15041 Osteosarcoma

Overview

Osteosarcoma is a type of cancer that starts in bone cells. It usually forms near the ends of long bones, such as the knee, thighbone, upper arm, or shoulder. Osteosarcoma is the most common type of bone cancer, but overall it is rare.

No. Osteosarcoma is rare. In the UK, about 160 people are diagnosed with it each year. It makes up a small percentage of all cancers.

Osteosarcoma can occur at any age, but it most often affects children, teenagers, and young adults between the ages of 10 and 20. It is slightly more common in boys. Older adults can also get it, especially if they have had radiation treatment or certain bone conditions.

Symptoms

Common symptoms

• Persistent pain in a bone, especially in the knee, leg, shoulder, or arm
• Swelling or a lump that can be felt over the bone
• Pain that gets worse at night or with activity
• Stiffness or reduced movement in the nearby joint
• Aching or tenderness that does not go away

Symptoms in children

• Limping or avoiding putting weight on one leg
• Bone pain that wakes the child at night
• A lump or swelling, sometimes after a minor injury
• Fever or tiredness (less common)

Symptoms in older adults

• Gradual bone pain and swelling that may be mistaken for arthritis or joint problems
• Pain in the back, pelvis, or jaw
• Weakening of the bone that can lead to a sudden fracture

Causes

Main causes

• The exact cause is not known.
• Osteosarcoma happens when cells that make new bone develop DNA errors that cause them to grow out of control.
• Most cases occur without a clear reason, not because of anything a person did or did not do.

Risk factors

• Being aged 10 to 20
• Having had radiotherapy in the past
• Certain inherited conditions, such as Li-Fraumeni syndrome or hereditary retinoblastoma
• Paget's disease of bone in older adults
• Previous bone problems or certain genetic changes passed down in families

When to see a doctor

See a doctor urgently if:

• See a GP within a few days if you have persistent bone pain that is not going away, especially if it is worse at night or at rest.
• Seek urgent medical help (same day) if you notice a hard, immovable lump on a bone.
• If you already have bone pain and also develop a fever or unexplained weight loss, speak to a doctor promptly.

Book a routine appointment if:

• Make a routine GP appointment if you have swelling or discomfort around a bone that lasts for more than two weeks.
• If pain is linked to a recent injury, but does not settle after normal self-care, ask for advice.

Diagnosis

Your GP will ask about your symptoms, medical history, and any family history. They will examine the area and may request blood tests and an X-ray. If the X-ray suggests a bone tumour, you will be referred to a specialist bone cancer centre for further tests.

Tests that may be done

• X-ray: the first imaging test to look for abnormalities in the bone
• Magnetic resonance imaging (MRI) scan: shows the tumour and nearby tissues in detail
• Computed tomography (CT) scan: checks whether the cancer has spread
• Bone biopsy: a small sample of the tumour is removed and examined under a microscope
• Blood tests: to check general health and signs of abnormal bone activity

What to expect at your appointment

If osteosarcoma is suspected, you will be referred to a team of specialists. The team will plan your tests and treatment together. A biopsy is usually done under a general anaesthetic. It can take a few weeks to get all the results and agree on a treatment plan.

Treatment

Treatment for osteosarcoma is planned by a specialist bone cancer team. It usually combines chemotherapy (anti-cancer medicines) with surgery. The aim is to remove the whole tumour and, if possible, keep the limb working. In rare cases, radiotherapy is also used.

Self-care at home

• Do not put weight on a painful bone until your specialist gives the all-clear.
• Ask your physiotherapist before doing exercises or lifting heavy objects.
• Stop smoking and limit alcohol, as this can help your body recover.
• Follow your follow-up appointment schedule and tell your team about any new symptoms.

Medical treatments

Chemotherapy is usually given before surgery to shrink the tumour, and sometimes again after surgery to remove any remaining cancer cells. Surgery removes the tumour and a margin of healthy bone around it. The surgeon may rebuild the bone with a graft, metal rod, or prosthesis. Radiotherapy may be used if the tumour cannot be fully removed with surgery or when it recurs.

When is surgery considered?

Surgery is offered when the tumour is localised (has not spread to other parts of the body) and can be safely removed. In some cases, amputation is necessary, but limb-sparing surgery is now possible in most patients.

Living with this condition

After treatment, you will have regular check-ups, including scans, to make sure the cancer has not returned. You may need physiotherapy to restore strength and movement in the affected limb. Many people gradually return to work, school, and normal activities, though it takes time.

Lifestyle tips

• Follow a balanced, varied diet to help your body heal and maintain bone strength.
• Take gentle exercise as recommended by your care team.
• Protect your bones from falls and injuries.
• Attend all follow-up appointments and report any new symptoms promptly.

Diet and exercise

A healthy diet with enough protein, calcium, and vitamin D supports bone healing and energy levels. Exercise should be individualised — your physiotherapist can guide you on safe movements. Avoid intense sports or heavy lifting until your bone has healed well.

Mental health and emotional wellbeing

A cancer diagnosis can bring anxiety, fear, sadness, or anger. These feelings are normal, and support is available. Talk to your care team about counselling or psychological support if you are struggling.

Prevention

There is no known way to prevent osteosarcoma. You cannot change the risk factors such as age or genetics. The best approach is to be aware of the symptoms and see a doctor early if anything concerns you.

Vaccines

There is no vaccine to prevent osteosarcoma.

Screening programmes

There is no routine screening test for osteosarcoma in the general population. People with inherited risk may be monitored more closely by specialists.

Complications

If left untreated

• The tumour can grow larger and weaken the bone, leading to fractures
• The cancer can spread (metastasise) to the lungs, other bones, or other organs
• Spinal tumours may press on the spinal cord, causing weakness or paralysis
• Untreated disease can become harder to cure and may be life-threatening

Long-term outlook

The outlook for osteosarcoma has improved greatly in recent decades. With modern treatment, most people with localised osteosarcoma are cured. The chance of cure is highest when the tumour has not spread at diagnosis and surgery completely removes the cancer. Even if the cancer has spread, treatment can still be successful. Your specialist will give you a clearer idea of your individual prognosis.

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