Osteosarcoma (bone cancer) - Treatments, Symptoms, Causes

Osteosarcoma – what is bone cancer? What are the causes and risk factors?

In order to better understand the course of osteosarcoma, a type of cancer that starts in the bones, it is necessary to have information about the normal bone structure.

Normal bone structure

All the bones in our body have different functions. Bones, which are part of the skeleton, also support this structure. While the skull, chest and rib bones, which are called flat bones, protect and support our internal organs, the long bones that serve as a roof for our muscles that enable us to move are located in the arms and legs. In addition, new blood cells are produced in the inner and softer bone marrow part of the bone. It also meets the body's mineral needs by storing minerals such as calcium.

So, how does cancer occur in this structure, which has many functions?

Osteosarcoma is the most common type of bone cancer in the bones. Cancer begins primarily in the cells that make up the bone. Osteosarcoma, which starts mostly in the bones of the arms and legs; It can occur in part of the thigh bone in the leg or in the lower leg bone near the knee. The part of the arm bone near the shoulder is the second most common site of cancer. Osteosarcoma can also occur in different bones such as the hipbone (pelvis), shoulder or jaw, although it is not very common.

Osteosarcoma (bone cancer) subtypes

There are certain subtypes of osteosarcoma. While the disease is mild in some of these subspecies, it can be more aggressive in some species.

Osteosarcomas can be grouped as low, moderate, or high grade (grade = grade = grade). If the number of dividing cells in the tumor is low, it looks more like normal bone and progresses more slowly. This group of osteosarcomas is called low-grade. If the number of dividing cells is greater and growing rapidly, osteosarcoma is high-grade. In this group, bone cancer is more aggressive and tends to spread (metastasize) more to other organs.

Causes of osteosarcoma – what are the risk factors?

Osteosarcoma is not a common type of cancer in Turkey. Approximately 200 new cases of osteosarcoma occur in young people each year. Although bone cancers can occur at any age, they are most common in young people.

Although the exact cause of most osteosarcoma formations is not yet known, certain risk factors are thought to be associated with this disease. Factors that affect a person's chance of getting the disease are risk factors. While we can change some risk factors in life, we cannot change others (for example, we can control some risk factors by quitting smoking, but we cannot change our age.

It is important to remember that different types of cancer have different risk factors. However, some lifestyle factors, such as poor diet, lack of exercise or obesity, have not been linked to osteosarcoma in teenagers or adults.

What are the symptoms of osteosarcoma – bone cancer?

Pain and swelling
Bone pain is the most common symptom of osteosarcoma. At first, the pain comes and goes. This pain may worsen at night. In particular, the pain increases when moving and may cause limping if the tumor is in the leg.

Swelling in the painful area may occur weeks later. Depending on the location of the tumor, you may feel the swelling.

Cancer may not be detected immediately, as arm pain or swelling is quite normal in mobile children and teenagers. These symptoms are less common in adults. Buddha should be perceived as a sign to go to the doctor.

Fractures in bones that develop osteosarcoma
Bones that develop osteosarcoma weaken over time but often do not break. However, when the bone is broken, very severe pain occurs.

Osteosarcoma – how is bone cancer treated?

Treatment of osteosarcoma (bone cancer) has made great progress in recent years. Before the 1960s, the only treatment was surgical removal of the tumorous limb, namely amputation. However, over time, it was seen that although the surgery is a highly effective method locally, it was observed that almost more than 80% of the patients developed metastases in their lungs and lost their lives as a result of lung metastases. The 10-year survival rate was 10-15% in patients who were treated only with surgery before chemotherapy.

Osteosarcoma treatment methods

The main methods used in the treatment of osteosarcoma are; surgery and chemotherapy. In many cases, both chemotherapy and surgical intervention are required. Due to its biology, osteosarcoma is not sensitive to radiotherapy. Therefore, radiotherapy is not preferred in the treatment of osteosarcoma, except in very special circumstances.

Factors affecting the success rate of osteosarcoma treatment

In the light of the cancer stage; Some factors such as being young (younger compared to older adults), being female, having the tumor in the arm or leg bones, not in the hip bone, completely removing the tumor by surgery, normal results from certain blood tests, and positive response to chemotherapy treatment of the patient with osteosarcoma. will increase its success.

Osteosarcoma – bone cancer surgery

In this type of cancer, surgery is a biopsy to confirm the presence of cancer and surgery to remove the tumor.

The main goal in surgery is to remove the entire cancer. Even if a small amount of cancer cells remain, it paves the way for the development of a new tumor. Surgeons may also remove some normal tissue along with the tumor to make sure the cancer doesn't recur. This is called wide excision (removal of a large section). The form of surgery is performed depending on the location of the tumor. Tumors that develop in the skull, spine or hipbone (pelvis) are more difficult to treat.

Chemotherapy

Chemotherapy is drug therapy administered to the patient to kill cancer cells. The purpose of administering chemotherapy in a patient with early-stage cancer is to reduce the probability of regeneration of the disease by destroying the cancer cells that we cannot see with the naked eye during the formation of the tumor, which are detached from the main tissue and gone to other organs such as the lung, as well as shrinking and destroying the cancer tissue that we detect with imaging methods. The aim of giving chemotherapy to an advanced stage patient (metastasized) is to regress the disease and prolong life rather than saving life.

Is early diagnosis and screening possible in osteosarcoma? How is it diagnosed?

There are currently no specific tests to detect osteosarcoma in a person without symptoms or strong risk factors. It is best to consult a doctor as soon as possible when any symptom of the disease (such as swelling or bone pain) occurs. The sooner the diagnosis is made, the faster the chance of recovery.

Medical history and physical examination

If there are signs that indicate a tumor, your doctor will learn about your medical history and conduct a physical exam. It will also request some tests to make a definitive diagnosis.

Imaging tests used to diagnose osteosarcoma

Imaging tests; It is applied to reveal a possible cancer disease, to detect its spread, to determine the success rate of the treatment applied, or to observe whether the cancer recurs.

Bone X-ray application in osteosarcoma

Plain x-ray film, which is one of the simplest methods, is an auxiliary method in the diagnosis of osteosarcoma. However, after this application, which is not sufficient on its own, other comprehensive imaging methods will also be applied, and biopsy will be performed for a definitive diagnosis.

MRI (magnetic resonance imaging) application in osteosarcoma

MRI can be useful in detecting the diameter of the tumor in the bone and the areas where it extends, but it can also be useful in detecting small tumors 4-5 cm from the tumor from time to time. Knowing how far the tumor has spread is important for planning the best surgical intervention.

PET scan in osteosarcoma

The tests that best display the bone are tomography, MRI called magnetic resonance imaging, and PET-tomography, which has many advantages in cancer imaging today. These imaging methods can sometimes be performed individually and sometimes in combination. In today's conditions, we mostly use PET-Tomography and MRI to determine the location of osteosarcoma, its spread to the lymph nodes, its contact with neighboring organs and its operability.

Biopsy application in osteosarcoma

A biopsy is the only way to be sure the tumor is osteosarcoma or another type of bone cancer. It is very important to determine the type and aggressive feature of osteosarcoma, namely its grade (grade), in the biopsy procedure where pathological examination is performed in the laboratory by taking a sample from the tumor. If the tumor is within the bone, a surgeon experienced in the treatment of bone tumors should perform the biopsy. If the biopsy is done correctly, it prevents later problems and reduces the number of surgical interventions that will be needed later. The biopsy can be performed under general or local anesthesia, depending on the situation. Two types of biopsy methods are used in the diagnosis of osteosarcoma. These; needle biopsy and open (surgical) biopsy.

Biopsy

It can be performed using fine needle, thick needle and open biopsy techniques in the operating room. However, the preferred methods in order to determine the tumor characteristics exactly are thick needle or open biopsy. Fine needle biopsy is not preferred due to the possibility of very little tissue to be taken. It is an important point to remember that open (surgical) biopsy will prevent future problems if done in expert hands.