Osteosarcoma

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Norton Children’s Cancer Institute

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Osteosarcoma is the most common type of primary bone cancer and accounts for about 3% of cancers that happen in children.

It is most common in teens going through a growth spurt because the cancer usually develops from osteoblasts, the cells that make new bone. Most cases of osteosarcoma in children involve the knee and seem to affect teens who are tall for their age.

Most osteosarcomas are linked to random and unpredictable changes in the DNA of growing bone cells during times of intense bone growth.

Although other types of cancer eventually can spread to bones, osteosarcoma is one of the few that actually begins in bones and sometimes spreads (or metastasizes) elsewhere, usually to the lungs or other bones.

With the proper diagnosis and treatment, most kids with osteosarcoma recover. The five-year survival rate for osteosarcoma that hasn’t spread is 77%, but advances in treatment in recent years suggest the current survival rate is much better.

Osteosarcoma is a risk for kids who inherit a gene mutation that is part of a family cancer syndrome. These mutations help explain why cancer seems to run in families. Children who have received radiation treatments for an earlier cancer may have had a DNA mutation, making them at increased risk for osteosarcoma.

Treating osteosarcoma requires experienced and skilled oncologists. Osteosarcoma in children has the best chance of being cured when it’s treated by pediatric cancer specialists. Young adults may benefit from treatment at a children’s hospital instead of an adult-service hospital because of the care team’s expertise specifically in childhood diseases.

Norton Children's Cancer Institute oncologist Kerry McGowan, M.D., with a patient - illustrating osteosarcoma in children and a novel surgical procedure to use the ankle to to the work of the knee.

Innovative Osteosarcoma Surgery Uses Child’s Ankle to Do the Knee’s Work

Rotationplasty is a specialized surgical procedure to remove the leg from above the knee. The foot and ankle are then rotated and reattached to the remaining part of the femur.

The board-certified and fellowship-trained oncologists at Norton Children’s Cancer Institute, affiliated with the UofL School of Medicine, come together at regular conferences to share viewpoints from various perspectives that help determine the best course of treatment. It’s like getting second, third and fourth opinions all at once.

By staying at the forefront of research, our physicians are experienced with newly approved therapies for osteosarcoma and can provide access to clinical trials of experimental treatments.

Symptoms of Osteosarcoma in Children

Pain and swelling in the leg or arm are the most common symptoms. The cancer often is found above or below the knee or in the upper arm near the shoulder. Pain that often wakes the child up should be a concern.

Sometimes the first sign is a broken arm or leg due to the cancer weakening the bone.

Like many childhood and adolescent cancers, osteosarcoma can start with vague symptoms that can be easily overlooked or attributed to other causes. Consulting with a pediatric cancer specialist offers the best opportunity for early diagnosis and successful treatment.

Diagnosis and Treatment of Osteosarcoma

In addition to a physical exam and a detailed medical history, the physician may order X-rays to see whether there are abnormal changes to the bone. A CT scan or MRI can help show whether the tumor has spread to nearby tissue.

A biopsy takes a small sample of the tumor either surgically or with a needle for a pathologist to examine under a microscope.

Treating osteosarcoma in children includes chemotherapy to shrink the tumor, surgery to remove as much of the tumor as possible and more chemotherapy to kill any remaining cancer cells and reduce the chance of the cancer coming back.

Surgical treatments for osteosarcoma include either amputation or limb-salvage surgery, in which the tumor is removed and the gap is filled with either a bone graft or prosthesis to reconstruct the bone.

For osteosarcoma that requires removal of the knee, rotationplasty surgery attaches the rotated ankle to the end of the femur so that it serves as a knee that can be attached to a prosthetic shin and foot.

The board-certified and fellowship-trained oncologists at Norton Children’s Cancer Institute, affiliated with the UofL School of Medicine, collaborate to examine every pediatric cancer patient’s case. The oncology team comes together at regular conferences to share viewpoints from various perspectives that help determine the best course of treatment. It’s like getting second, third and fourth opinions all at once.

Our physicians actively conduct clinical trials and publish their discoveries about new ways to identify and treat sarcomas and other pediatric cancers. By staying at the forefront of sarcoma research, our physicians are experienced with newly approved therapies and can provide access to trials of experimental treatments.

The Norton Children’s Difference

Norton Children’s Hospital’s cancer care program is one of the oldest oncology programs in the U.S. that has been continuously accredited by the American College of Surgeons’ Commission on Cancer. Backed by nearly 60 years of pediatric expertise, we have a proven cancer care team of more than 200 leading cancer specialists, including oncologists, surgeons, nurses, social workers, chaplains, behaviorists, therapists and pharmacists. This skilled, multidisciplinary team is entirely focused on the needs of your child and family.

In addition, we are home to:

  • Kentucky’s leading multidisciplinary pediatric brain tumor program
  • Kentucky’s only pediatric apheresis and pediatric photopheresis programs
  • An immunotherapy program
  • One of the country’s largest sickle cell anemia treatment programs
  • Kentucky’s leading Adolescent and Young Adult Program and Transition Clinic
  • Kentucky’s only CAR-T cell therapy treatment for pediatric patients
  • Life after cancer survivorship program
  • Pediatric bleeding and clotting program (hemostasis and thrombosis)

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