Bone Cancer (osteosarcoma) and Bone Tumors (fibrous histiocytoma): Treatment - Patient Information [NCI PDQ]
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Osteosarcoma/Malignant Fibrous Histiocytoma of Bone
Description
What is osteosarcoma?
Osteosarcoma is a disease in which cancer (malignant) cells are found in the
bone. It is the most common type of bone cancer. Osteosarcoma most often occurs in
adolescents and young adults.
In children and adolescents, tumors appear most often in the bones around the knee. The symptoms and chance for recovery in children and adolescents appear to be the same.
Malignant fibrous histiocytoma (MFH) of bone is a rare tumor of the bone. It may occur following radiation treatments. MFH is generally treated the same as osteosarcoma and appears to have a similar response to treatment.
Ewing’s sarcoma is another kind of bone cancer, but the cancer cells look
different under a microscope than osteosarcoma cancer cells. (Refer to the PDQ
summary on Ewing’s Family of Tumors Treatment for more information.)
If a patient has symptoms (such as pain and swelling of a bone or a bone
region), a doctor may order x-rays and blood tests. If it is suspected that
the problem is osteosarcoma, your doctor may recommend seeing a specialist
called an orthopedic oncologist. The orthopedic oncologist may cut out a piece
of tissue from the affected area. This is called a biopsy. The tissue will be
looked at under a microscope to see if there are any cancer cells. This test
may be done in the hospital.
The chance of recovery (prognosis) and choice of treatment depend on the size,
location, type, and stage of the cancer (how far the cancer has spread), how
long the patient had symptoms, how much of the cancer is taken out by surgery
and/or killed by chemotherapy, and the patient’s age, blood and other test
results, and general health.
Stage Explanation
Stages of osteosarcoma
Once osteosarcoma has been found, more tests may be done to find out if cancer
cells have spread to other parts of the body. This is called staging. At
present, there is no staging system for osteosarcoma. Instead, most patients
are grouped depending on whether cancer is found in only one part of the body
(localized disease) or whether the cancer has spread from one part of the body
to another (metastatic disease). Your doctor needs to know where the cancer is
located and how far the disease has spread to plan treatment. The following
groups are used for osteosarcoma:
Localized osteosarcoma
The cancer cells have not spread beyond the bone or nearby tissue in which the
cancer began. In young patients, most tumors occur around the knee.
Metastatic osteosarcoma
The cancer cells have spread from the bone in which the cancer began to other
parts of the body. The cancer most often spreads to the lungs. It may also
spread to other bones.
About one in five patients with osteosarcoma has cancer that has metastasized by the time it is diagnosed.
Recurrent
Recurrent disease means that the cancer has come back (recurred) after it has
been treated. It may come back in the tissues where it first started or it may
come back in another part of the body.
Osteosarcoma most often recurs in the lung. When osteosarcoma recurs, it is usually within 2 to 3 years after treatment is completed. Later recurrence is possible, but rare.
Treatment Option Overview
How osteosarcoma is treated
If it is suspected that the problem is osteosarcoma, before the first biopsy,
your doctor may recommend a specialist called an orthopedic oncologist.
There are treatments for all patients with osteosarcoma. Three kinds of
treatment are used:
- Surgery (taking out the cancer in an operation).
- Chemotherapy (using drugs to kill cancer cells).
- Radiation therapy (using high-dose x-rays to kill cancer cells).
In addition to these standard therapies, a treatment called biologic therapy is being tested for localized and metastatic osteosarcoma. Biologic therapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.
All patients with localized osteosarcoma should have surgery to remove the tumor, if possible. The doctor may remove only the
cancer and some of the healthy tissue around the cancer (limb-sparing surgery). When the tumor is in a weight-bearing bone, the bone should be protected during activity to avoid fractures that could prevent limb-sparing surgery. Sometimes all or part
of an arm or leg may have to be removed (amputated) to make sure that all of
the cancer is taken out. If cancer has spread to lymph nodes, the lymph nodes
will be removed (lymph node dissection).
In patients with osteosarcoma that has not spread beyond the bone, researchers
have found no difference in overall survival whether patients have limb-sparing surgery or whether they have surgery with amputation. When the cancer
can be taken out without amputation, artificial devices or bones from other
places in the body can be used to replace the bone that was removed.
The process of rebuilding (reconstructing) a part of the body changed by previous surgery is called reconstructive surgery. Options for reconstructive surgery in patients with osteosarcoma depend on many factors, including where the tumor is, how large it is, the age of the patient, and how much the patient will continue to grow.
Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by
pill or put into the body by a needle in a vein or muscle. Chemotherapy is
called systemic treatment because the drug enters the blood stream, travels
through the body, and can kill cancer cells throughout the body. Chemotherapy
with more than one drug is called combination chemotherapy.
Sometimes chemotherapy is injected directly into the area where the cancer is
found (regional chemotherapy). In osteosarcoma, surgery is often used to
remove the local tumor and chemotherapy is then given to kill any cancer cells
that remain in the body. Chemotherapy given after surgery has removed the
cancer is called adjuvant chemotherapy. Chemotherapy can also be given before
surgery to shrink the cancer so that it can be removed during surgery; this is
called neoadjuvant chemotherapy.
Radiation therapy uses x-rays or other high-energy rays to kill cancer cells
and shrink tumors. Radiation for osteosarcoma usually comes from a machine
outside the body (external radiation therapy).
Treatment for osteosarcoma depends on the stage of the disease, where the
cancer is found, and the patient’s age and general health.
A patient may receive treatment that is considered standard based on its
effectiveness in a number of patients in past studies, or may choose to go into
a clinical trial. Not all patients are cured with standard therapy, and some
standard treatments may have more side effects than are desired. For these
reasons, clinical trials are designed to find better ways to treat cancer
patients and are based on the most up-to-date information. Clinical trials for
osteosarcoma are ongoing in many parts of the country. If you want more
information, call the Cancer Information Service at 1-800-4-CANCER
(1-800-422-6237); TTY at 1-800-332-8615.
Some cancer treatments cause side effects that continue or appear years after cancer treatment has ended. These are called late effects. Late effects of cancer treatment may include physical problems; changes in mood, feelings, thinking, learning or memory; and having second cancers (new types of cancer). Some late effects may be treated or controlled. It is important to talk with your child's doctors about the possible late effects caused by some treatments. Refer to the PDQ summary on Late Effects of Treatment for Childhood Cancer for more information.
Localized Osteosarcoma/Malignant Fibrous Histiocytoma of Bone
Treatment of osteosarcoma may be the following:
- Neoadjuvant chemotherapy followed by surgery followed by adjuvant chemotherapy.
- Clinical trials of new methods of giving chemotherapy and new
schedules of treatment.
- A clinical trial of high-dose radiation therapy with or without chemotherapy.
- A clinical trial of chemotherapy with or without biologic therapy.
Treatment of malignant fibrous histiocytoma of bone may be the following:
- Neoadjuvant chemotherapy followed by wide local excision of the tumor.
Metastatic Disease at Diagnosis
Metastatic disease is cancer that has spread from the place in which it started to other parts of the body.
OSTEOSARCOMA
Treatment for osteosarcoma with metastasis may be one of the following:
- Chemotherapy followed by surgery to remove the cancer followed by
adjuvant chemotherapy.
- Surgery to remove the cancer followed by adjuvant chemotherapy.
- A clinical trial of chemotherapy with or without biologic therapy.
Surgery often includes removal of cancer that has spread to the lungs.
MALIGNANT FIBROUS HISTIOCYTOMA OF BONE
The treatment for malignant fibrous histiocytoma of bone with metastasis is the same as for osteosarcoma with metastasis.
Recurrent Osteosarcoma
Treatment depends on where the cancer recurred, what kind of treatment was
given before, as well as other factors. A clinical trial may be a reasonable
treatment option.
If the cancer has come back only in the lungs, treatment may be surgery to
remove the cancer in the lungs with or without chemotherapy. If the cancer has
come back in other places besides the lungs, treatment may be combination
chemotherapy. Clinical trials are evaluating new chemotherapy drugs and peripheral stem cell support as palliative therapy, to relieve pain and improve quality of life.
Changes to This Summary (08/10/2006)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Changes were made to this summary to match those made to the health professional version.
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In the United States, about two-thirds of children with cancer are treated in a clinical trial at some point in their illness. A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about new treatments, the risks involved, and how well they do or do not work. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard."
Listings of clinical trials are included in PDQ and are available online at NCI's Web site. Descriptions of the trials are available in health professional and patient versions. For additional help in locating a childhood cancer clinical trial, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.
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The Children's Oncology Group (COG) is the major group that organizes clinical trials for childhood cancers in the United States. Information about contacting COG is available on the NCI Web site or from the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.
THE PDQ DATABASE CONTAINS LISTINGS OF CANCER HEALTH PROFESSIONALS AND HOSPITALS WITH CANCER PROGRAMS.
Because cancer in children and adolescents is rare, the majority of children with cancer are treated by health professionals specializing in childhood cancers, at hospitals or cancer centers with special facilities to treat them. The PDQ database contains listings of health professionals who specialize in childhood cancer and listings of hospitals with cancer programs. For help locating childhood cancer health professionals or a hospital with cancer programs, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.
Date Last Modified: 2006-08-10
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