Bone cancer is one of the most common types of childhood cancer, accounting for about 5% of all childhood cancers. Bone cancers can form in any bone in the body, though they are more common in some bones than others. They are part of the subtype of cancers called sarcomas. (Did you know? July is Sarcoma Awareness Month.)
There are two main types of bone cancer that affect children: osteosarcoma and Ewing’s sarcoma. Osteosarcoma is the most common bone cancer in children. It usually occurs in the long bones of the leg near the knee or in the upper arm. Ewing’s sarcoma is usually found in the thigh, pelvis, upper arm or rib.
Both osteosarcoma and Ewing’s sarcoma are usually diagnosed in the second decade of life, around the time the child is going through their adolescent growth spurt. They are very rare in children under 5. Both are slightly more common in boys than girls.
Symptoms of Bone Cancer in Children
The most common symptom of bone cancer is bone pain. Other symptoms can include:
- A lump on the bone
- Stiffness, swelling, or tenderness around a bone or joint
- Limping (for tumors in the leg)
- Broken bones
- Fatigue, fevers, weight loss or anemia (low red blood cells)
Because many of the symptoms of bone cancer are common in healthy adolescents and young adults, they are often mistaken for sports injuries or growing pains, which occur far more often than cancer in this age group. As a result, the child may not receive a bone cancer diagnosis for weeks or months after their symptoms start.
Diagnosing Bone Cancer in Children
If a doctor suspects bone cancer, they will order imaging tests such as an X-ray or MRI to look at the bone and soft tissue surrounding it. If they see a tumor on the imaging tests, they will order a biopsy, where a surgeon will remove some cells from the tumor to be examined under a microscope. A pathologist can then determine the type of cancer or whether the tumor is benign (non-cancerous).
Once a diagnosis of bone cancer is made, the doctor will order more imaging tests, such as bone scans and CT scans, to see if the cancer has spread to the lungs or other parts of the body. This will help the doctor determine how advanced the cancer is and the best course of treatment. These scans will typically be repeated during treatment to track how well the treatment is working.
Treatment for Bone Cancer in Children
Treatment for bone cancer depends on the type of cancer, the child’s age, where the tumor is located and how advanced the cancer is.
Treatment usually involves surgery to remove as much of the tumor as possible. Chemotherapy and sometimes radiation can be used to shrink the tumor before surgery, and to kill any cancer cells left behind after surgery.
There are two main types of surgery for bone tumors: limb salvage surgery and amputation. In limb salvage surgery, a surgeon will cut out the bone and any muscle or surrounding tissue containing the tumor. They will then replace the bone with a bone graft (a piece of bone from another part of your body or from a donor) or a metal prosthesis.
Sometimes, when the bone cancer has invaded nerves, arteries, tendons or important muscles surrounding the bone, it’s not possible to remove all of the tumor and still have a working limb. In these cases, amputation is recommended. Amputation involves removing the tumor and some or all of the arm or leg.
Once the tumor is removed, the patient may have reconstructive surgery to rebuild the limb and help them retain function in their arm or leg. For example, when a bone tumor occurs near the knee, the surgeon may amputate the knee, the lower part of the thigh, and the upper part of the lower leg. They can then turn around the bottom of the leg and reattach it to the thigh bone, with the backward-facing ankle serving as a replacement knee joint. This reconstructive surgery is called a rotationplasty. The patient can then be fitted for a prosthesis to replace the lower part of their leg and foot, enabling them to eventually walk and even run again.
Rehabilitation After Bone Cancer Surgery
Bone cancer surgery can be life-altering, and for some patients, the recovery is a long and difficult process. It also may take the patient time to adjust to how they look and feel with the changes to their body.
Rehabilitation is key to helping the child get back to day-to-day living. After bone cancer surgery, the child will need physical therapy to help them rebuild their strength and flexibility in the affected area. If the cancer was in their leg, they may need to relearn how to walk. They may also need occupational therapy to help them learn how to do daily activities, like showering and getting in and out of bed, with their prosthesis or other devices such as braces, splints or walking aids.
Prognosis for Children with Bone Cancer
Overall, about 60% of children with bone cancer survive. The survival rate is higher if the tumor hasn’t spread beyond the original site at the time of diagnosis, and lower if it has. There are many other factors that affect an individual child’s prognosis, including:
- The child’s age at diagnosis
- The type of tumor
- The size and location of the tumor
- Whether the whole tumor can be removed surgically
- How well the tumor responds to radiation and chemotherapy
- Whether the cancer has spread to the lungs or other parts of the body
Sometimes the cancer will come back after treatment. When that happens, the chances of survival are usually poor. But it’s important to remember that every child is unique, and your child’s doctor will be able to give you the best understanding of his or her individual outlook.
July is Sarcoma Awareness Month, and at the American Childhood Cancer Organization, we know how devastating a pediatric sarcoma diagnosis is. That’s why we’re dedicated to shaping policy, funding research, and providing support to children with cancer, survivors and their families — all made possible by your donations. Please give today.
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