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Note: This section has health/medical information. It was not written by a health care professional. The medical references are:
- NCI web site sections on the different types of bone cancers, accessed 2009
- Childhood Cancer: A Parents Guide to Solid Tumor Cancers, 2th ed., by Honna Janes-Hodder and Nancy Keene, 2002
Also see on this site: Warning Signs of Childhood Cancer: Bone Cancers
Osteosarcoma and Ewing's sarcoma are the most common malignancies of bone tissues in children. Osteosarcoma, the more common of the two types, usually presents in bones around the knee; Ewing's sarcoma may affect bones of the pelvis, thigh, upper arm, or ribs.
Recommended cancer.gov link: NCI PDQ
There are several types of cells in our bones. Osteoblasts are the cells that form the matrix of the bone. Osteoclasts prevent too much bone matrix from accumulating, help bones maintain their proper shape, and control the amount of minerals in the blood. Some bones also contain bone marrow, which consists of fat cells and hematopoietic cells (cells which produce blood).
Our bones come in two main types: "flat" and "long". Flat bones help protect the brain and organs; long bones sport the legs and arms. Osteosarcoma usually develops at the edges of the long bones, in the "metaphysis", which is the name for the growing ends of the bone. About 80-90% of these tumors develop in the ends of the long bones that form the knee. The second most common site for these tumors is in the ends of the upper arm bone close to the shoulder; they can also be other places, like the pelvis, shoulder, and skull.
Osteosarcomas are classified according to subtypes and grades, which are determined by X-rays and histological analysis:
- low grade: intraosseous low grade, parosteal
- intermediate grade: periosteal
- high grade: conventional, central, telangiectatic, small cell, high-grade surface
Treatment and prognosis depends on the subtype and grade of the tumor. Low grade tumors are surgically removed and usually not treated with chemotherapy; 85% of the patients should expect a five year event free survival. Intermediate grade tumors are treated with both surgery and chemotherapy. High grade tumors consist of immature cells which require aggressive chemotherapy; 75% of these patients expect a five year survival. Osteosarcomas do not respond to radiation therapy.
When possible, the limb is spared by removing the tumor and replacing the bone with a bone graft or metal rod. If chemotherapy is used, the drugs are usually ifosfamide, cisplatin, methotrexate, and doxorubicin.
- 900 new cases in US each year
- usually occurs in teenagers
- accounts for about 5% of all childhood cancers
- twice as common in males
- 20% have metastasized at diagnosis
Recommended cancer.gov link: NCI PDQ
Ewing's is the second most common malignant bone tumor in children, comprising 10-15% of childhood bone cancers. Most other types of bone cancers are usually found only in adults. Ewing's consists of small round blue cells. It can occur in any bone in the body, but it is most common in the pelvis, thigh, lower leg, upper arm, and rib. Ewing distinguished the tumor from osteosarcoma on the grounds that it was responsive to radiotherapy. (See about James Ewing on the Children's Cancer Web site.)
The treatment and prognosis depend on the site of the primary tumor and whether the disease is metastatic. It is treated with surgery, radiation, and chemotherapy.
- occurs in 0.6 per million people
- most common in the second decade of life
- accounts for 1% of all childhood cancers
- 50% of patients without metastatic disease may have a long-term disease-free survival
The following ped-onc resource lists have appropriate sections for parents of children with bone cancers:
The following web sites provide good, general information on bone cancers and their treatment.
- Sarcoma Alliance Information on treatment options; a great resource founded by patients and parents.
- SARC: Sarcoma Alliance for Research Through Collaboration. Information on treatment and diagnosis, awareness, more.
- Resources on saromas on the Liddy Shriver Sarcoma Initiative. This patient-generated web site contains a wealth of helpful and practical information on treatment for sarcomas. A must-see site.
- Northwest Sarcoma Foundation.
- Bone cancers on the cancer.gov site.
- The Cure our Children Foundation has wonderful information and links on the subject of Ewing's Sarcoma.
- St. Judes site for osteosarcoma and Ewing's sarcoma. Descriptions of disease and treatment.
- Washington Cancer Institute, Center for Orthopaedic Oncology and Musculoskeletal Resarch.
These pages are intended for informational purposes only and are not intended to render medical advice. The information provided on Ped Onc Resource Center should not be used for diagnosing or treating a health problem or a disease. It is not a substitute for professional care. If you suspect your child has a health problem, you should consult your health care provider.