Osteosarcoma is the commonest cancer that affects bone as the primary organ, but still one of the rarest of cancers (all organs included). It usually affects adolescents and young adults, although it can affect younger or older individuals too. While the cause of this cancer is unknown in most patients, a causative factor may be available in a small subset of patients- which may be genetic, environmental (radiation exposure) or pre existing lesion like Pagets disease. Injury has no proven role in etiology of osteosarcoma but is frequently remembered by the parents or the patients as being the beginning of all symptoms. These patients frequently have pain and swelling in a limb, frequently but not always close to a joint, most commonly the knee. There may even be a fracture of the involved bone, often without any significant injury.
The diagnosis and treatment of osteosarcoma should be undertaken only at specialised centers, where a multidisciplinary team called Musculoskeletal Disease Management Group”, a team consisting of Orthopedic Oncology, Pediatric/ Adult Sarcoma medical oncology, Musculoskeletal Radiation oncology, Musculoskeletal Pathology , Musculoskeletal Radiology, Nuclear Medicine, Psycho Oncology and physiotherapy teams is available. After initial evaluation with an X ray and an MRI, the diagnosis is confirmed with a biopsy, which is usually a core needle biopsy. This biopsy is an OPD procedure under local anesthesia (except young children where it is done under sedation). Rarely, an open surgical biopsy will be needed. A staging work up follows, which will include a whole body PET CT or a combination of CT scan of chest and a whole body bone scan. Patients with osteosarcoma who have no spread (metastasis) of disease have upto 70- 80 percent chance of cure, with complete treatment.
Treatment will consist of a combination of chemotherapy and surgery. This treatment is planned by the multidisciplinary team in close coordination with the parents, with the aim of maximising the chances of cure and retaining a functional limb. Surgery for osteosarcoma nowadays is limb salvage surgery in more than 90 percent of patients. These are technically challenging surgeries where the results are best when done at centres with specialised orthopedic oncology units. The treatment usually starts with chemotherapy, and a detailed discussion around available options of limb salvage are held with the family. Each patient will have their own age specific needs, expectations, socio economic and other factors, which are very important things to be considered when limb salvage surgery is being planned. For young children, growth issues with expected limb length discrepancy are managed with expandable prothesis, or rotationplasty.