main grades.
- Low grade: This type of cancer grows very slowly . Most of the time, it stays where it started and doesn't spread easily.
- High grade: This is the most dangerous type. These cancers grow very quickly and are more likely to spread to other parts of the body (for example, the lungs).
- Intermediate grade: This is a situation between the two types mentioned above.
What are the symptoms of osteosarcoma?
The symptoms of this disease do not appear suddenly. They develop gradually. Sometimes these symptoms look like a normal injury or sprain, so many people do not pay attention to them at first. But it is very important to be aware of these symptoms.
| Symptom | A simple explanation |
|---|---|
| Bone pain | This is the most common symptom. The pain increases over time. The pain can be especially severe at night and during exercise. |
| A swelling or lump | The area of pain will begin to swell. Sometimes it may feel like a lump in your hand. If you touch the area, it may feel a little warmer than other places. |
| Limited joint movement | If the cancer is near a joint, it can be difficult to bend or twist that joint. For example, if it is near the knee, it can be difficult to bend the leg. |
| Bone fractures for no reason | Cancer weakens the bone. Therefore, a bone can break even with a minor fall or accident that would not normally break it. We call these ``pathologic fractures``. |
| Other features | You may also notice things like unexplained fever, changes in skin color, and, if it's cancer in the leg, limping. |
The most important thing is that if a child complains of pain in the same place for weeks, they should definitely see a doctor, without dismissing it as something they did while playing.
Why does this kind of cancer develop?
Experts are still unable to say exactly what causes this. However, they have identified several risk factors that are thought to contribute to the development of this cancer.
Rapid bone growth
During growth spurts, when a child suddenly grows taller and develops a lot, their bones also grow very quickly. At this time, cells divide very quickly. It is believed that something goes wrong during this rapid cell division, increasing the chance of cancer cells forming. This is a major reason why this disease is so common in young people.
Exposure to radiation
If you have previously received radiation therapy as a treatment for another cancer, there is a small risk of developing osteosarcoma in the bones in the areas that received radiation.
Genetic factors
This is a bit complicated. Simply put, there are special genes in our body that stop cancer from forming. Like our body's own guards. These are called `tumor suppressor genes`. `p53` is one such gene. If there is a change in these genes, that is, a `mutation`, the risk of developing cancer increases. Also, a gene called `retinoblastoma (Rb)`, which is associated with eye cancer in young children, has been found to be related to this.
Additionally, people with the following rare genetic conditions are also at increased risk of developing osteosarcoma:
- Li-Fraumeni syndrome
- Paget's disease of the bone (osteitis deformans)
- Hereditary retinoblastoma
- Bloom syndrome
- Diamond-Blackfan anemia
- Rothmund-Thomson syndrome
- Werner syndrome
Bone infarction
If the blood supply to a part of a bone is cut off for some reason, the cells in that part die. This is also thought to be why cancer cells can sometimes form.
How does the doctor diagnose this disease?
When you see a doctor with the symptoms you mentioned above, he will follow a few steps to determine the exact nature of the disease.
1. Asking about symptoms: First, your doctor will ask you and your child about the symptoms (when the pain started, what it feels like, is there any swelling, etc.) and whether anyone in your family has had cancer.
2. Physical examination: Then, a thorough examination is performed to check for any lumps or swelling.
3. Referral for tests: After that, you will be referred for several tests to confirm the disease.
- X-ray examination: This can give an initial idea of whether there is a cancerous change in the bone.
- MRI or CT scan: These can give a very clear picture of the size of the cancer and how far it has spread to surrounding tissues.
- A biopsy: This is the most important test to confirm the diagnosis 100% . Here, a small piece of tissue is taken from the area where the cancer is and examined under a microscope. This will help determine whether it is osteosarcoma or another type of cancer, and what the grade of the cancer is.
- Blood tests: These help determine general health status and some cancer indicators.
Once the disease is confirmed as osteosarcoma, the next step is to see if the cancer has spread to other parts of the body. This is called 'staging' . This may involve a 'bone scan' or a 'PET scan', which examines the bones of the whole body.
What are the treatments?
Treatment for osteosarcoma is usually done by a team. This means that many people, including oncologists, surgeons, and physiotherapists, come together. There are two main treatment methods.
The usual treatment plan is: Chemotherapy → Surgery → Chemotherapy
1. Chemotherapy: This involves giving the body powerful drugs that kill cancer cells. Because these drugs travel throughout the body through the bloodstream, they can kill cells in the main tumor as well as small cancer cells that have spread to other parts of the body (that we can't see on scans). Chemotherapy given before surgery can shrink the tumor and make the surgery easier. Chemotherapy given after surgery can kill any remaining cancer cells and prevent the disease from coming back.
2. Surgery: The main goal here is to completely remove the cancerous lump. The surgeon removes the lump along with some healthy tissue around it. This is done to ensure that not a single cancer cell is left behind. There are several types of surgery.
| Type of surgery | Description |
|---|---|
| Limb salvage surgery | This is the most common procedure today. The entire arm or leg is not removed. Only the part of the bone with the cancer is removed and replaced with a metal prosthesis or bone graft from someone else. |
| Amputation | If the cancer has spread widely, or if important blood vessels or nerves have been damaged, it is sometimes necessary to remove the arm or leg. Then a prosthetic arm or leg can be used. |
| Rotationplasty | This is a rare, specialized surgery. In cases of cancer of the knee, the part of the knee where the cancer is located is removed, the leg is rotated 180 degrees, and then reattached to the thigh. The leg then functions like a knee. It can be fitted with an artificial leg and you can walk well. |
In some cases, radiation therapy may be given if the cancer has spread to areas where surgery is not possible.
Are there any side effects after treatment?
Yes, these treatments, especially chemotherapy, are powerful and can cause short-term and long-term side effects. Things like nausea, vomiting, hair loss, and fatigue can occur during treatment. Also, in the long term,
- Risk of developing another type of cancer
- Impact on the ability to have children (`Infertility`)
- Effects on the functioning of organs such as the heart, lungs, kidneys, and ears
- Effects on thinking and memory
Things like this can happen. Therefore, it is very important to continue to follow up with your doctor even after treatment.
Take-Home Message
- Never ignore persistent pain or swelling in a child's bones, especially around the knees and shoulders. Don't ignore it, thinking it's normal, but see a doctor immediately.
- Osteosarcoma is a bone cancer that most often occurs in young people. However, if detected early, it can be successfully treated and completely cured .
- Treatment is usually a combination of chemotherapy and surgery. With today's advanced treatments, it is increasingly possible to treat the disease without removing the limb.
- Psychological support is very important for both the child and the parents during this difficult time. Talk to your doctor about that as well.
- If you have any questions about this disease, its treatment, or its side effects, don't hesitate to ask your doctor.
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