Osteosarcoma is the most common primary bone cancer in children and young adults, and it often starts near the knee during the teenage growth spurt. The pain is easy to blame on sports, so persistent or night pain in a growing bone needs imaging.
Key symptoms
- Bone pain that keeps getting worse, often worse at night
- Swelling or a firm lump near a joint, usually the knee or shoulder
- Limp or less use of the limb
- Sudden severe pain from a fracture through the weakened bone
What you find on exam
- Firm, tender mass fixed to the bone
- Warmth and dilated veins over the swelling
- Reduced range of motion of the nearby joint
- Lymph nodes and a lung exam for spread
Tests
- X-ray: destructive lesion with a sunburst pattern and Codman triangle
- MRI of the whole bone to map the tumor
- Biopsy at a sarcoma center to confirm the diagnosis
- Chest CT and bone scan or PET to look for metastases; alkaline phosphatase and LDH
Treatment basics
- Care by a specialized sarcoma team
- Chemotherapy before surgery, often methotrexate, doxorubicin and cisplatin
- Limb-sparing surgery to remove the whole tumor, amputation when needed
- More chemotherapy after surgery, then long-term follow-up for relapse and late effects
Red flags
- Night pain or pain at rest in a young person's bone
- Fracture after minimal trauma through an abnormal bone
- Cough, chest pain or shortness of breath suggesting lung spread
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.