What is bone cancer?
There are two main types of bone cancer that affect children and young people, osteosarcoma and Ewing’s Sarcoma. Sarcomas are classified as tumours that start in the structures of the body – the body’s scaffolding – which include the bones, muscle and cartilage. Osteosarcoma means bone cancer and it can develop in any bone and sometimes the tissue surrounding bones. Ewing’s Sarcoma is a specific type of bone cancer that most commonly starts in the pelvis or legs. It can, rarely, start in other tissues of the body. The information on this page refers to bone cancer in general.

Who does it affect?
Bone cancers are most commonly found in adolescents and young people between 10 and 15 years. Because of this it is thought that they may be associated with periods of rapid bone growth, such as 'growth spurts' in adolescents. They affect more boys than girls.

What are the symptoms?
The most specific symptom of bone cancers is pain in the bone affected. There may also be swelling and difficulty in moving. Sometimes it is diagnosed when a bone is broken as the result of a minor fall.

How is it diagnosed?
Bone cancers are diagnosed using X-rays, bone scans and MRI scans. A biopsy will also be done so a small sample of the tumour can be analysed to find out its grade.

How is it treated?
Bone cancers are treated using surgery, chemotherapy and radiotherapy. The combination of therapies will be determined by the location, the size and spread of the tumour, (its stage) as well as its grade (how fast growing it is).

Chemotherapy can be given to treat Ewing’s Sarcoma to reduce the size of the tumour before surgery is used. Chemotherapy can also be given after surgery to try and prevent the cancer returning or spreading away from the initial site. Because the tumour is inside the bone, surgery will be carried out by a specialist (orthopaedic) surgeon. The aim is to remove the tumour whilst causing the minimum amount of damage to the whole limb.  Sometimes the tumour can be removed without causing too much damage to the bone. In other cases the affected bone is removed and replaced with a bone graft or by an artificial bone known as a prosthesis. This procedure is known as limb-sparing surgery. However, especially if the tumour has spread into the tissues surrounding the bone, the whole limb will be removed. This is known as an amputation. An artificial limb will be fitted once the child has healed and will be adjusted so it grows as the child does. Radiotherapy can also be used in the treatment of Ewing’s Sarcoma either before or after surgery, or for when surgery isn’t possible because of the location of the tumour.

Surgery and chemotherapy are the most common form of treatment for osteosarcoma.  The chemotherapy can be given before surgery to reduce the size of the tumour and after surgery to try to prevent the cancer from returning. The size and site of the tumour will determine what type of surgery is carried out. In some cases, the affected part of the bone will be removed and a bone graft or artificial bone will replace it. This is known as limb-sparing surgery. In other cases, because of the size and spread of the tumour the whole limb will be removed. An artificial limb will be fitted once the child has healed and will be adjusted so it grows along with the child. Radiotherapy is only occasionally used in the treatment of osteosarcoma.

Side-effects
The side-effects associated with chemotherapy are tiredness, sickness and diarrhoea, temporary hair loss and infection, all of which can be managed with help from the child’s consultant or nursing team.  For more information about side-effects please visit our side-effects section.

After treatment
Children and young people who have had limb-sparing surgery will need to return to hospital over the following years to have their prosthesis adjusted as they grow. They may also need to be careful not to damage their artificial bone or bone graft.  Children and young people who have had amputations often adjust very well and can take part in normal activities such as sports.

Long-term side-effects
Some children may go on to develop longer term side effects. Please remember that all children are different and only a small number develop long-term problems as a result of their treatment. Parents can talk to their child’s consultant if they are concerned about them.

Follow-up care
All children will need to be monitored regularly at an outpatients clinic. The consultant will be looking for any signs that the cancer has returned (recurrent cancer) and checking the functions of major organs to make sure that they have not been affected by the cancer treatment.

Source: www.clicsargent.org.uk