childhood osteosarcoma

Childhood Osteosarcoma: A Rare but Aggressive Bone Cancer

Childhood osteosarcoma, also known as pediatric osteosarcoma, is a rare and aggressive type of bone cancer that affects children and adolescents. It is the most common malignant bone tumor in this age group, accounting for approximately 400 cases per year in the United States.

Characteristics and Symptoms

• Osteosarcoma typically starts in the wide ends of long bones, such as the femur (thigh bone), tibia (shin bone), or humerus (upper arm bone).
• It can also occur in flat bones like the pelvis and skull.
• Common symptoms include:
  • Swelling or a lump near the affected bone
  • Bone pain that worsens over time, often becoming constant and more severe at night
  • Fractures (broken bones) due to weakened bone structure

Incidence and Demographics

• Osteosarcoma is extremely rare, affecting only about 1 in 100,000 children per year.
• It is most common in teenagers and young adults, with a slight peak incidence around the age of 15-19.

Treatment and Prognosis

• Treatment for osteosarcoma typically involves a combination of limb-sparing surgery and chemotherapy.
• Advances in treatment have significantly improved outcomes, with many children experiencing complete remission or long-term survival.

References:

[1] Osteosarcoma is the most common malignant bone tumor among children, adolescents, and young adults. [2] Osteosarcoma usually starts in the wide ends of long bones. [3] Symptoms include swelling, fractures, and bone pain. [4] Treatment typically includes limb-sparing surgery and chemotherapy. [6]

Diagnostic Tests for Childhood Osteosarcoma

Childhood osteosarcoma, a type of bone cancer, requires accurate diagnosis to determine the best course of treatment. The following diagnostic tests are commonly used to diagnose and stage osteosarcoma in children:

• Imaging tests: These tests create pictures of the body and can show the location and size of an osteosarcoma. Tests may include:
  • X-ray: A small amount of radiation is used to take pictures of bones and other body tissues.
  • MRI (Magnetic Resonance Imaging): Radio waves and strong magnets are used instead of x-rays to create detailed images.
  • CT (Computed Tomography) scan: A series of x-ray images taken from different angles to create a 3D picture.
  • Bone scan: A small amount of radioactive material is injected into the bloodstream, which accumulates in areas with high bone activity.
  • PET (Positron Emission Tomography) scan: A type of imaging test that uses a small amount of radioactive material to detect cancer cells.
• Blood tests: Blood tests can show changes in some blood tests, such as:
  • Liver tests
  • Erythrocyte sedimentation rate (ESR)
  • Lactate dehydrogenase (LDH) and alkaline phosphatase levels
• Biopsy: A biopsy is needed to diagnose osteosarcoma. The biopsy may be done with a needle or with surgery, and it's essential that the biopsy be done by a doctor with experience in bone tumors.

These diagnostic tests help determine the exact type of tumor, whether it has spread, and guide treatment decisions for childhood osteosarcoma.

References:

• [1] Osteosarcoma diagnosis may begin with a physical exam. Imaging tests make pictures of the body. They can show the location and size of an osteosarcoma. Tests might include: X-ray. MRI. CT. Bone scan. Positron emission tomography scan, also ...
• [2] Testing and diagnosis for osteosarcoma. ... Joint replacement if your child's osteosarcoma is located on or near the knee, hip or shoulder.
• [3] Osteosarcoma can cause changes in some blood tests. For instance, liver tests and the erythrocyte sedimentation rate may be higher than normal. Blood tests ...
• [4] A biopsy is needed to diagnose osteosarcoma. The biopsy may be done with a needle or with surgery. It's very important that a biopsy be done by a doctor with experience and knowledge about bone tumors.
• [5] Diagnostic procedures for osteosarcoma are used to determine the exact type of tumor your child has and whether the tumor has spread. Your child's doctor will perform a complete medical and physical examination. In addition, your child's physician may order some of the following diagnostic tests for osteosarcoma: X-ray
• [6] Diagnosis of osteosarcoma. Several tests are used to diagnose osteosarcoma. They include: Health history and physical exam Blood tests to learn about symptoms, general health, past illnesses, and risk factors. Imaging tests to look for tumors and help determine other tests that are needed.

Treatment Options for Childhood Osteosarcoma

Childhood osteosarcoma, a type of bone cancer most common in children and teens, is typically treated with a combination of chemotherapy and surgery. The main goal of treatment is to eliminate the cancer cells while preserving as much normal tissue as possible.

Chemotherapy: A Key Component of Treatment

Chemotherapy plays a crucial role in treating childhood osteosarcoma. It involves using medications to kill cancer cells or slow their growth. The most common chemotherapy combination used to treat childhood osteosarcoma is:

• High-dose methotrexate
• Doxorubicin (Adriamycin)
• Cisplatin

These drugs work by interfering with the cancer cells' ability to grow and divide, ultimately leading to cell death.

Targeted Therapy: A Promising New Approach

Researchers are now studying newer targeted therapy drugs that specifically target certain parts of tumor cells or nearby cells. These targeted drugs work differently from standard chemotherapy drugs and may offer new treatment options for children with osteosarcoma who have not responded to traditional therapies.

Other Treatment Options

In some cases, other types of drugs might be an option when chemo drugs are no longer helpful. These include:

• Targeted therapy drugs
• Radioactive drugs (radiopharmaceuticals)

It's essential to note that treatment plans can vary depending on each child's situation, and a team approach is recommended when treating osteosarcoma.

References:

• [3] The chemotherapeutic drugs most active in osteosarcoma are doxorubicin, cisplatin, and high-dose methotrexate (for which a low dose is ineffective).
• [5] Chemotherapy is a group of drugs that interferes with the cancer cells' ability to grow and divide.
• [6] Various drugs have been used to treat osteosarcoma, including doxorubicin, cisplatin, ifosfamide, and high-dose methotrexate (MTX) with leucovorin rescue.
• [8] The most common chemotherapy combination used to treat childhood osteosarcoma is: high-dose methotrexate, doxorubicin (Adriamycin), and cisplatin.

Differential Diagnoses of Childhood Osteosarcoma

Childhood osteosarcoma, a type of bone cancer, can be challenging to diagnose due to its similarity in symptoms with other conditions. The following are some of the key differential diagnoses that need to be considered:

• Osteomyelitis: This is an infection of the bone and marrow, which can present with similar symptoms such as pain, swelling, and fever [4]. It is essential to differentiate osteosarcoma from osteomyelitis, especially in children, as the treatment approach would be different.
• Rhabdomyosarcoma: This is a type of soft tissue cancer that can also present with pain and swelling in the affected area. Rhabdomyosarcoma needs to be ruled out through imaging studies and biopsy [5].
• Chondrosarcoma: This is another type of bone cancer that can occur in children, although it is less common than osteosarcoma. Chondrosarcoma typically presents with pain and swelling in the affected area, similar to osteosarcoma [6].
• Ewing's sarcoma: This is a rare type of bone cancer that can also present with pain and swelling in the affected area. Ewing's sarcoma needs to be ruled out through imaging studies and biopsy [11].

Key Points

• Osteomyelitis, rhabdomyosarcoma, chondrosarcoma, and Ewing's sarcoma are all potential differential diagnoses for childhood osteosarcoma.
• Accurate diagnosis is crucial to determine the appropriate treatment approach.
• Imaging studies and biopsy are essential in differentiating these conditions.

References

[4] - Osteomyelitis can be easily ignored as normal growing pains in children, which makes regular check-ups and referrals to specialists extremely important [2]. [5] - Rhabdomyosarcoma needs to be ruled out through imaging studies and biopsy [5]. [6] - Chondrosarcoma typically presents with pain and swelling in the affected area, similar to osteosarcoma [6]. [11] - Ewing's sarcoma needs to be ruled out through imaging studies and biopsy [11].