Testing and diagnosis for osteosarcoma

Many symptoms of osteosarcoma can be easily ignored as normal growing pains in children, which makes regular check-ups and referrals to specialists extremely important. Prompt diagnosis and identification of cancer is crucial to successful treatment.

If your child has been referred to an orthopedic or oncology specialist, your child’s diagnostic evaluation will begin with a thorough medical history and physical examination. A detailed neurological assessment may also be performed. This involves a series of questions and tests to check your child’s brain, spinal cord and nerve function.

At the Children’s Hospital the clinical experts use a variety of diagnostic tests to diagnose tumors, including:

• X-rays, which produce images of bones.
• Magnetic resonance imaging (MRI), which uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of organs, soft tissues, muscles, ligaments and other structures within the body. Your child is exposed to no radiation during an MRI.
• Computed tomography (CT) scan, which uses a combination of X-rays and computer technology to examine bones and other regions, such as the lungs, and produces cross-sectional images (“slices”) of the body.
• EOS imaging, an imaging technology that creates 3-dimensional models from two flat images. Unlike a CT scan, EOS images are taken while your child is in an upright or standing position, enabling improved diagnosis due to weight-bearing positioning.
• Positron emission tomography (PET) scan, which uses radioactive sugar injected into a vein and a scanner to make detailed, computerized pictures of areas of the body.
• Needle biopsy, which is a procedure where a doctor places a small needle through the skin and into the lesion to withdraw a small sample of the abnormal tissue. The tissue is analyzed to confirm the diagnosis.

In addition to diagnosing the specific type of cancer your child may have, these tests will also help determine the size and location of the tumor, and stage of the cancer. All this information is crucial in determining the best treatment options for your child.

Chemotherapy

Initial treatment for osteosarcoma always involves chemotherapy. Chemotherapy refers to medicines that help fight cancer. These medicines are usually given before and after surgery. This helps target the primary tumor as well as any cancer cells that may have already spread but may not yet been detected.

In most cases, chemotherapy is given to your child through an implantable venous port in the chest. This port remains in place for the duration of therapy and helps your child avoid multiple needle sticks.

Surgery

There are two goals of surgery in treating osteosarcoma:

• To remove the tumor
• To preserve or restore function at the site of the tumor

Surgery is always performed at the site where the tumor started (primary site).  Sometimes, surgery is also recommended to remove sites where the tumor has spread (metastases).

About 90 percent of children with osteosarcoma can be treated with limb-sparing (also known as limb-salvage) and reconstructive surgery. Surgeons regularly perform these complex surgeries and are constantly working to improve outcomes for children with the most difficult-to-treat tumors.

Limb-sparing surgery is performed under general anesthesia. It involves cutting out the tumor and a margin of healthy tissue surrounding it. Depending on the size and location of the tumor, as well as your child’s age and stage of growth, surgeons may use a variety of reconstructive methods to restore your child’s body function.