Child Osteosarcoma

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By Chris Ryan and Dr. Kevin Buckman

One of the most common types of bone cancers that occur in young kids is Pediatric osteosarcoma. This condition also affects young adults between 10 to 25 years of age. The age of 15 is when this condition can peak since the long bones in the body are going through a major spurt in growth. Such cases of osteosarcoma are found to be equal between boys and girls till about the age of 13. Post this; there is a marked increase in male cases. About 400 new cases of this sarcoma are seen annually in the United States.

About 5-6% of childhood tumors are bone cancers and more than half of these cases are osteosarcoma related. This is 4th among the common childhood cancers, the others being lymphoma, leukemia, and brain tumors respectively. Another called Ewing’s sarcoma is also a common childhood cancer which accounts for about 34%. Demographic statistics indicate the prevalence of Osteosarcoma is only slightly more in whites than in blacks. However the incidence of Ewing’s sarcoma is much higher amongst white folks – the numbers being six times higher than blacks.

Evidence suggests that there are multiple causes for osteosarcoma. A few well defined associations and risk factors do exist. For instance, those people who have the Li-Fraumeni syndrome (a rare inherited disorder) face a higher than usual risk of contracting cancers (including osteosarcoma). This seems to suggest a genetic connection to this cancer. Similarly children suffering from a condition like retinoblastoma (a rare tumor of the eye) stand to face a higher risk against osteosarcoma. The mutation of the RB1 gene is considered to be the primary factor in both conditions.

Rapid bone growth is also considered a key factor in the development of this disease given that its occurrence usually takes place in those areas of bone which divide rapidly (i.e. areas closest to the ‘physes’ or ‘growth plates’). More than 90 percent of osteosarcomas is present in the long bones at their growing ends. Within that, about 80 percent occur around the knee at the tibia (upper end) or at the femur (lower end). The humerus (upper arm bone that is nearest the shoulder) is also another area which is prone to get affected. Other sites of occurrence are the pelvis, clavicle, rib along with the flat bones found in the skull and face, although these tumors are slightly different from other osteosarcomas. Survival rates for tumors of the craniofacial or other flat bones after a complete removal of the involved bone are very good. However the nature of the surgery itself can be difficult and disfiguring because of the location of the tumors.

Typical osteosarcoma symptoms are pain (there may or may not be swelling) in the long bones. Affected area may possibly feel heated. In several cases the osteosarcoma has been discovered when the child in question has an injury to the area. The tumor of course has not been caused by the injury (an erroneous assumption in the past) but it does bring the problem into focus. An unexplained or persistent limp in a child can also be a sign of a possible tumor. There might be a reduced ability in moving the joint in question.

It must be kept in mind that all osteosarcomas don’t necessarily develop as solitary lesions within the long bones. There can be multiple sites of malignancy, or the disease can start as a solitary lesion after which it spreads within a few months of the initial examination. Pain is the chief indicator/symptom of this disease especially when that pain occurs during an activity. Respiratory symptoms (breathlessness) may also be present in case the disease has spread to the lungs.


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