Osteosarcoma

Diagnosis

The doctor initially performs physical assessment to know the cause of the symptoms.

• Imaging tests: These are the diagnostic tests that may be performed to understand better what causes the symptoms, check for any signs of cancer and if the cancer has metastasized:
  • X-ray
  • Computerized Tomography (CT)
  • Magnetic Resonance Imaging (MRI)
  • Positron Emission Tomography (PET)
  • Bone scan
• Biopsy: Biopsy if performed by removing a sample of the tumor which will be sent to the laboratory to determine the presence of cancer as well as its stage and its grade (how aggressive it is). Osteosarcoma may be diagnosed by using the following types of biopsy:
  • Needle biopsy. A thin needle is inserted into the skin to reach for the tumor and get a small sample of tumor tissue.
  • Surgical biopsy. An incision is made by a surgeon on the skin and takes out a part (incisional biopsy) or the whole tumor (excisional biopsy).

Talk to your doctor on which type of biopsy should be performed in order to avoid getting in the way of possible cancer removal surgery in the future. An expert surgeon in osteosarcoma treatment should see you first before undergoing the biopsy.

Treatment

Surgery and chemotherapy are the common treatment for osteosarcoma or in some cases, radiation may also be used.

Surgery

Surgery is mainly done to take out all the cancer cells but it also depends on many factors, such as the size and location of the sarcoma.
The following surgical techniques are done to treat osteosarcoma:

• Limb-sparing surgery. Surgery may be done to remove the cancer without affecting the limb’s functionality. However, it depends on the extent of cancer and if a lot of muscles and tissues are removed.
  The doctor will do bone reconstruction if a portion of the bone is removed which may include bone grafting or prosthetics.
• Amputation. The whole limb or only a part of the limb may be removed. A prosthetic joint may further aid in resuming the limb’s function.
• Rotationplasty. This surgery may be done on children who are still growing. The technique is removing the cancer and the tissues around it, as well as the knee joint. Then, the foot and ankle is rotated while the ankle plays the role of the knee. For the lower leg and foot, a prosthesis will be utilized and this whole process results to returning the patient to normal activities of daily living, including physical activities and sports.

Chemotherapy

Chemotherapy uses medications which is administered intravenously or orally, or both. It may be done before surgery (neoadjuvant therapy) in order to shrink the tumor and spare the limb from surgery.
If the cancer is very aggressive, chemotherapy might not work. So, the doctors may need to combine different chemotherapy regimen or recommend a surgery that is more extensive to remove all the cancer. After the surgery, chemotherapy may also be applied to ensure that all the cancer cells are destroyed.
If osteosarcoma recur or has metastasized, chemotherapy may be used to slow down the disease.

Radiation therapy

Radiation therapy utilizes high powered energy beams through X-rays and protons to destroy cancer. Radiation may be used in situations where surgery cannot be done or if cancer cannot be totally removed by the surgeon.
A machine is navigated through the patient’s body while lying on a table. The beam is focused on the osteosarcoma’s area to spare the health cells nearby.