Osteosarcoma

Last reviewed: 1 Jun 2022
Last updated: 17 May 2022

Summary

Definition

History and exam

Key diagnostic factors

  • childhood and adolescence
  • worsening pain over weeks to months
  • mass/swelling
More key diagnostic factors

Other diagnostic factors

  • male sex
  • limp
  • history of trauma
  • limited range of motion
  • overlying skin ulceration
Other diagnostic factors

Risk factors

  • childhood and adolescence
  • Paget disease
  • radiation therapy
  • Rothmund-Thomson syndrome
  • familial retinoblastoma syndrome
  • Li-Fraumeni syndrome
  • fibrous dysplasia
  • chemotherapy
  • male sex
More risk factors

Diagnostic investigations

1st investigations to order

  • conventional radiographs
  • MRI primary tumor
  • CT thorax
  • radionuclide bone scan
  • 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG-PET-CT)
  • serum alkaline phosphatase
  • serum lactate dehydrogenase
More 1st investigations to order

Investigations to consider

  • CT primary tumor
  • bone biopsy
More investigations to consider

Treatment algorithm

ACUTE

low-grade disease at presentation

high-grade nonmetastatic disease at presentation

metastatic disease at presentation

ONGOING

recurrent disease

Contributors

Authors

David Loeb, MD, PhD

Chief

Division of Pediatric Hematology, Oncology, and Marrow & Blood Cell Transplantation

Children's Hospital at Montefiore

Associate Professor, Pediatrics

Associate Professor, Developmental and Molecular Biology

Albert Einstein College of Medicine

Bronx

NY

Disclosures

DL declares that he has no competing interests.

Acknowledgements

Dr David Loeb would like to gratefully acknowledge Dr Luminita Rezeanu and Dr Michael J. Klein, the previous contributors to this topic.

Disclosures

LR and MJK declare that they have no competing interests.

Peer reviewers

Edward Sauter, MD, PhD

Professor of Surgery

Ellis Fischel Cancer Center

University of Missouri

Columbia

MO

Disclosures

ES declares that he has no competing interests.

Rachael Windsor, BSc, MBBS, MSc, MRCPCH

Locum Consultant Paediatric Oncologist

University College Hospital

London

UK

Disclosures

RW declares that she has no competing interests.

  • Osteosarcoma images
  • Differentials

    • Ewing sarcoma
    • Chondrosarcoma
    • Malignant fibrous histiocytoma
    More Differentials
  • Guidelines

    • NCCN clinical practice guidelines in oncology: bone cancer
    • ACR appropriateness criteria: malignant or aggressive primary musculoskeletal tumor staging and surveillance
    More Guidelines
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