Bone cancer

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Treatment of osteosarcoma

The following are treatment options for all stages of osteosarcoma. The types of treatments given are based on the unique needs of the person with cancer.

Rather than using the standard staging system, a simpler system is often used when planning treatment for osteosarcoma. This system divides osteosarcomas into 2 groups: localized and metastatic.

Localized osteosarcoma

With localized osteosarcoma, the cancer is only in the bone where it started and may be in the tissues next to the bone. Localized osteosarcomas are further divided into 2 groups: resectable (they can be removed by surgery) and unresectable (cannot be removed by surgery).

  • Most osteosarcomas are high grade, which means they may grow and spread quickly.
  • Some osteosarcomas are low grade, which means they are likely to grow slowly.

Localized resectable osteosarcoma

Resectable tumours are those in which all the visible tumour can be removed by surgery and the cancer has not spread to other parts of the body.

  • Surgery is the primary treatment for localized resectable osteosarcoma.
    • Surgery is usually the only treatment used for low-grade, localized resectable osteosarcomas (chemotherapy is not given).
    • The types of surgery done include:
      • limb-sparing surgery
      • amputation
      • reconstruction
      • rotationplasty
  • Chemotherapy may be offered for localized resectable osteosarcoma.
    • It is usually given before surgery.
    • Chemotherapy is also given after surgery to destroy any remaining cancer cells.

Localized unresectable osteosarcoma

Localized unresectable tumours have not spread to other parts of the body, but they cannot be completely removed by surgery. They may be too large or too close to vital structures in the body to be resected.

  • Chemotherapy is usually the first treatment offered for localized unresectable osteosarcoma.
  • If the tumour shrinks enough to become resectable, it is then treated with surgery.
  • If the osteosarcoma is still unresectable after chemotherapy, radiation therapy may be given to control pain.

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Metastatic osteosarcoma

Metastatic osteosarcoma has already spread to distant parts of the body at the time of diagnosis. It usually spreads to the lungs.

  • Chemotherapy is usually the first treatment offered for metastatic osteosarcoma.
  • If the surgeon thinks that all of the metastatic tumours are resectable after chemotherapy, they are removed with surgery.
    • More than one surgery may be required to remove all the metastases.
  • If some tumours remain unresectable after chemotherapy, radiation therapy may be given to control pain.

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Recurrent osteosarcoma

Recurrent osteosarcoma means that the bone cancer has come back (has recurred) after it was treated. In rare cases, it may recur in the same location as the original cancer (local recurrence). Usually it recurs in the lungs.

  • If possible, surgery is done to remove the tumour or tumours.
  • If the cancer recurs in the same location on an arm or leg after limb-sparing surgery, amputation of the limb may be recommended.
  • Chemotherapy may be offered for recurrent osteosarcoma to control the growth of the tumour.
  • Radiation therapy may be offered to help relieve symptoms.

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Clinical trials

People with osteosarcoma may be offered the opportunity to participate in clinical trials. For more information, go to clinical trials.

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