The first steps in seeking a diagnosis typically include a physical exam, discussion of medical history and lab tests.
The doctor may recommend one or more of these imaging tests to locate the cancer and find out if it has spread:
- Computerized tomography (CT)
- Magnetic resonance imaging (MRI)
- Positron emission tomography (PET)
- Bone scan
The doctor may recommend a procedure to remove a sample of tissue (biopsy) from the tumor for lab testing. Testing can show whether the tissue is cancerous and, if so, what type of cancer. Testing also reveals the cancer's grade, which helps doctors understand how aggressive the cancer may be.
Types of biopsy procedures used to diagnose osteosarcoma include:
- Needle biopsy. The doctor inserts a thin needle through the skin and guides it into the tumor. The needle is used to remove small pieces of tissue from the tumor.
- Surgical biopsy. The doctor makes an incision through the skin and removes either the entire tumor (excisional biopsy) or a portion of the tumor (incisional biopsy).
Determining the type of biopsy needed and the specifics of how it should be performed requires careful planning by the medical team. Doctors need to perform the biopsy in a way that won't interfere with future surgery to remove the cancer. For this reason, ask your doctor for a referral to a team of experts with extensive experience in treating osteosarcoma before the biopsy.
After the diagnosis, the extent (stage) of the cancer needs to be determined — whether and how far it has spread. Localized osteosarcoma has not spread beyond its origin or nearby tissues. Metastatic osteosarcoma has spread to other areas of the body. The cancer stage and other factors guide treatment options.
Over the years, major advances have been made in treating osteosarcoma. Treatment typically includes limb-sparing surgery and chemotherapy, but there are other options.
- Surgery. The goal of surgery is to remove the cancer cells, but surgeons also perform operations to maintain function and minimize disability. The extent of surgery for osteosarcoma depends on several factors, such as the tumor size, location and the person's age.
- Limb-sparing surgery. In most cases, surgery for osteosarcoma focuses on removing the tumor and sparing the limb so that function can be maintained. Whether this is feasible depends, in part, on the extent of the cancer and how much muscle and tissue need to be removed.
- Amputation. With advancements in limb-sparing surgery, the need for amputation — removing a limb or part of a limb — has greatly reduced over the years. If amputation is necessary, advances in prosthetic joints can significantly improve outcomes and function.
- Rotationplasty. In this surgery, sometimes used for children who are still growing, the surgeon removes the tumor and surrounding area, including the knee joint. The foot and ankle are then rotated and the ankle functions as a knee. A prosthesis is used for the lower leg and foot. Results typically enable the person to function very well in physical activities, sports and daily living.
- Chemotherapy. Chemotherapy uses drugs to kill cancer cells. Doctors often recommend using chemotherapy before surgery for osteosarcoma, to reduce the size of the tumor, and after surgery, to kill any cancer cells that may remain.
- Radiation therapy in select cases. Radiation therapy uses high-energy beams, such as X-rays and protons, to kill cancer cells. Though typically radiation is not used due to lack of effectiveness in treating osteosarcoma, newer forms of radiation therapy are being studied and may rarely be used.
Clinical trials. Clinical trials are studies to investigate new ways of treating cancer. Many of the advances in treating pediatric cancers, including osteosarcoma, come from clinical trials of the Children's Oncology Group, which has more than 200 participating medical institutions from the United States and other countries.
Coping and support
A diagnosis of osteosarcoma can be frightening. With time you'll find ways to cope with the distress and uncertainty of cancer. Until then, you may find it helps to:
- Learn enough about osteosarcoma to make decisions about care. Ask your doctor about this sarcoma, including treatment options. As you learn more, you may become more confident in understanding and making decisions about treatment options. If your child has cancer, ask the health care team for guidance on sharing this information in a caring and age-appropriate way.
- Keep friends and family close. Keeping your close relationships strong can help you deal with cancer. Friends and relatives can provide the practical and emotional support you'll need, especially when you feel overwhelmed.
- Ask about mental health support. The concern and understanding of a counselor, medical social worker, psychologist or other mental health professional also may help you. If your child has cancer, ask your health care team for advice on providing emotional and social support and options for professional mental health support. You can also check online for a cancer organization, such as the American Cancer Society, that lists support services.
Preparing for your appointment
If there are signs and symptoms that worry you, you'll likely start by making an appointment with your primary care doctor — or the pediatrician if the concern is with your child. If your doctor suspects osteosarcoma, ask for a referral to an experienced specialist.
Osteosarcoma typically needs to be treated by a team of specialists, which may include, for example:
- Orthopedic surgeons who specialize in operating on cancers that affect the bones (orthopedic oncologists)
- Other surgeons, depending on patient age (for example, pediatric surgeons)
- Doctors who specialize in treating cancer with chemotherapy or other systemic medications (medical oncologists or, for children, pediatric oncologists)
- Doctors who analyze tissue to diagnose the specific type of cancer (pathologists)
- Rehabilitation specialists who can help in recovery after surgery
What you can do
Before the appointment, make a list of:
- Signs and symptoms, including any that seem unrelated to the reason for the appointment
- Any medications being taken, including vitamins, herbs and over-the-counter medicines, and their dosages
- Key personal information, including any major stresses or recent life changes
- Bring previous scans or X-rays (both the images and the reports) and any other medical records related to this situation
- Consider taking a relative or friend along to help you remember all the information provided during the appointment
- Prepare a list of questions to ask the doctor to make the most of your time
Whether you're the patient or your child is the patient, your questions might include, for example:
- What type of cancer is this?
- Has the cancer spread?
- Are more tests needed?
- What are the treatment options?
- What are the chances that treatment will cure this cancer?
- What are the potential side effects and risks of each treatment option?
- Which treatment do you think is best?
- Will treatment affect the ability to have children? If so, do you offer fertility preservation evaluations and services?
- Are there any brochures or other printed material that I can have? What websites do you recommend?
What to expect from your doctor
Your doctor will likely ask several questions. Be ready to answer them to allow more time to cover other points you want to address. Whether you're the patient or your child is the patient, the doctor may ask:
- What are the signs and symptoms that you're concerned about?
- When did you first notice these symptoms?
- Have the symptoms been continuous or occasional?
- How severe are the symptoms?
- What, if anything, seems to improve the symptoms?
- What, if anything, appears to worsen the symptoms?
- Is there a personal or family history of cancer?