Diagnosis & Treatment of Osteosarcoma
Osteosarcoma is usually discovered because a person exhibits certain signs or symptoms, such as swelling or pain in a bone or joint, that prompts a visit to the doctor. If the doctor suspects a bone sarcoma after completing a medical history and performing a physical exam of the patient, other testing is required to confirm the diagnosis.
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This includes one or more of the following:
- Imaging tests, including:
- X-ray: An X-ray is a type of energy beam that can pass through the body and onto a film to make a picture of areas inside the body. X-rays will be taken of the chest and the area where the tumor is located.
- EOS imaging: EOS imaging is a type of X-ray obtained by scanning a patient in either a standing or sitting position using a low dose of radiation; in children, EOS imaging simultaneously captures frontal and lateral full body images in just 15 seconds.
- Magnetic resonance imaging (MRI) scan: This procedure uses a magnet, radio waves and a computer to make a series of detailed pictures of areas inside the body. Your child is not exposed to radiation during an MRI.
- Computed tomography (CT) scan: This type of scan uses a combination of X-rays and computer technology to create cross-sectional images of bones or other parts of the body.
- Bone scan: In this procedure, a very small amount of radioactive material is injected into a vein and travels through the bloodstream to collect in the bones affected by cancer. A scanner is used to detect the radioactive material.
- Positron emission tomography (PET) scan: In this type of imaging, a radioactive sugar is injected into a vein. A scanner detects the radioactive material to make detailed, computerized pictures of areas of the body.
- Biopsy: If the results of imaging tests strongly suggest that a patient has osteosarcoma or some other type of bone cancer, a biopsy (the removal of some of the tumor for viewing under a microscope and further testing) will be performed. Two main types of biopsies are used to diagnose suspected bone tumors:
- Core needle biopsy: For this type of biopsy, the doctor uses a hollow needle to extract a small cylinder of tissue from the tumor. This procedure is typically performed with local anesthesia, where a numbing medicine is injected into the skin and other tissues at the biopsy site.
- Surgical (open) biopsy: In an open biopsy, the physician – usually an orthopedic surgeon – cuts through the skin to expose the tumor and remove a small sample. Open biopsies are usually performed in an operating room with the patient under general anesthesia.
- Lab tests: A pathologist tests the biopsy samples. If osteosarcoma is diagnosed, the pathologist will assign the tumor a grade, which is a measurement of how quickly the cancer is likely to grow and spread based on the appearance of the tumor cells.
- Blood tests: Though not used to diagnose osteosarcoma, blood tests may be ordered once a diagnosis is made to help gauge the advancement of the osteosarcoma and to provide the doctor with a profile of a person’s overall health. Blood tests are also used to monitor a person’s health while they receive chemotherapy.
How is Osteosarcoma Treated?
If your child is diagnosed with osteosarcoma, his or her care team at UH Rainbow Babies & Children’s Angie Fowler Adolescent & Young Adult Cancer Center will discuss treatment options with you. It is you important to weigh the benefits of each option against possible risks and side effects.
Treatment options for osteosarcoma include surgery, chemotherapy, radiation therapy, Samarium, targeted therapy and immunotherapy:
- Surgery
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Whenever possible, surgery is used to remove the entire tumor. Among the surgical procedures we perform are:
- Wide local excision: Removal of the cancer and some healthy tissue surrounding it
- Limb-sparing surgery: Removal of the tumor in a limb (arm or leg) without the need for amputation; most patients who have osteosarcoma in a limb are eligible for limb-sparing surgery
- Amputation: In some cases, surgery to remove part or all of an arm or leg may be necessary, particularly when removal of the entire tumor via limb-sparing surgery is not possible. Following amputation, the patient may be fitted with a prosthesis (artificial limb).
- Rotationplasty: A surgical procedure in which a knee tumor and a knee joint are removed. The portion of the leg that remains below the knee is then attached to the section of the leg that remains above the knee, with the foot facing backward and the ankle acting as a knee. Often, a prosthesis will be attached to the foot.
After all the cancer that is visible at the time of the surgery is removed, patients receive chemotherapy to kill any cancer cells that remain in the area where the tumor was removed or that have spread elsewhere in the body. Treatment provided after surgery to lower the risk of the cancer returning is called adjuvant therapy.
- Chemotherapy
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Chemotherapy uses drugs to stop the growth of cancer cells, either by killing the cells or by preventing their division/reproduction. It is typically administered before and after the surgery to remove the primary tumor. When chemotherapy is taken orally or injected into a vein or muscle, the drugs enter the bloodstream and reach cancer cells throughout the body (systemic chemotherapy).
- Radiation Therapy
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Osteosarcoma cells are not easily killed by external radiation therapy. However, external radiation therapy may be utilized when a small amount of cancer remains after surgery or in combination with other treatments.
The UH Proton Therapy Center is Northeast Ohio’s only provider of proton therapy, an advanced type of radiation therapy used in the treatment of osteosarcoma and other types of cancers. Available only at select hospitals across the country, proton therapy delivers most of its energy to a very narrow field at the location of the tumor, resulting in less damage to surrounding healthy tissue. In comparison to other forms of radiation therapy, proton therapy can result in better quality of life during treatment and may reduce the risk of patients developing radiation-induced secondary cancers later in life.
- Samarium
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Samarium is a radioactive drug that targets areas where bone cells are growing, including cancer cells. This medicine assists in relieving pain caused by bone cancer. This therapy is used to treat osteosarcoma that returns after initial treatment to appear in a previously unaffected bone. Treatment with samarium may be followed by a stem cell transplant.
- Targeted Therapy
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Targeted therapy is a form of treatment that uses drugs or other substances to identify and attack specific cancer cells. It generally causes less harm to normal cells than chemotherapy or radiation therapy. The two main types of targeted therapy used in the treatment of osteosarcoma are:
- Kinase inhibitor therapy: Kinase inhibitors block a protein needed for cancer cells to divide. Kinase inhibitor therapies such as Sorafenib, Regorafenib and Lenvatinib may help in the treatment of osteosarcoma.
- Mammalian target of rapamycin (mTOR) inhibitors: These inhibitors block a protein called mTOR, which may inhibit the growth of cancer cells and prevent the formation of new blood vessels that tumors need to grow. Everolimus is an example of an mTOR inhibitor indicated in the treatment of recurrent osteosarcoma.
- Immunotherapy
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Immunotherapy utilizes a person’s own immune system to help kill cancer cells. Most immunotherapeutic approaches are relatively new and in the clinical trial phase of development. These approaches offer hope for young cancer patients to receive targeted treatment agents that may prevent the long-term, damaging side effects associated with more traditional cancer treatment methods such as chemotherapy and radiation.
The physician-scientists at the UH Rainbow’s Center for Pediatric Immunotherapy in the Angie Fowler Adolescent & Young Adult Cancer Institute are spearheading research efforts to find, test and develop new immunotherapy agents, which have unlimited potential and could represent the most effective cancer-killing treatments of the future.
Current research efforts in immunotherapeutic approaches for treating osteosarcoma include a Phase I and II clinical trial that will begin in the first quarter of 2022 to examine the effectiveness of a natalizumab – a humanized monoclonal antibody – to treat recurrent, refractory and progressive pulmonary metastatic osteosarcoma. Natalizumab works to target white blood cells in a way that may reduce inflammation caused at tumor site. Early results suggest this therapy may be effective in treating osteosarcoma and other types of pediatric sarcomas.
In addition, researchers at the Center for Pediatric Immunotherapy have identified a naturally derived compound from oat bran as a potential novel cancer therapeutic. The outer shell of the oat is highly immunogenic and can stop tumor growth in mouse models of osteosarcoma and certain other cancers by eliciting a strong anti-tumor immune response.
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