Pediatric Oncology and Cancer Care

Osteosarcoma Childhood Bone Cancer

Osteosarcoma childhood bone cancer is the most common primary malignant bone tumor in children and adolescents, typically arising during periods of rapid bone growth in the teenage years. This tumor originates from primitive bone-forming mesenchymal cells and usually develops in the metaphyseal region of long bones, most commonly affecting the distal femur, proximal tibia, and proximal humerus. The cause of osteosarcoma is not entirely understood, but genetic conditions such as Li-Fraumeni syndrome, hereditary retinoblastoma, and Rothmund-Thomson syndrome are associated with an increased risk. The classic presentation includes localized bone pain that may worsen at night or with activity, swelling, and sometimes a noticeable mass near a joint. Fractures can also occur at the tumor site due to weakening of the bone. Diagnostic evaluation involves radiographic imaging, magnetic resonance imaging to determine the local extent of the tumor, and a biopsy to confirm diagnosis and histological subtype. Additional tests such as chest computed tomography and bone scans or positron emission tomography scans are conducted to assess for metastatic disease, which most often spreads to the lungs. Treatment of osteosarcoma is based on a combination of neoadjuvant chemotherapy, surgical resection, and adjuvant chemotherapy. Chemotherapy typically includes agents like methotrexate, doxorubicin, and cisplatin, which are effective in shrinking the tumor and eliminating micrometastases. Surgical options include limb-sparing surgery or amputation, depending on the tumor size, location, and response to chemotherapy. Advances in surgical techniques and prosthetic development have made limb preservation possible for the majority of patients. However, in some cases where the tumor encases vital structures, amputation remains necessary. Radiation therapy is generally not effective for osteosarcoma due to its resistance to radiation. Prognosis depends on several factors, including tumor size, response to chemotherapy, and presence or absence of metastasis at diagnosis. While the overall survival rate for localized osteosarcoma approaches 70 to 75 percent, outcomes are significantly poorer for patients with metastatic disease. Long-term survivors may experience chronic health issues such as cardiotoxicity, nephrotoxicity, hearing loss, and functional impairments, underscoring the importance of lifelong follow-up and multidisciplinary survivorship care. Research continues to investigate targeted molecular therapies, immunotherapies, and biomarkers that may allow for more individualized and less toxic treatment regimens. Osteosarcoma childhood bone cancer remains a significant focus in pediatric oncology, with ongoing efforts to improve cure rates while minimizing long-term harm.