Osteosarcoma refers to a malignant bone tumor and is therefore colloquially known as bone cancer. The cancer cells affect the bone and also spread throughout the body, especially to the lungs. If the disease is treated early, there is generally a good chance of cure.
What is osteosarcoma?
The term osteosarcoma, or osteogenic sarcoma, is used by physicians to describe a malignant tumor that affects the patient’s bones. Both the bone and often a nearby joint are affected and destroyed. Via the bloodstream, the cancer cells migrate to the lungs and form metastases there. Osteosarcoma is the most common bone tumor – approximately 200 people are diagnosed with it in Germany each year. Males between the ages of 10 and 25 are particularly frequently affected. The disease mostly affects the so-called long bones such as the upper arms or thighs, especially near the shoulder or knee joint. Osteosarcomas of the spine or skull, on the other hand, occur only in very rare cases.
Causes
The exact causes of osteosarcoma are not yet known. However, because the disease occurs particularly often during puberty, it is suspected that the increased bone activity that occurs at this time is related to osteosarcoma. In addition to bone growth, genetic factors are also very likely to play a role. Pre-existing diseases of bone or cartilage such as Paget’s disease] or even osteochondroma may increase the risk of osteosarcoma. Prior cancer with additional chemotherapy or radiation therapy may also contribute to the development of osteosarcoma.
Symptoms, complaints, and signs
Osteosarcoma is mainly characterized by swelling around the affected bone. The swelling enlarges quickly but is usually painless. However, if pain occurs in the bone regardless of weight-bearing, this is a clear indication of osteosarcoma. Then, at the site of the swelling and redness, there is pressure sensitivity in addition to persistent bone pain. Bone cancer that is located near a joint causes particularly stressful symptoms. This can lead to a very painful restriction of mobility. Since the structure of the bone is destroyed by the tumor, it can no longer adapt to everyday stresses. The affected bone therefore has a completely unstable structure. The risk of bone fractures is greatly increased. Thus, sudden bone fractures can occur even under normal conditions without load. As long as the cancer has not spread, the symptoms remain localized to the affected bone or adjacent joints. However, after metastasis to other organs, other symptoms appear, but they are nonspecific. Thus, fever, fatigue, and loss of performance, among other symptoms, are observed. If the cancer has not yet spread, the prospects of cure are very good, provided that the tumor could be completely removed. Usually, however, the removed bone must be replaced by an endoprosthesis.
Diagnosis and course
If osteosarcoma is suspected, the attending physician will order an x-ray of the bones. Often, a diagnosis can already be made based on this. To determine the extent to which the cancer cells have already spread in the body, a computer tomography scan and a blood test, for example, may also be performed. A tissue sample taken directly from the tumor can also confirm the diagnosis and provide information about the patient’s condition. If osteosarcoma is treated in time, the chances of cure and survival are quite good, depending on the patient’s general condition and the spread of metastases. Statistically, 70% of patients survive the first 5 years after diagnosis. However, if therapy is not received, osteosarcoma is definitely a life-threatening disease.
Complications
Usually, osteosarcoma results in cancer in the bones. This cancer occurs in most cases directly in the legs and in the arms of the patient, so that it comes increasingly to strong pain and to restrictions in the everyday life and also in he movement of the patient. Those affected also continue to appear fatigued and suffer from a significantly reduced ability to cope with stress.Likewise, the tumor can also spread to other regions of the body and form cancer cells there. In this case, the patient’s life expectancy is reduced in most cases. Complications and life-threatening conditions usually occur when osteosarcoma is not treated. Self-healing does not occur in this case. Osteosarcoma is usually treated by chemotherapy followed by surgery. Usually, no complications occur. However, the chemotherapy itself can be associated with severe side effects. Radiation therapy may also be necessary for osteosarcoma to completely defeat the cancer. In most cases, however, patients with osteosarcoma also rely on psychological treatment.
When should you see a doctor?
Swelling of the bones or limitations in range of motion should be presented to a doctor. If there is a permanent or gradual impairment of the musculoskeletal system, there is cause for concern. Since the fastest possible diagnosis and treatment are important for the healing prospects of an osteosarcoma, a visit to the doctor should already be made at the first irregularities. Otherwise, in an advanced stage of the disease, the premature death of the affected person is imminent. Ulcers, pain or impaired joint function should be examined and treated. A general feeling of malaise, an unwanted loss of body weight, and a sensation of warmth in the affected areas indicate a disease requiring treatment. Fever, a drop in physical resilience or general performance as well as faintness and fatigue are signs that should be presented to a doctor. Sensory disturbances, a feeling of numbness and hypersensitivity to touch should be clarified. If there is inner weakness or restlessness, mood swings and apathy, a medical examination should be carried out. If the patient is no longer able to perform normal daily activities without pain and is unable to participate in sports, he or she needs medical care. A characteristic feature of osteosarcoma is a steady increase in symptoms and, at the same time, a gradual decrease in quality of life. A visit to the physician is recommended at the first suspicion of a disorder.
Treatment and therapy
If the treating physician has clearly diagnosed osteosarcoma, he or she will most likely order chemotherapy. This is to help prevent the cancer cells from growing and spreading further in the body. In addition, this type of treatment usually shrinks the tumor, making it more accessible. This is followed by surgery to remove the tumor. If metastases already exist, these must also be surgically removed, if this is possible. As a matter of principle, healthy tissue from the immediate vicinity is also always removed during this operation in order to exclude the possibility of the osteosarcoma recurring. In some cases, amputation of the affected part of the body may be necessary; however, this is rarely the case. In most cases, chemotherapy is necessary again after the operation. If the tumor could not be completely removed, radiation therapy may also be administered. Even after the tumor has been cured, regular follow-up care must take place to ensure that there are no more cancer cells in the body. For this purpose, among other things, the lungs are also examined in detail, and this is done over a period of about five years. Only then can one speak of a complete cure in the medical sense. Whether the therapy is effective and the cancer can be defeated depends on the general condition of the patient and also on the stage of the disease.
Outlook and prognosis
The prognosis for osteosarcoma depends largely on how large the tumor is at the time of discovery, which bone has been affected, and whether metastases are already present in other organs. Tumors on the trunk and very extensive osteosarcomas are more difficult to treat successfully than small tumors and osteosarcomas on the extremities. If complete surgical removal of the tumor is possible and aggressive chemotherapy given before and/or after surgery responds well, physicians estimate a 5-year survival rate of 50 to 80 percent under favorable circumstances.If lung metastases also have to be removed, the chance of survival or cure drops to around 40 percent. If chemotherapy does not achieve the desired effect – i.e. less than 90 percent of the tumor cells can be killed – the chance of survival in the long term also falls below 50 percent. In the event of recurrence of the disease (relapse), the 5-year survival rate is statistically only about 25 percent; however, the actual prospect of long-term tumor freedom depends on many factors and cannot be predicted for individual cases. Recurrences usually occur within the first two to three years after initial diagnosis. Patients who live longer than five years after diagnosis can usually be considered cured.
Prevention
Because the causes of osteosarcoma are not clearly understood, prevention in the strict sense is not possible. However, if complaints such as pain, redness and swelling occur in the area of the knee joint or the upper arm or thigh bone over a longer period of time, a doctor should always be consulted as a precaution to rule out a possible osteosarcoma.
Follow-up care
After cancer treatment, patients are by no means conclusively cured. There is a risk that osteosarcoma may return and spread. Therefore, follow-up care is an indispensable part of any tumor treatment. Physician and patient usually agree on the place and extent of follow-up care before the end of therapy. In the first few years, an examination usually takes place once a quarter. Thereafter, the interval increases from appointment to appointment. From the fifth year of freedom from symptoms, annual follow-up examinations are usually sufficient. Patients are strongly encouraged to attend the suggested appointments. Diagnosis in the early phase promises the best treatment success. Immediately after treatment of osteosarcoma, rehabilitation often takes place. This prepares the patient for reintegration into his or her profession and social environment. During this time, experts specifically address the patient’s symptoms and promote mobility and independence. Subsequent medical follow-up examinations initially include a discussion in which the current condition is inquired about. If necessary, a physical examination is also performed. Important components in the treatment of osteosarcoma are imaging procedures such as X-rays and computer tomographies. This allows the doctor to detect a tumor in the body from the outside.
Here’s what you can do yourself
Osteosarcoma is a serious disease that requires mandatory medical treatment. Nevertheless, patients can help regenerate and improve their quality of life through self-help in everyday life. This is possible through physically and psychologically oriented measures. Consultation with the attending physician is always advisable. In the physical area, osteosarcoma and its surgery can lead to bone damage, which can be compensated by muscle training. Stabilization through muscle training is instructed in physiotherapy and can be continued by the patient at home. Moderately dosed endurance training often restores fitness and well-being after therapy. Swimming and walking are particularly suitable in this context because they are easy on the joints. Patients with cancer such as osteosarcoma receive psychological stability in self-help groups and from psychologists and psychotherapists. Psychooncologists are specially trained for the needs of cancer patients. Conversations with relatives and friends are also often helpful, although sometimes it is the social gathering that provides distraction and creates normality. A healthy diet and sufficient sleep are important for all cancer patients and therefore also for osteosarcoma. Nutritional supplements or immunostabilizing agents may only be taken after consultation with the doctor. Relaxation brings procedures such as autogenic training, progressive muscle relaxation as well as yoga. These can be learned from health insurance companies, in adult education centers or in studios.