Osteosarcoma is a rare malignancy. Annually, approximately 1,000 new osteosarcoma cases are identified in the United States. Approximately fifty percent of these cases involve children and adolescents. Most osteosarcomas manifest in children, adolescents, and young adults aged 10 to 30. Adolescents are the most frequently impacted demographic, although individuals of any age may acquire osteosarcoma. Approximately 10% of osteosarcomas manifest in individuals over the age of 60. Osteosarcoma primarily occurs in the long bones and infrequently in soft tissues.
Clinical Description, classification and symptoms
| Classification Level | Disorder |
| Prevalence | 1-9 / 100 000 |
| Age of Onset | Childhood |
| Inheritance | NA |
Osteosarcomas can be categorized as high grade, intermediate grade, or low grade based on the appearance of the cancer cells under the microscope. Both the tumor’s stage and the method of treatment are affected by its grade. Osteosarcomas of high grade are the ones that grow the quickest. Under the microscope, they appear abnormal, and numerous cancer cells are actively dividing to form new cells. In young people, high-grade osteosarcomas predominate. Doctors can predict the likelihood of rapid tumor growth and metastasis based on the tumor grade. The symptoms will differ based on the precise location and severity of the disease. The most prevalent symptom of osteosarcoma is pain, and often, a palpable mass or lump is present. Localized disease, which refers to the cancer’s persistence in the initial site of development, is observed in eighty percent of individuals. Osteosarcoma has the potential to metastasize to other regions of the body, with the lungs being the most likely destination. Radiation can induce osteosarcoma, although the precise cause is unknown in most cases.
Figure 1: Osteosarcoma, Image source: Malini Gupta
Diagnosis and treatment
Historically, all osteosarcoma patients received amputation, although the cure rate was below 10%, and most died within a year. In specialized bone tumor facilities, pre- and postoperative chemotherapy and surgery cure 60% to 70% of localized osteosarcoma cases (80%). Osteosarcoma treatment depends on the tumor’s location, extent, grade, total resection feasibility, age, and health.
Almost 90% of surgeries are conservative and aim to preserve limbs. Tumors in the axial skeleton and those with metastases have a 30% cure rate. Plain radiography, computed tomography, magnetic resonance imaging, angiography, and dynamic bone scintigraphy are used to diagnose, assess tumor involvement, and determine the best surgical approach and reconstruction.
Recurring cancers often require chemotherapy. If the cancer is unresectable, chemotherapy can shrink the tumor(s) to prepare for surgery. If the malignancy is operable, chemotherapy may follow surgery. In advanced cancers, chemotherapy may relieve symptoms.
The treatment plan may include radiation. It can sometimes control tumor growth and relieve symptoms. Novel therapy clinical trials may be an option for treating these malignancies, which are difficult to treat.
Understanding Osteosarcoma requires a comprehensive approach to managing its impact on the body and exploring various treatment and supportive care options to enhance patient outcomes and quality of life. For more on therapeutics against this disease, stay tuned for O for Osteosarcoma Part II. Meanwhile, click here for more available resources and support groups for Osteosarcoma.
Sources
- https://rarediseases.org/rare-diseases/osteosarcoma/
- https://www.orpha.net/en/disease/detail/668#
- https://www.curesarcoma.org/sarcoma-resources/patient-resources/sarcoma-information-links/
- https://www.cancer.org/cancer/types/osteosarcoma/about/what-is-osteosarcoma.html
- Figure derived from: https://www.nejm.org/doi/full/10.1056/NEJMra2103423
- Figure derived from: https://www.nature.com/articles/nrendo.2017.16#MOESM146
