Osteosarcoma: Specialists and Information

In German-speaking countries, two to three people per million inhabitants are diagnosed with osteosarcoma each year.

The disease sometimes occurs at an early age. At the time of diagnosis, girls are 14 years old on average, and boys are 18. After that, the incidence declines again.

However, the risk rises again between the ages of 40 and 60.

Osteosarcoma often causes no or only mild symptoms. Even the tumor-related swelling is often painless.

If pain occurs in a bone regardless of physical activity, it may be a sign of bone cancer. About half of all patients experience pain in the knee, which is usually mistaken for an injury. If you experience pain, it is important to see a doctor as soon as possible.

Some patients also experience breathing difficulties in later stages.

Extensive testing is necessary to determine whether these symptoms are actually caused by cancer.

The precise diagnosis serves to determine the location, spread, and stage of the tumor. It is crucial for selecting the appropriate treatment. Examinations should be performed by a doctor who specializes in this field.

During the initial consultation, the doctor asks about the nature of the symptoms and their progression. He or she palpates the bone and has the patient perform exercises to identify any limitations in movement.

This is followed by imaging tests:

An X-ray is used to detect a tumor. Small tumors often cannot be detected by this test. To allow for comparison, an X-ray of the same bone on the opposite side of the body is also taken.

The most accurate test is magnetic resonance imaging (MRI). It allows the location of the tumor and its spread within the bone and into the soft tissues to be determined. In the past, a computed tomography (CT) scan was often performed instead. However, CT is not as accurate and is therefore no longer considered state-of-the-art.

In addition to these imaging procedures, a tissue sample (biopsy) is taken. The samples are examined in the laboratory by a pathologist, who determines whether the tumor is benign or malignant.

A chest X-ray and a CT scan of the chest are used to rule out lung metastases. The liver can be examined for metastases using an ultrasound or a CT scan of the abdomen. A scintigraphy allows doctors to determine whether the tumor has formed metastases in other bones.

Angiography is rarely necessary today to determine the extent of tumor spread. As a rule, this test is not performed.

If chemotherapy is planned, a dynamic MRI with contrast dye or a scintigraphy with contrast dye is recommended. Ideally, this allows for a comparison of the boundaries between non-calcified scar tissue and viable tumor tissue before and after chemotherapy.

Many patients feel uncertain and anxious until they learn the results of these tests. Talking with family members or friends often helps during this difficult time. For some patients, it may also be helpful to seek professional psychotherapeutic support.

The standard approach for osteosarcoma is neoadjuvant chemotherapy, followed by surgery. Neoadjuvant means that the purpose of the chemotherapy is to shrink the tumor, thereby making surgery easier.

In addition, chemotherapy may be able to treat any existing tumor metastases in the rest of the body. Under certain circumstances, this allows for a less radical approach, i.e., limb-sparing surgery.

Osteosarcoma is not very sensitive to radiation; however, radiation therapy is also performed in cases of unfavorable tumor location (e.g., the spine).

The side effects of chemotherapy for osteosarcoma are numerous and depend on the cytostatic drugs used.

Follow-up examinations are conducted at intervals of three to six months within the first three to five years after diagnosis.

Whether it is beneficial for the patient to attend a rehabilitation clinic after treatment depends on their individual situation. Outpatient rehabilitation is also an option. The goal of rehabilitation is to enable the patient to resume participation in their professional, family, and social life.

Depending on the patient and the severity of the disease or its consequences, the focus is on

• reintegration into professional life or
• promoting social contacts.

Through rehabilitation measures, the patient can learn to

• adapt their life to the new situation,
• alleviate any symptoms, and
• deal with problems effectively.

Effective rehabilitation can

• successfully combat pain,
• improve quality of life through specialized training, and
• enable new life experiences.

Exercises tailored to the patient help them regain physical strength. They also help boost self-confidence. This leads to improved mobility and independence, thereby reducing the need for care.

Active exercise therapy is preferred, but passive treatments are also possible.

With properly administered multimodal therapy,

• 89 percent of cases with limb-sparing procedures and
• 97 percent of cases involving amputations

.

The 5-year survival rate, depending on the number of sites originally affected, ranges from 66 to 79 percent for peripheral locations and from 35 to 52 percent for locations on the trunk.