Osteosarcoma High Grade
Anyone who has a lump or mass in their bone should see a doctor right away. They may need a biopsy to find out if it’s cancer.
People who have osteosarcoma need surgery and chemotherapy. They might also need radiation therapy or a medical device to fill in the space where the tumor was removed from their bone.
Grade 1
Osteosarcomas of grade 1 are considered low-grade and grow slowly. These tumors can be removed (resected) completely by surgery. If these osteosarcomas are in the bones of the limbs, pelvis, or skull, they have a good prognosis. These types of osteosarcomas are also less likely to spread to other parts of the body, called metastasis.
These osteosarcomas are more common in the femur than in other bones of the body. They are often found in the distal femur. They can be found in other bone areas, including the proximal tibia, humerus, jaw, and pelvis. Some people with these tumors may have skip lesions, which are small tumors that can’t be seen on X-ray but cause pain and other symptoms.
Some surgeons might use surgical biopsy to evaluate a person’s tumor. This involves cutting out a small sample of the tumor and then looking at it under a microscope. This helps doctors know whether the tumor is cancerous and what the chances are of it spreading.
Grade 2
Osteosarcoma develops when healthy bone cells start to grow and form a lump (mass). The cancer may spread to other parts of the body, a process called metastasis. This can happen when the cancer cells break away from the site of the tumor and travel through blood vessels to other parts of the body.
The cells in low-grade osteosarcoma look a lot like normal cells and tend to grow and spread slower than the high-grade cells. These cancers are sometimes referred to as low grade or resectable osteosarcoma. They may be cured with surgery alone, but doctors often recommend chemotherapy as well to prevent the cancer from returning.
The general outlook for people with osteosarcoma depends on the grade and stage of the tumor, as well as their age and overall health. Every person is different, and survival rates vary widely from one person to the next.
Grade 3
This type of bone cancer often starts in the end of long bones like the femur or tibia. It can also start in the top of the arm bone (humerus) close to the shoulder. It’s more common in boys than girls. The cancer can spread to other parts of the body, including the lungs. This stage is called advanced or metastatic osteosarcoma.
It’s important to know the stage of your child’s cancer. This helps the doctors plan treatment. Staging describes how far the cancer has spread.
Grade 1 cancers look more like normal cells and grow and spread slower than grade 2 tumors. All Ewing sarcoma and most osteosarcoma and spindle cell tumors are grade 2.
If the cancer has spread to other parts of the body, it’s called stage 4. Two out of 4 patients with metastatic osteosarcoma in the lungs died. The others had a good outcome with a combination of chemotherapy and surgery.
Grade 4
These are rare tumors, found most often in the distal femur but also occur in the proximal tibia, pelvis, jaw and ribs. They can spread (metastasize) to other bones and other organs, particularly the lungs.
Histologically, these tumors appear to be well differentiated. However, radiologically they can have a variety of appearances, including calcifications and cortical destruction.
Previously, the standard of care for these tumors was neoadjuvant chemotherapy followed by surgery. However, these tumors recur in about 20% of patients after surgical removal.
To improve the outcomes of these tumors, it is important that the patient be treated with a combination of therapy. This includes X-rays, CT scan or MRI of the primary tumor, as well as chest X-rays and bone scans to look for metastases in other bones. Then, the patient is given chemo to shrink the cancer before surgery, and then more chemo after surgery to catch any remaining cancer cells. Then the patient has surgery, which may include removing more than one area of the bone.
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