How Osteosarcoma Is Diagnosed
There are different ways Osteosarcoma can be diagnosed. Often osteosarcoma may be suspected from an x-ray or MRI but the only way to definitively diagnose osteosarcoma is for a pathologist to examine the tumor cells under a microscope.
Symptoms of Osteosarcoma.
Symptoms of osteosarcoma can vary, depending on the bone in which cancer develops. Some of the symptoms may include:
- Bone pain or tenderness.
- A mass or lump (tumor) that is warm and might be felt through your skin.
- Swelling and redness at the site of your tumor.
- Increased pain with lifting (if it affects your arm).
- Limited movement (if it affects a joint).
- Unexplained fever.
- Broken bone (sometimes this happens after a simple movement).
Types of Tests Used For Osteosarcoma.
There are a few different types of tests that can be used to diagnose Osteosarcoma. These tests include:
Biopsy:
- A biopsy can be done in two different ways. The first method involves a small incision and a piece of tumor removed, this is called an open biopsy. The second method is called a needle biopsy where a needle is inserted into the tumor and a core of cells is removed for diagnosis.
PET Scan:
- A PET scan is typically not a standard scan for osteosarcoma, but your doctor may use it in conjunction with, or instead of a bone scan. This scan uses a sugar particle tagged with a tracer to evaluate tissue metabolism. Cancers often have increased metabolism so they tend to pick up a lot of the sugar.
X-Ray:
- An X-Ray allows the doctor to visualize the bone and tumor. The doctor can measure and determine the amount of destruction of the bone and if there are concerns for stability or fracture.
MRI:
- An MRI can be ordered with or without contrast to evaluate the primary tumor size and extension into the soft tissue/ muscle/ bone marrow (center of the bone). This test will show where the blood vessels and nerves are in relation to the tumor which will help with surgical planning.
Bone Scan:
- This test uses a small amount of radioactive material injected into your body to identify bone disorders.
Next Steps After Osteosarcoma Diagnosis
Unlike the common cold or flu where you work with your family doctor for all aspects of treatment, a diagnosis of osteosarcoma comes with setting up an entire team to provide the care and treatment needed. Below is a sample list of the types of individuals that may make up your treatment team and create your treatment plan.
Team Of Doctors
- Oncologist: The oncologist is an expert on cancer and, in some cases, may specialize in sarcomas. All aspects of treatment are run through the oncologist.
- Charge Nurse: The charge nurse is an experienced nurse who is the floor manager. For patients and families, they are a good resource to help if there are any problems with your assigned nurse during your inpatient stays.
- Child Life Specialist: Child Life Specialists are trained in how to discuss medical topics with young patients. They can show patients what their medical procedures will be like ahead of time such as: what a port-a catheter is, how it is used and what will happen before, during and after surgery.
- General Surgeon: A general surgeon is called in for more common surgical needs. This may include the procedure to implant a port-a-catheter. If a recurrence occurs, a general surgeon or thoracic surgeon more familiar with internal surgeries may be called in for the thoracotomy.
- Insurance Case Manager: Insurance case managers help clients understand their coverage, treatments and equipment that may or may not be covered. They are typically a nurse by training, similar to the case managers at the hospital.
- Pathologist: The pathologist will examine tissue from biopsies and surgeries under a microscope. Their goal is to determine the appropriate diagnosis and to provide other information that will impact care.
- Orthopedic Oncology Surgeon: An orthopedic oncology surgeon is needed for the initial biopsy and to remove the tumor and any bone it is attached to. They are experts on removing tumors with sufficient margins to reduce the chance of any future recurrence.
- Nutritionist: Treatment can interfere with a child’s ability or interest in eating. A good nutritionist can offer suggestions on food choices and increasing calorie intake to minimize weight loss.
Linda from Pennsylvania suggests, “Trust your instincts about your doctors. If you feel a strong connection and a lot of confidence in your doctor, then go with it. If you do not feel confident or feel something is off, go with that as well and look for a doctor you trust and feel confident in. We felt a very strong connection with the surgeon who diagnosed our son and a level of confidence that helped us to have a positive outlook.”
Discuss Treatment Options
- Chemotherapy: Chemotherapy prior to surgery is called neoadjuvant chemotherapy. This is done to start killing the cancer cells as quickly as possible since choosing a surgical option and planning necessary surgery can take longer than is optimal to begin treatment.
- Surgery: Surgical options will differ depending upon the bone(s) impacted by the osteosarcoma, spread, ability to surgically get all the cancer out, future function requests and preference by the patient.
Liz from Chicago says, “My son was diagnosed with this cancer I had never heard of; I was absolutely terrified and felt like my mind was whirling 100 mph but I was simultaneously completely paralyzed. A colleague that battled cancer prior visited me and said that the first week or two was the worst, once you have information and a plan of attack it all becomes clearer and you have a way forward. Those words held me over and were accurate for us... once we had a plan we had a way to fight and a way to win.”
Resources For Osteosarcoma Patients
*No two osteosarcoma patients are the same, therefore there is no substitute for the expert care of your medical team. This is not meant to replace the guidance of your oncology team. It is meant to share resources, information and support.
