Osteosarcoma Cancer from Detection to Treatment
What Is Osteosarcoma?
Osteosarcoma is a type of bone cancer that usually starts in the cells that form bones.
It most commonly occurs in the long bones of the arms and legs, especially near the knees and shoulders.
It is more common in children, teenagers, and young adults, but can occur at any age.
Osteosarcoma is a type of bone cancer that usually starts in the cells that form bones.
It most commonly occurs in the long bones of the arms and legs, especially near the knees and shoulders.
It is more common in children, teenagers, and young adults, but can occur at any age.
1. Initial Evaluation
Common Symptoms:
• Persistent bone pain, especially at night or during activity
• Swelling or lump around the affected bone
• Reduced movement or limping
• Fracture after minor injury
• In advanced cases ➧ fatigue | weight loss | or fever
Common Sites:
• Long bones ➧ distal femur | proximal tibia | proximal humerus
• Less commonly ➧ pelvis | jaw | or spine
Common Symptoms:
• Persistent bone pain, especially at night or during activity
• Swelling or lump around the affected bone
• Reduced movement or limping
• Fracture after minor injury
• In advanced cases ➧ fatigue | weight loss | or fever
Common Sites:
• Long bones ➧ distal femur | proximal tibia | proximal humerus
• Less commonly ➧ pelvis | jaw | or spine
2. Physical Examination
• Palpation of the affected area for swelling, tenderness, or warmth
• Check for range of motion and neurovascular involvement
• Examine nearby lymph nodes
• Palpation of the affected area for swelling, tenderness, or warmth
• Check for range of motion and neurovascular involvement
• Examine nearby lymph nodes
3. Imaging and Scanning Tests
X-ray
Reveals classic “sunburst” appearance or Codman’s triangle.
Suggests malignancy ➧ further imaging needed.
Magnetic Resonance Imaging
Determines tumor size, local spread, and soft tissue involvement.
Essential for surgical planning.
CT Scan
Checks for lung metastases | most common site of spread.
Bone Scan | PET-CT
Detects metastases in other bones or distant sites.
X-ray
Reveals classic “sunburst” appearance or Codman’s triangle.
Suggests malignancy ➧ further imaging needed.
Magnetic Resonance Imaging
Determines tumor size, local spread, and soft tissue involvement.
Essential for surgical planning.
CT Scan
Checks for lung metastases | most common site of spread.
Bone Scan | PET-CT
Detects metastases in other bones or distant sites.
4. Biopsy | Definitive Diagnosis
Types:
Core needle biopsy
Open surgical biopsy
Sample sent to pathology for:
Histological type
Grade
Molecular tests
Types:
Core needle biopsy
Open surgical biopsy
Sample sent to pathology for:
Histological type
Grade
Molecular tests
5. Histologic Types
➛ Conventional Osteosarcoma
➛ Telangiectatic osteosarcoma
➛ Small cell osteosarcoma
➛ Parosteal osteosarcoma
➛ Periosteal osteosarcoma
➛ Conventional Osteosarcoma
➛ Telangiectatic osteosarcoma
➛ Small cell osteosarcoma
➛ Parosteal osteosarcoma
➛ Periosteal osteosarcoma
6. Staging | AJCC / Enneking System
IA - Low-grade tumor, localized
IB - Low-grade, extra-compartmental
IIA - High-grade, localized
IIB - High-grade, extra-compartmental
III - Metastatic disease
IA - Low-grade tumor, localized
IB - Low-grade, extra-compartmental
IIA - High-grade, localized
IIB - High-grade, extra-compartmental
III - Metastatic disease
7. Multidisciplinary Treatment Planning
Team includes:
• Orthopedic oncologist | surgery
• Medical oncologist | chemotherapy
• Radiologist
• Pathologist
• Physical therapist & rehabilitation team
• Psychologist and nutritionist
Team includes:
• Orthopedic oncologist | surgery
• Medical oncologist | chemotherapy
• Radiologist
• Pathologist
• Physical therapist & rehabilitation team
• Psychologist and nutritionist
8. Treatment Plan
➛ Neoadjuvant Chemotherapy | Before Surgery
Purpose:
Shrink the tumor
Kill micrometastatic cells
Improve surgical outcomes
Common drugs:
Cisplatin + Doxorubicin | Adriamycin
High-dose Methotrexate with Leucovorin rescue
Ifosfamide + Etoposide
Usually given for 8-10 weeks before surgery.
➛ Surgery | Main Treatment
Goal:
Remove entire tumor with clear margins.
Limb-Sparing Surgery:
Tumor removed and bone reconstructed with metal prosthesis, bone graft, or 3D-printed implant.
Amputation:
If tumor involves major nerves or blood vessels and limb cannot be preserved.
Rotationplasty:
Part of leg rotated and reattached to allow functional prosthesis use.
Surgeons confirm tumor-free margins
➛ Adjuvant Chemotherapy | After Surgery
Purpose: destroy any remaining microscopic cancer cells.
Same drug combinations as pre-surgery for another 6–8 months.
Response is evaluated based on necrosis rate.
➛ Radiation Therapy
Osteosarcoma is relatively radio-resistant, but radiation is used when:
• Surgery cannot remove all tumor tissue.
• Inoperable tumors.
• Palliative treatment for pain relief in metastasis.
➛ Targeted and Immunotherapy
Mifamurtide ➧ boosts immune system against osteosarcoma cells.
Denosumab.
Checkpoint inhibitors | PD-1 blockers | in trials for refractory cases.
➛ Neoadjuvant Chemotherapy | Before Surgery
Purpose:
Shrink the tumor
Kill micrometastatic cells
Improve surgical outcomes
Common drugs:
Cisplatin + Doxorubicin | Adriamycin
High-dose Methotrexate with Leucovorin rescue
Ifosfamide + Etoposide
Usually given for 8-10 weeks before surgery.
➛ Surgery | Main Treatment
Goal:
Remove entire tumor with clear margins.
Limb-Sparing Surgery:
Tumor removed and bone reconstructed with metal prosthesis, bone graft, or 3D-printed implant.
Amputation:
If tumor involves major nerves or blood vessels and limb cannot be preserved.
Rotationplasty:
Part of leg rotated and reattached to allow functional prosthesis use.
Surgeons confirm tumor-free margins
➛ Adjuvant Chemotherapy | After Surgery
Purpose: destroy any remaining microscopic cancer cells.
Same drug combinations as pre-surgery for another 6–8 months.
Response is evaluated based on necrosis rate.
➛ Radiation Therapy
Osteosarcoma is relatively radio-resistant, but radiation is used when:
• Surgery cannot remove all tumor tissue.
• Inoperable tumors.
• Palliative treatment for pain relief in metastasis.
➛ Targeted and Immunotherapy
Mifamurtide ➧ boosts immune system against osteosarcoma cells.
Denosumab.
Checkpoint inhibitors | PD-1 blockers | in trials for refractory cases.
9. Supportive and Rehabilitation Care
➛ Pain management and psychological support.
➛ Physiotherapy to regain limb function after surgery.
➛ Nutritional support during chemo.
➛ Prosthetic training | for amputees.
➛ Fertility preservation counseling before chemotherapy.
➛ Pain management and psychological support.
➛ Physiotherapy to regain limb function after surgery.
➛ Nutritional support during chemo.
➛ Prosthetic training | for amputees.
➛ Fertility preservation counseling before chemotherapy.
10. Follow-up and Monitoring
After Treatment:
Every 3 months for first 2 years
Every 6 months for next 3 years
Annually after 5 years
Includes:
Physical exam
X-ray or MRI of surgical site
Chest CT for metastasis detection
Blood tests for drug toxicity
After Treatment:
Every 3 months for first 2 years
Every 6 months for next 3 years
Annually after 5 years
Includes:
Physical exam
X-ray or MRI of surgical site
Chest CT for metastasis detection
Blood tests for drug toxicity
Read More
➛ Step by Step Overview
➛ Patient's Appeal
➛ Patients’ Stories
➛ Transparency Page
➛ Volunteer / Partner Page