The clinical picture depends on the size or extent, location, and stage.
The following symptoms and complaints may indicate osteosarcoma:
Main symptoms
- Early bone pain that is load-dependent at onset but later occurs at rest and/or at night
- Local swelling, deformation at joints and bones (palpable) – swelling may be reddish or bluish in color
- Restriction of mobility of the adjacent joint.
- Fractures (bone fractures) after minor trauma, mostly femur (thigh bone) and humerus (upper arm bone) are affected – osteolytic tumors break down bone substance; generally, the bone loses strength due to the tumor
- Inhibition of bone growth in the area of the tumor (in children).
Associated symptoms (in advanced disease).
- Loss of appetite
- Weakness in performance
- Fatigue
- Vertigo (dizziness)
- B-symptomatics (see below).
B-symptomatics
- Severe night sweats (wet hair, soaked sleepwear).
- Unexplained, persistent or recurrent fever (> 38 °C).
- Unintentional weight loss (> 10% percent of body weight within 6 months).
Localization
Typical of primary bone tumors is that they can be assigned to a characteristic localization in addition to a specific age range. They arise clustered at the sites of most intense longitudinal growth (metaepiphyseal/articular area).
The following questions should be answered by diagnostic measures:
- Localization in the skeleton → Which bone is affected?
- Localization in the bone → epiphysis* (joint end of the bone (near the joint)), metaphysis* (transition from epiphysis to diaphysis), diaphysis* (long bone shaft), central, eccentric (not central), cortical (at the solid outer shell of the bone), extracortical, intraarticular (within the joint capsule).
Osteosarcoma commonly occurs in the metaphyses of the long tubular bones of the femur (thigh bone), humerus (upper arm bone), and tibia (shin bone) (> 80%). In about 50% of cases it is found near the knee joint and in 10% near the shoulder joint. Rarely, osteosarcoma is also found in the forearm, pelvis, skull or spine.
* Example of the structure of a long bone: epiphysis – metaphysis – diaphysis – metaphysis – epiphysis.
